This is a guest post from my colleague and dear friend, Anna Hodges, MSW. Scroll down to learn more about Anna and her incredible work. Anna helps individuals and families find the best treatment solution for a variety of situations. Anna gives her expert advice on how to begin the process of finding residential care for yourself or your loved one.
1-Residential treatment is not only for substance use disorder.
If you take one point away from this article – make it this one. Write it down. Most of us have at some point in our lives known someone who has “done a stint in rehab”. Or we’ve seen movies like 28 Days or Clean and Sober (one of Michael Keaton’s best performances). While this level of care is incredibly important for those working to find sobriety from substances, it is ALSO important for those seeking recovery from several other conditions as well. Let’s talk about mood disorders, for example. We might think of those with unregulated Bi-Polar Disorder as cycling in and out of the hospital. Those hospitalizations typically last for a few days, maybe a week. Patients and families convince themselves that this time was the most helpful, and this most recent med adjustment will do the trick. That same pattern might develop in the military veteran. Or the anxiety-stricken businessman. But for these types of clients, a residential level of treatment may be particularly effective. Even when those clients have no history whatsoever of substance abuse. Robust residential treatment is available to people seeking care for mood disorders, trauma, eating disorders, sexual compulsivity, process addictions like gambling or shopping, and even chronic pain. Those of us in the behavioral health treatment world are learning more and more every day about the prevalence of trauma that underlies most other behavioral and mental health problems. So the individual whose multiple previous treatment attempts seem to have failed, may have far more success in recovery by focusing on their trauma as the root of their condition.
2-Recovery is a family affair.
An essential part of comprehensive, effective treatment is the incorporation of the family system. Family, of course, can be defined a number of different ways. The important point is that the person in treatment, or the “identified patient”, has individuals in their life who are not only willing to offer support along the recovery journey, but are also willing to work on themselves. Look, if you have a loved one who might need a residential level of care, chances are that they did not create this situation on their own. You, yes you, the spouse, the parent, the sibling, you have a role and responsibility to accept as well. Supporting your loved one through treatment may very well mean that you find yourself working through some of your own issues.
3-Read reviews with a grain of salt.
I read reviews before I make almost any purchase. Ice cream scoops. Shower curtains. Need a new door stop? Buddy, it better have five stars! So why would shopping for a treatment program be any different? There are many reasons.
I spoke with a hotel manager recently who was seeking treatment for a loved one. He compared the process to searching for the best hotel. My how these two things could not be more different. The objective of a hotel is to provide as much comfort, convenience, and luxury as it takes to prompt the guest to come back. The objective of residential treatment is to facilitate hard work, so that the guest won’t ever have to come back. Therapeutic treatment is often challenging, and even painful. The identified patient is being pushed to open up old wounds, to question their pattern of thinking, to commit to change, and to accept responsibility. It can create a new state of vulnerability, the formation of which should be seen all the way through in a safe setting. When patients reject these challenges, they may choose to leave treatment prematurely, and feel compelled to write a bad review. Perhaps a family member has written a negative review about a program who supported their loved one in establishing new, healthy boundaries that the review’s author does not like.
Be leery too, of the program with nothing but stellar reviews. There are programs that boast a high degree of comfort and luxury but have little to show for quality clinical care. Remember, people find sobriety at the Salvation Army all the time. Additionally, there are a number of ways that programs can boost their ratings through inorganic reviews. Some of these methods may even be ethically questionable.
Ice cream scoops can be returned. Shower curtains can be exchanged. Relying on reviews to guide a decision about an investment of this kind of time and money, and with the future of your mental health on the line is simply lazy.
If we can’t rely on reviews, what can we rely on to gauge program quality? Take a look at the experience. First, consider how long the program has been open. I tend not to recommend any program that has not been operating for at least 5 years. There are exceptions to this rule, of course. And younger programs can be very good – even the most highly respected programs in the country all had a grand opening once. But in general, after five years a program has had an opportunity to work out major issues, develop its own rhythm, and prove that it has some staying power. Then, look at the leadership and clinical team. I tend to have more confidence in programs with clinicians such as Psychologists, LMFTs, and LCSWs in positions of leadership, rather than investors and bankers. I prefer those who are calling the shots to have actual clinical experience. Consider how much experience the individuals on the clinical team have. Look at how long they have been practicing, where they received their training, and if any conflicts of interest might be apparent. Look at what specialties the program offers, and specifically which clinicians specialize in which area. This information should be easy to uncover with a minimal amount of research. If it is not readily apparent, the program should be happy to provide it to you. Shy away from any program – or any individual for that matter – who claims to specialize in everything. If there is a particular area of specialty you are interested in, try finding an expert in that particular area, and then see if they happen to be affiliated with a residential program. Or seek out what programs they would recommend.
Anytime I tour a new program, I always stop to look out the windows. When a client is sitting in group, and their mind begins to wander, or later in the day, they take a moment for introspection, or they’ve had a really tough day, and they want to leave, they look out the window and what do they see? Is it a busy highway? Is it a parking lot? Is it their old corner? As I’ve stated, quality clinical care is the singular most important aspect of a residential treatment program. But being surrounded by an environment conducive to healing makes a big impact. If it is clinically appropriate for the client, space to walk around outside or get a breath of fresh air can be the difference between retaining a client in treatment and a premature discharge.
