Residential treatment programs provide live-in treatment for specific issues. These treatment programs are also sometimes referred to as inpatient treatment programs. There are numerous residential treatment programs that specialize in specific types of mental health issues, such as substance abuse, eating disorders, etc., and other residential treatment programs combine different types of clients into an overall program of care.
There are some basic distinctions between a residential treatment program and an inpatient treatment unit in a hospital.
Inpatient treatment in a hospital unit is extremely intensive treatment that offers strict 24-hour care and round-the-clock medical monitoring for individuals who may not be safe to be left alone. The goal of inpatient treatment is to stabilize acute symptoms, develop a treatment plan, and then hopefully get the individual into a long-term program. For instance, inpatient treatment programs and psychiatric wards are more likely to handle issues with acute suicidality than residential treatment programs. Once it is believed that the individual’s issues with potential suicidal ideation have been resolved, they can be transferred to a different environment, such as a residential treatment.
Residential treatment programs are typically not located in the psychiatric wings of hospitals but in more homelike settings. While clients are in the treatment facility all day, the level of supervision is a step down from inpatient treatment in a psychiatric unit.
Residential treatment programs provide a variety of different services, including medical management (medications from a physician and treatments from other medical professionals like nurses), group therapy, individual therapy, social support group participation, and other types of specific treatment interventions. Residential treatment programs may specialize according to the treatment modality. Options include:
- Withdrawal management: Inpatient/residential withdrawal management programs (medical detox programs) are primarily designed to initiate treatment for individuals who develop physical dependence on some type of drug or alcohol. The program offers other interventions, but the primary goal is to help the individual safely go through the withdrawal management process without suffering any mental or physical damage or without relapsing. Withdrawal management alone does not address the social, emotional, and other behavioral problems that are associated with substance use disorders.
- Short-term residential treatment: Short-term residential treatment programs provide very intensive but brief interventions. Often, these programs last several days to six weeks, depending on the intervention and the client. For example, according to the National Institute on Drug Abuse (NIDA), short-term residential treatment programs for alcohol abuse might follow a 12-Step approach that is modified for the shorter length of the intervention and then transfer the individual to extended participation in 12-Step groups and outpatient therapy.
- Long-term residential treatment: Long-term residential treatment programs may last 6-12 months. Individuals in these programs often have very severe issues, including significant psychological/psychiatric issues, substance abuse issues, and tendencies toward self-harm or harming others, etc. Treatment is highly structured, depending on the needs of the individual and the particular type of issues the program specializes in treating. For instance, some of these programs cater to individuals involved in the criminal justice system; some cater to individuals with psychotic disorders; some cater to those with personality disorders, etc.Comprehensive interventions are delivered in these environments that can include the use of medications and therapy as well as support services aimed at job-training, tutoring, speech therapy, etc. By their very nature, these programs must have modifications to treat individuals who have special needs. In some cases, clients may stay extremely long periods of time, or their stay may be permanent, depending on their level of disability.
NIDA and other mental health professional organizations, such as the American Psychiatric Association (APA), state that successful treatment interventions should be customized in order to fit the needs and specific style of the individual. Several other approaches to residential treatment programs are also available, including:
- Therapeutic communities: Therapeutic communities are residential treatment programs where clients and treatment providers live within the residence. These programs typically focus on re-socializing individuals as the major form of intervention and are designed to help clients develop attitudes, self-concepts, and behaviors that are constructive, allowing them to accept responsibility for themselves and lead productive lives. The majority of these types of programs address individuals with co-occurring disorders (a substance use disorder and some other mental health disorder).
- Residential treatment for co-occurring disorders: Other types of residential programs specialize in providing treatments to individuals who have co-occurring disorders or dual diagnoses. Typically, these types of programs use an integrated treatment approach that combines treatment providers from different disciplines to work together to assist the individual. For instance, an individual who has an anxiety disorder and a co-occurring substance use disorder could be treated by a team of providers that includes an addiction medicine physician, a psychiatrist who specializes in anxiety disorders, a psychologist who specializes in substance use disorder treatment, a therapist or counselor who specializes in anxiety disorders, and other treatment providers as required in the specific case. For instance, a homeless individual might have a case manager who concentrates on placement for the individual once they are released from the program, or an individual with a co-occurring physical issue might need physical or occupational therapy. The integrated team develops an overall treatment plan together, treats the individual for specific issues related to their specialty, and communicates with each another through progress notes and scheduled meetings.
