Traditional programs of psychiatric care and drug rehabilitation followed the medical model – remove the person from their environment, cure them, and then return them to the “outside world.” There are many people whose ability to function safely in an unstructured environment is so compromised that full in-patient care is necessary. However, with the protections of an around the clock environment comes a lost opportunity to apply insights and skills learned in treatment to real world settings. While people may be able to learn to fly in flight simulators, the experience of flying above the ground provides more effective learning.
In a study by the Substance Abuse and Mental Health Services in 2014, 4.1% of Americans suffered severe mental illness, 7% experienced significant drug use, and 3.3% suffered a combination of drug and psychiatric issues. It is clear that the problem of therapeutic strategies exist. Some people may function fine with outpatient treatment – seeing a therapist while leading near normal lives. Others may be so severely impacted that they are unable to function safely in an independent existence. Partial Hospitalization Program, or PHP, provides a nuanced combination to best effect.
As explained by Psych Central, a PHP is a short-term and intensive treatment program offered in a clinical setting for those who require acute care, but may not need it 24 hours a day, seven days a week. Particularly for patients for whom cognitive therapy is a good choice, partial hospitalization offers the intensity of treatment in a safe environment with the opportunity to retain such existing social functioning while practicing skills and building on insights gained in therapy. The intensity of in-facility therapy allows for evaluation of effectiveness of treatment in the person’s day to day functioning, while offering necessary interventions based on experience.
For people suffering primarily from drug addiction, inpatient treatment may be required for detoxification and management of medications to reduce cravings, minimize withdrawals, and determine effective dosages of medications for co-occurring conditions. As progress allows, a considered and planned partial hospitalization provides a safe way to re-enter the demands and address the original triggers of drug use in a supportive structure. Supports can be faded as the person gains success in day to day functioning.
For people with mental illness, the course is similar. Mental illness, for all its comparisons to physical illness, generally has social and interactive elements that need to be addressed along with medication. Acute episodes may require inpatient stays for medication management and stabilization, but for many, if not most, the support offered for addressing the emotional, social, and vocational aspects of their conditions are effectively provided in the secure environment of a part time facility stay. Home stays start as field experiences in testing insights, newly acquired skills, the effects of medication and serve both the patient and therapist as diagnostic and prescriptive measures.
Unlike the broken arm, the effects of drug addiction and mental illness do not disappear once treated. Most often the return to a healthy life is a slow process requiring longer term support. For people moving from inpatient to partial hospitalization care, the final step is a form of outpatient supports ranging from individual therapy, group, family therapy, medication management and other community support.
After completing a short-term PHP program, individuals should transition into outpatient care. Outpatient services include group, family, and individual therapy sessions, support group meetings, relapse prevention programs, education and training programs, medication management, follow-up care and aftercare programs provided by trained professionals within the confines of a specialized addiction treatment facility or program. These services are important for sustained recovery after completing a PHP.
From the treatment programs of decades past where large institutions warehoused people for decades, to some communities where all issues must be resolved in a ten day window to meet insurance requirements, care for people with drug addiction and mental illness is one important in providing what is needed most to build and support each person’s ability to function in society.
One such program of note is Centrec Care in St. Louis, noted for its focus on using well-researched, effective and efficient tools of cognitive therapy in multi-leveled supports for people with drug, psychiatric or a combination of issues.