It is important to know that the best care may not be in your backyard. In many cases, accessing the best treatment may require some travel. When I’m working with a family, it breaks my heart ever time to hear the question “yeah, but is there anything closer?” When my husband needed life-saving surgery, at no point was the geography ever a factor in choosing a surgery center. When the Mayo Clinic agreed to treat my mother’s idiopathic heart condition, she didn’t decline the invitation because it was too far of a drive. Our lives are so much more valuable than limiting ourselves to only those programs which happen to be closest to us. Further, in many cases, separating the identified client from the environment in which they had been living can often be an important factor in encouraging deeper work. Geographic distance can also allow family members to do the internal work we discussed earlier.
6-Value supersedes cost.
I think of treatment cost in much the same way that I think about geography. The value of the life saved will always be greater than the number of dollars spent. That said, for most of us, cost is an inescapable factor. The tricky thing about the treatment price tag, is that is can be misleading in two ways. We’ve already addressed the high-end luxury treatment with little to no clinical program to speak of. You might as well have spent upwards of $50,000 on an all-inclusive vacation. On the other hand, people all over the world find sobriety by attending rehab for free at the Salvation Army. Just because it’s expensive, doesn’t mean it’s good. And just because it’s more affordable doesn’t mean it isn’t.
Ok, but can we get down to brass tacks? Start by thinking about this. The average outpatient therapy visit costs anywhere between $80 and $130 per hour. I’m estimating here, of course, Residential treatment generally includes between one and three individual therapy sessions per week. Group therapy sessions are generally going to be less expensive, but there will be multiple group therapy sessions per day. Specialty modalities such as neurofeedback, EMDR, and equine therapy will typically be more expensive than standard individual therapy. Add to that psychiatry and the cost for any medications that might be needed. We haven’t even begun to address the cost of room and board, three meals and snacks every day, and 24 hour staffing. You can see how the cost adds up quickly. But here again, my heart always breaks at the question “can you find anything cheaper?”
I’m so confused! Don’t be. Just think about what it is you’re paying for, rather than how much you’re paying. The ultra luxe treatment program you re-mortgaged your house for may have 1000 thread count sheets, a five star chef, and all private rooms. But is that what you want in a treatment program? On the other hand, there are plenty of treatment options that are in-network with many insurance companies. Certainly, the hope is that a family would be able offset some of the cost by utilizing insurance leaving the family with a manageable remaining out of pocket balance.
7-Residential treatment is the beginning of recovery.
One of my early mentors used to say about Twelve-Step meetings that a person could always find what they were looking for. Looking for someone to by drugs from? You’ll find them. Looking for someone to sell to? You’ll find them. Someone to use with? You’ll find them. But if you go looking for a healthy, stable sponsor, you’ll find them at a Twelve-Step meeting. Looking for encouragement and support, someone to call in the middle of the night, inspiration to make it one more day? You’ll find them at a Twelve-Step meeting. The same philosophy applies to residential treatment. Those who are serious about their recovery and search fearlessly within themselves for that which can be improved, they will find what they are looking for in treatment. However, regardless of the work that is done while in treatment day, discharge day should be thought of in much the same way as a high school Commencement Ceremony. You’ve spent your time gaining the knowledge and tools necessary to start the hard work. Residential treatment is not a cure. Residential treatment does not fix anyone.
Discharge planning is an important component of treatment. In fact, planning for life after treatment should begin fairly soon after admitting in to a program. In many cases, discharge planning should include continued treatment at lower levels of care on the continuum. There are a plethora of Twelve Step and non-Twelve Step based community programs available in most communities and virtually. It will take a network of healthy supportive people to help individuals continue to question old patterns of thinking, and continually implement the tools learned while in treatment. It did not take thirty days to create the circumstances which prompt and individual to seek residential treatment. It will take far more than 30 days to correct them. Healthy recovery includes a life-long commitment to the continual work of self-improvement.
The decision to pursue residential treatment typically comes at a time of high stress and anxiety for not only the identified patient, but for their whole support team. It is a process for which most families are unprepared. It can be overwhelming and scary. As a professional, I work with families to help them identify the true root cause of their loved one’s problematic behaviors, encourage them to consider their own role in their loved one’s journey, understand what the internet reviews for different programs may actually indicate, consider the experience and environment at different programs, evaluate program value versus cost, and prepare them for the ongoing journey to come after program completion. It is no small feat, but in the end, the value of the life saved is well worth it.
More about Anna:
Anna began her career with every intention of becoming a licensed, private practice mental health clinician. However, after the encouragement from a a favorite professor, she transitioned into specializing in “macro” practice. She graduated with an MSW with a concentration in Management, Leadership, and Community Practice. She worked for a Federally Qualified Health Center and then a small local non-profit. She took some time away from the workforce shortly after she got married to care for her husband as he underwent an organ transplant. To serve as a caregiver for a loved one is a privilege, and it was an experience that taught Anna as much as any formal education ever did. Following his recovery, she joined the national Alzheimer’s Association. There she gained more formal leadership experience and the opportunity to honor her grandmother, after whom she is named, and who died of the disease when she was 18. After moving to Las Vegas, she was fortunate enough to find the Treatment Placement Specialist position with Acadia Healthcare, which allows her to stay involved in all the different areas of mental health practice that she enjoys. Anna believes “There is great joy in thinking that I serve as a guide for clients and their families during one of the most challenging phases of their lives”. Like many, she has found new hobbies during the COVID quarantine experience. She spends weekends attempting to bake, desperately trying to keep a few plants alive, and successfully exploring Red Rock Canyon with her husband.