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Holistic residential treatment programs: Holistic treatment takes into account all of the issues the person has in their entirety and does not focus on the specific presenting diagnosis. For example, withdrawal management programs are very limited in the type of intervention they deliver, whereas holistic treatment attempts to address all the needs of the individual. These programs are very similar to the integrated treatment programs that are used for individuals with co-occurring disorders.
Holistic programs would attempt to complete a thorough assessment of the individual’s needs before developing a treatment program. This assessment would cover the individual’s physical health, psychological health, and social situation. Interventions would be delivered at all areas of need. For instance, an individual with a severe methamphetamine addiction is likely to have significant problems with their dentition. The holistic treatment program would include dental treatment. It should be noted that the majority of residential treatment approaches attempt to address all the needs of each individual to some extent these days.
Holistic treatment programs often add complementary and alternative interventions in their overall program to address all the needs of clients. Some holistic programs may not include medical management treatment for residents, particularly medical management for psychiatric/psychological problems. Some programs may attempt to supplement the use of medicines with diet and complementary and alternative approaches. This can be a detrimental to the successful treatment of the individual as well as being a potentially dangerous practice.
Complementary and alternative residential treatment programs: A complementary and alternative treatment is technically a form of intervention that is an adjunctive treatment to a more major form of intervention. It offers an alternative approach to rational types of medical interventions and therapy. For instance, music therapy can be very beneficial for individuals with depression, substance abuse problems, anxiety disorders, etc. However, music therapy alone does not have sufficient empirical evidence to allow it to be delivered as a primary form of treatment for these issues. Instead, it complements mainstream treatment approaches for these issues and increases the effectiveness of the intervention. Nonetheless, there are some residential programs that focus only on these types of interventions and downplay major empirically validated treatments.
A residential program that does not focus on primary interventions, such as medical management, traditional psychotherapy, support group participation, etc., and only offers alternative therapies, such as art therapy, psychodrama, music therapy, animal-assisted therapy, yoga, tai chi, etc., should be avoided. While these activities do have utility in treating individuals with mental health issues, they are not sufficient as primary forms of treatment for the vast majority of individuals who have mental health disorders.
Residential treatment for specialized populations: Residential treatment programs often specialize in a particular subgroup, such as adolescents, women, individuals in trouble with the law, etc. This allows the treatment program to tailor itself to the specialized needs of a specific population.
Issues with Residential Treatment
Several disability rights associations oppose placement of certain groups of individuals in residential treatment programs, such as adolescents, due to issues with:
- Inappropriate and harsh discipline
- Lack of communication to the outside world
- In some cases, neglect of important medical conditions
There are numerous issues with the monitoring and licensing of many of these types of facilities. The Federal Trade Commission offers some guidelines for parents considering placing their child in a residential treatment community. Adults can also use these guidelines to help them to eliminate inferior programs or poor-quality programs when investigating placing an adult in a residential facility.
- There are numerous research studies that have found that residential treatment is effective for individuals with:
- Substance use disorders
- Long histories of legal involvement
- Personality disorders
- Eating disorders
- Issues with mood, such as depression, bipolar disorder, etc.
- Severe psychotic disorders, such as schizophrenia
- Issues with suicidality and self-harm
The basic tenets of a good residential treatment program are outlined below.
- The program delivers its treatment interventions in a manner that fits the individual’s specific needs.
- Most research studies indicate that the effective approach to treating mental health issues is to use a combination of medication and psychotherapy. Psychotherapy should be available for individuals in a group format and in individual sessions.
- The program initially performs a comprehensive assessment of the person’s physical, cognitive, emotional, and social functioning and then develops a treatment plan based on the findings of the assessment. The treatment plan is continually reviewed, updated, and altered as needed based on the individual’s progress in treatment.
- The interventions must be readily available for the client. Placing clients on long waiting lists is typically counterproductive for their success.
- The treatment program should be of sufficient length to address the goals of the treatment plan. Lengthier periods of time where the client maintains their participation in an organized treatment program are associated with greater overall success rates for any type of mental health issue.
It is important for family members and friends to maintain contact with their loved one and offer their support. This helps the individual in the residential treatment program to develop a sense that they are not alone in their struggles and know that their efforts have a broader meaning.