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May 14, 2019

Talking to Parents and Students About Residential Treatment

The topic of mental health has moved increasingly into the mainstream on college campuses, and that’s a good thing. Today, there is more awareness, there are more programs, and there is more understanding than ever before. Issues including the stigma of seeking out care, while still existent, are becoming less common. That said, mental health is still far from enjoying the mainstream understanding and support that other illnesses benefit from.

When confronted with a mental health issue, families and college students will no doubt be caught off guard, confused, and have many questions. What is the optimal path of treatment? Does the student need to take a leave of absence? Will they be able to return to school? They will likely be unsure of treatment options, next steps, and most importantly lack clarity on what the future holds. The guidance of a college health counselor can be critical.

One treatment option that may be not fully known to parents and students is residential treatment. Before we discuss situations and diagnoses that may benefit from this form of treatment, it might be helpful to break down the space more broadly to understand the full slate of options.

Forms of Mental Health Treatment

Hospitalization and Inpatient Care

Occasionally, hospitalization is necessary for optimal mental health treatment, and these patients are often referred by loved ones or a first responder. Rarely do patients choose to enter hospitalized care themselves. This form of care can be helpful in stabilizing patients during acute episodes, especially a first occurrence or initial diagnosis of severe mental illness. These patients generally need constant monitoring and medication adjustment. The goal is to get their disorder under basic control and to determine the best next steps after inpatient care.

Intensive Outpatient Care (IOP) or Partial Hospitalization Programs (PHP)

Unlike inpatient hospitalization, patients in IOP and PHP settings do not stay in a health care facility 24 hours a day. Treatment is scheduled over several hours, several days a week. The specific number of hours and days spent at the facility varies depending on the program and the patient’s needs. This treatment is often used as a step down from hospitalization as people stabilize and learn to cope with a new diagnosis or medication regimen.

Residential Treatment

Residential treatment itself encompasses a variety of settings that vary in terms of services, psychiatric disorders treated, and approaches to treatment. Some focus on community and socialization, others focus on independence. The American Residential Treatment Association (ARTA) categorizes residential treatment into four groups.

• Clinical residential – often feature private and semi-private assisted-living style settings with professional, clinical care
• Group residential – group homes which utilize their communities as a part of the treatment process
• Apartment-based – offer a sense of independence with a center of treatment and socialization nearby
• Farm-based – characterized by a balance of therapeutic work opportunities within a therapeutic community in nature, with professional clinical care

There is no right course of treatment for every person. It’s important to point out the inherent variability and personal nature of a mental illness. College counselors, medical professionals, even families and friends all play a role in understanding the needs of a someone suffering with a mental illness.

Hopewell is a farm-based residential therapeutic mental health community, and we believe residential treatment, especially for college students with certain diagnoses, has some distinct advantages compared to other types of treatment.

Advantages of Residential Treatment

For serious psychiatric illnesses such as major depression, schizophrenia, schizoaffective disorder and bipolar disorder, the most successful people learn to cope with their disease throughout their daily life. There isn’t a cure or a shortcut to achieving this balance. That’s why residential treatment can be so beneficial. It gives people the time, support and structure necessary to deal with their disease.

The first and most distinctive benefit of residential treatment is its support structure and care. While under supervision, residents are immersed in a healing atmosphere and learn to live with their illness by developing positive habits in support of their treatment goals. By contrast, no matter how effective the treatment in an outpatient setting, patients are still living within the world where their mental health issue developed. They may still be dealing with work, providing care for others, and in some cases remain around people other people who may influence ineffective behavior. These can be difficult positions to be in for people learning to manage medications and cope with major illness.

Mental illnesses can be isolating, even among the closest family and friends. The social component of residential treatment can also be immensely beneficial. Receiving the support and solidarity of those that are learning to live with similar issues, cope with similar problems, and navigate their new lives can be very helpful. The natural support group that forms within a residential treatment is a critical element of treatment.

Then there is the advantage of stepping outside of one’s usual context and seeing the world in a new way. Residential treatment provides a new environment, which ? for many ? can be empowering. For example, experiencing nature can be a powerful element of the healing process. With farm-based facilities, the work in which residents participate is therapeutic and offers new ways of thinking, feeling and behaving.

Additionally, we believe residential treatment, while requiring a commitment of time away from their education, gives students the best chance of returning to a level of normalcy, and to their studies, once treatment is complete. At Hopewell, we’ve even had residents enroll in college classes during the recovery process. Whereas intensive outpatient and partial hospitalization-based programs attempt to provide stabilization and coping tools in the context of the rest of a client’s current situation, we feel many people could benefit from the separated immersive and 24/7 experience residential treatment provides.

We believe residential facilities provide treatment that allows people to most effectively command their lives, learn to take medication properly, and return to the highest level of functioning they are capable of.

What to Look for in Residential Treatment

Accreditation and/or licensure

Licensing requirements vary from state to state, but high-quality facilities will often seek accreditation from organizations such as the Commission on Accreditation of Rehabilitation Facilities (CARF), the Council on Accreditation, and The Joint Commission. For instance, Hopewell is licensed and certified by the Ohio Department of Mental Health and Addiction Services and was the first therapeutic farm community in the United States to be accredited by CARF for Therapeutic Community: Mental Health (Adults). Hopewell is also a member of the National Alliance on Mental Illness, or NAMI, and the American Residential Treatment Association (ARTA).

Additionally, you may consider a facility that has partnered with objective research partners. At Hopewell, we have completed several outcome studies at the farm with the help of Case Western Reserve University.

Staff and therapies

No two mental illnesses are alike and it is important for a facility to have a variety of treatments to respond to the individual needs of each resident. Look for a description of the center’s overall approach to treatment. At Hopewell we call offer a multi-faceted approach to providing customized and balanced care to each resident. Additionally, residential environments require talented staff capable of balancing the various needs and dynamics present in a group setting. Many treatment centers provide a the biographies and experience of their staff on their websites.

Residential Treatment Checklist

Finally, if you are considering residential treatment for someone in your care, consider the following as you guide them through the process:

• Be educated and know there are options – mental health treatment is not one size fits all and you should be ready to ask questions and understand why a certain path may be most appropriate.
• Talk to care providers – this is the only way to understand if a facility could be the right fit. Hopewell is available to answer specific questions about our program or to provide more general guidance.
• The financial situation – private health insurance and government programs such as Medicaid are often not available for residential treatment facilities, which can put treatment out of reach for some. Hopewell works with philanthropic organizations and donors to bring down costs to a minimum and we work with families on an individual basis to explore options for treatment.
• Know what’s right for your client – is distance a concern, or a benefit for someone who needs to separate themselves from the stress and strains that accompany their mental illness? Does the facility you are considering offer all the therapeutic modalities you think would be helpful? These are questions no one can answer for you.

Choosing the best care for each client is a difficult process, but the first step is to understand the landscape of options. Residential treatment has significant advantages when compared to other forms of treatment for specific clients. By knowing the options and potential for care, a decision can be made about the best treatment path to approach.