{"id":2168,"date":"2015-05-28T06:52:52","date_gmt":"2015-05-28T12:52:52","guid":{"rendered":"https:\/\/sunrisertc.com\/?p=2168"},"modified":"2024-03-07T16:02:22","modified_gmt":"2024-03-07T22:02:22","slug":"residential-treatment-vs-inpatient-hopsitalization","status":"publish","type":"post","link":"https:\/\/sunrisertc.com\/residential-treatment-vs-inpatient-hopsitalization\/","title":{"rendered":"Residential Treatment vs Inpatient Hopsitalization"},"content":{"rendered":"

Before coming to residential treatment<\/a> as a therapist, I spent 10 years as a crisis worker in two emergency room hospitals. \u00a0My job was to do mental health evaluations on teens, and adults to determine whether or not they qualified or needed to go to a psych unit. \u00a0Often, I did the follow up therapy after they had been discharged from the psych unit. \u00a0I have spent thousands of hours evaluating clients both before and after their stays in psychiatric units in hospitals. \u00a0I am telling you this because I want to make a comparison between residential treatment and stays in psych units. \u00a0Typically, if a person is \u201ccutting, having thoughts of suicide<\/a>, struggling in relationships, or having just attempted to take their life\u201d, it would have not been the first time. Most of these high risk behaviors occur more than once. I dare say that over a two year span, I evaluated the same person twelve times in the same small Utah hospital emergency room. \u00a0There was literally no end to the mayhem, despite hours and hours of intensive outpatient therapy. \u00a0We could not stop this person\u2019s pattern. \u00a0Some people believe that the only treatment is in outpatient settings<\/a> and in the hospital. \u00a0This is simply not true. \u00a0Residential treatment is a viable option for some people to consider. \u00a0Residential treatment can be the finish line to endless nights in an ER, or multiple short stays in a psych unit, or outpatient therapy that is not working.
\nIn Utah, a typical stay in a psych unit lasts 4-7 days. \u00a0In California, the average length of stay in a psych unit is 11 days, according to Quanbeck, Tsai, Szabo. \u00a0Primarily, there are two reasons for placing a person in a psych unit. \u00a0One, the placement is to get quick access to a psychiatrist, who almost always administers medication. \u00a0And, the other reason for staying in a psychiatric hospital is to \u201ckeep a person safe\u201d. \u00a0Many times, medication will give a person hope, and literally help regulate the chemicals in the nervous system. \u00a0How grateful I am for the technology, safety, and efficacy of modern medications. \u00a0I have seen so many people go through the healing process with the help of medications. However, the medical team realizes that many medications need more than a week to take \u201cit\u2019s full affect\u201d, so the professional has to trust that the patient will continue the healing process upon discharge. \u00a0A client leaving a psych unit, often is still struggling to problem solve, seek assistance, take the medication as prescribed, and make sure the dose is right to get the largest benefit from the medication. \u00a0Staying in the hospital longer than a week, is costly if the main reason is to see that a medication is working optimally. \u00a0As professionals, we have to accept<\/a> the fact that hospitalization is an expensive way to \u201ckeep a person safe\u201d. \u00a0\u00a0Realistically, an unsafe person cannot live in a hospital until they feel completely safe. \u00a0So to curtail the cost, and maximize safety, professionals use safety contracts or an agreement with the client and friends and family of the client to keep themselves safe. \u00a0The problem is that safety contracts can be broken. \u00a0I am aware of experiences when people make a commitment to be safe and later end up killing themselves. They are few, but this has happened. \u00a0I know that there are families that would say that keeping loved ones safe can be a challenge. \u00a0I remember vividly the words of an emergency room doctor with whom I was chatting about how sly some people can be at not presenting suicidal. \u00a0He said, \u201cThere is no way I would have guessed that Eric (name changed) was going to leave the ER and kill himself\u201d. \u00a0Human beings can be suicidal and good liars. \u00a0This past week, a 16 year old girl said, \u201cI could fool them (meaning professionals at hospitals where she had been) because I knew that it would end soon\u2026I can\u2019t fool people here (at Sunrise)\u201d. \u00a0Teens have finite minds, they can endure \u201cfor a week or two\u201d, but they cannot fake a professional as easy, who sees them almost every day for months at a time. People sometimes need more time to commit to being safe, more than an hour session. \u00a0People need more time than a week to fix the problems that caused the high risk behaviors. \u00a0\u00a0In a residential treatment center<\/a>, a person has an extended time to keep themselves safe, and to get the medication figured out. \u00a0They even have the opportunity to dig deep into the problems that caused the suicidal thoughts, the cutting<\/a>, and the high-risk behaviors that brought on the acute hospitalization. In an era when we want to problem solve quickly, real change takes time.
