We are all nidotherapists

We disagree with Tyrer et al's comparison of ‘standard and nidotherapy perspectives of the environment for those with mental illness’ (Psychiatric Bulletin, January 2007, 31, ). The views attributed to ‘ standard’ perspective (which we assume refers to usual clinical practice) do not represent the practice or belief of any clinician we know. The authors’ suggestion (for standard perspective) that the ‘ environment is of secondary importance in psychiatric practice’ sharply contrasts with the biopsychosocial approach which is drummed into trainees from their first day in psychiatry. Similarly, we are not aware of any clinician who believes that ‘once people with mental illness get better their original environmental problems resolve’. On the contrary, all clinicians we know identify with the perspectives attributed to nidotherapy even if limited resources constrain their implementation.

Although it is helpful to highlight the importance of the environment in the management of people with mental illness, giving this a fancy name sounds like ‘rebranding old wine in new bottles’. What we need are the resources to continue to improve all aspects of the lives of people with mental illness.