It would be arrogant to assume that nidotherapy has any definite place in mental health services at this stage of its development but it clearly is more relevant to some areas than others. The diagnostic groups that might be considered are described in chapter 2; here we describe the services where it might be contemplated. It is already apparent from the earlier discussion about the indications for nidotherapy that acute services would have relatively little reason to consider nidotherapy in view of their focus on the management of presenting problems, but even here there may be a place for an environmental approach in acute manifestations of chronic conditions. However, most of the people who would naturally come to mind when thinking of nidotherapy are those who are in longer-term forms of care, many of which are subsumed under what is now called the recovery model.

The recovery and social models of mental illness

Models are used to fill in the gaps when data are missing and may be of value in establishing frameworks of intervention in psychiatric services, but despite their attraction they are not a substitute for data. The recovery model is a useful bridging concept that can be applied to help services that used to be clumsily described as ‘the continuing care client’ but in other parlance would be more simply described as ‘chronic’. Across the globe we have neat sets of services for the ideal psychiatric patients who fit neatly into diagnostic groups, present to services in a predictable way and respond to treatment well. Where we fail is in providing similar slotted services for the complex people who make a nonsense of diagnosis and are confusingly described as having ‘multiple comorbidity’, who find psychiatric services unattractive or frankly odious, present there unwillingly after first going somewhere else, and make only a partial response to treatment, sometimes fighting it every step of the way. All these people can be incorporated into a loose recovery model, which thus covers a very heterogeneous group of people.