\nIn a psych unit, the professionals often do not know the patient. \u00a0They are seeing them for the first time and making critical decisions based upon limited information. \u00a0I remember many times going home and not being able to sleep, \u201cthinking did I make the best decision, to let that person go home, with a safety contract and a plan to follow up. \u00a0I did not know if they were actually going to do what they said they were going to do. \u00a0Since being at a residential treatment facility, I can check up on the client and make sure myself whether or not they completed my assignment. \u00a0I know that they are being \u201cwatched\u201d and kept safe by staff who I trust. \u00a0They are steps away from the patient at all times. \u00a0There can be great piece of mind keeping a person safe for months at a time, instead of taking the gamble each time a person is released from a psych unit. \u00a0In fact, Sunrise Residential Treatment Center provides the same level of safety as a psych unit and at a lower cost per day. At a psych unit hospital in California, Quanbeck, Tsai, and Szabo reported that a Medicaid patient pays 600.00 to 1,700.00 dollars per day and a Medicare patient pays 1,100.00 per day. At Sunrise, the cost is substantially lower than a typical psych unit per day. \u00a0\u00a0In other words, the cost of a short hospital stay could equal the cost of one month\u2019s stay in residential treatment. \u00a0If a person has multiple hospitalizations, the cost could equal a complete residential stay. \u00a0So not only can cost be comparable, the knowledge of a client at a residential treatment facility far outweighs the understanding a professional has of a client who has been at a psych unit for one week.
\nResidential treatment centers can have similar clientele placed at their facility. \u00a0On the other hand, the psych unit is more obligated to take \u201cwho comes in the door\u201d, only having to separate children from adults. It is very likely that a middle aged man with schizophrenia participates in a group with an 18 year old female who is having problems cutting, and another girl who has depression who does not want to interact with either, while the other three in the group include a forty year old female battling borderline personality disorder, a thirty year old male who just attempted suicide because he was going through a divorce, and an elderly man mumbling to himself because he is \u201cmanic\u201d and struggling to focus. \u00a0Whereas, at a residential treatment facility the clients can be very similar, such as girls who are about the same age, teen girls<\/a> who are struggling in relationships, teen girls who have eating disorders, or teen girls who have engaged in high risk behaviors because of low self-worth. \u00a0In a group with more similarities, more learning will take place and group members will be more likely to connect and engage in problem solving with each other. \u00a0The group member\u2019s levels of trust will be higher. \u00a0Relationships that can be applied to treatment will have a higher chance to develop, especially if interaction will be taking place for months, rather than for 4-7 days. \u00a0With more time for interaction, similar ages, and trusting relationships at a residential treatment center, healing has a greater chance.
\nHealing is what we want. \u00a0If healing can take place in one week, let\u2019s do it. \u00a0If healing takes more time, let\u2019s do it. \u00a0I want to see the change last, and change that lasts happens over time. \u00a0I have seen lasting change occur in residential treatment, more prominent than in psych units. \u00a0The biggest change that has occurred at hospitals has been from medication, and the biggest change that I have seen in residential treatment is from persistent effective treatment over time. The model of residential treatment will ultimately bring lasting change.
\nCameron Quanbeck MD, Gary Tsai MD, Kaitlin Szabo MD, MBA. \u00a0\u00a0\u00a0\u201cCost-effectiveness analysis of Assisted Outpatient Treatment implementation in California\u2019s civil sector\u201d. \u00a0dhmh.maryland.gov<\/p>\n","protected":false},"excerpt":{"rendered":"

Before coming to residential treatment as a therapist, I spent 10 years as a crisis […]<\/p>\n","protected":false},"author":1,"featured_media":2170,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[11],"tags":[],"_links":{"self":[{"href":"https:\/\/sunrisertc.com\/wp-json\/wp\/v2\/posts\/2168"}],"collection":[{"href":"https:\/\/sunrisertc.com\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/sunrisertc.com\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/sunrisertc.com\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/sunrisertc.com\/wp-json\/wp\/v2\/comments?post=2168"}],"version-history":[{"count":3,"href":"https:\/\/sunrisertc.com\/wp-json\/wp\/v2\/posts\/2168\/revisions"}],"predecessor-version":[{"id":8290,"href":"https:\/\/sunrisertc.com\/wp-json\/wp\/v2\/posts\/2168\/revisions\/8290"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/sunrisertc.com\/wp-json\/"}],"wp:attachment":[{"href":"https:\/\/sunrisertc.com\/wp-json\/wp\/v2\/media?parent=2168"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/sunrisertc.com\/wp-json\/wp\/v2\/categories?post=2168"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/sunrisertc.com\/wp-json\/wp\/v2\/tags?post=2168"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}