Following an inpatient hospitalization, some patients are referred for residential mental health treatment. Patients who are no longer considered a risk to themselves or others but remain too impaired to live independently may be admitted to residential treatment.
These referrals often come from the outpatient world and have one or more of these attributes:
- Outpatient treatment has not helped the patient with their mental health conditions. The outpatient visits have not reduced the distress and dysfunction.
- The patient may have a limited number of emotional support systems, such as friends, family, psychiatrists, or psychotherapists. This can lead to diminished or depleted resources that the patient cannot rely on during high symptomatology or other psychosocial stressors.
- There is no clear indication that an acute inpatient hospitalization should be considered.
- There is a lot of diagnostic ambiguity that could be clarified or eliminated through regular or round-the-clock behavioral observations in a controlled setting. For example, to determine if a behavioral disorder is better attributed to a rapid cycling mood disorder or hidden substance abuse.
- There are safety concerns, such as the escalating level of substance abuse, disordered eating and purging behaviors, or self-injurious behaviors. These can be reduced in a controlled, but not necessarily locked, treatment milieu that includes 24-hour behavioral observations.
Matching facility resources and patient needs
Once it is decided that residential treatment is something that patients should consider, clinicians and patients will need to make a decision about which facility to use. To maximize the chance of a positive outcome, it is important to find the right fit between residential facilities and patients.
As therapists, residential facilities have many different goals. Their theoretical orientation, treatment paradigms, and specific features vary. Patients may prefer to live in small, intimate facilities with four- to six beds that are located within single-family residences. However, they might gravitate towards larger facilities housing multiple patients on larger campuses.
- State licensing and/or licensure for high-quality residential facilities are often subject to oversight and scrutiny by state licensing bodies or other entities providing accreditation to healthcare organizations. Accrediting and licensing authorities often require high standards of evidence-based care, documentation, and medication storage and handling.
- Fully credentialed staff Residential facility staff must be sensitive to the needs of patients, group dynamics, conflict dynamics between staff and patients, and subtle signs that a patient is in danger and requires more intensive care or hospitalization. Residential facility staff can benefit from previous experience in inpatient care.
- The ability to increase staffing quickly: Residential facilities that have flexible staffing capacities can adjust to the fluctuations in inpatient care. Effective treatment centers can “staff up”, to accommodate the needs of patients with more severe conditions. This ability not only protects each patient but also ensures that the treatment environment can be modified by additional staff as necessary.
- Quick access to emergency and urgent care services: Both accidents and self-harm are possible. Residential facilities with working relationships with local hospitals and urgent-care facilities are better equipped to provide care for patients in crisis.
Outpatient Therapist, Residential Treatment Team
An outpatient therapist is a critical role in helping to ensure positive outcomes for the patient being referred for residential treatment. The therapist is most likely to be the most reliable source of information about the patient’s symptoms and preadmission functioning. He or she will likely have a prioritized listing of urgent symptoms that require treatment. This is why therapists are often contacted within 24 hours of the patient’s admission to a residential treatment facility.
Many outpatient psychotherapists would like to be kept informed of the status of their patients. Some may be available for phone or in-person visits, and some will want to continue a direct psychotherapy role throughout the residential stay. Although the individual treatment centers might not permit this, it is always a good idea to inquire.
Although planning for aftercare should be initiated as soon as the patient is admitted, some cases may require further diagnostic clarification. In all cases, outpatient therapists should be included in the aftercare planning process. This is usually done via phone or email without the need to visit the therapists in person. If all goes well, the resident stay will not require inpatient hospitalization. The patient will be able to return to outpatient treatment after discharge. While a small number of patients may choose to keep in touch with the clinicians they treated during their residential stay for a few days, most patients opt not to.
Although residential treatment is only one option for therapists with patients who are experiencing a worsening course of their patient’s clinical condition, it is still a useful option.