The recent New York Times piece, “The Woman Who Ate Cutlery,” was disheartening and all-too familiar. The article discusses the widespread failure to provide consistent and informed care to psychiatric patients until they are in the midst of a crisis—swallowing knives and forks, in this particular example. The author, a psychiatrist, writes, “The consequences are felt in our communities, where the undertreated [are vulnerable to] criminal recidivism (with additional court and incarceration costs), victimization and suicide.” This tragic tale of untreated mental illness runs parallel to the story of untreated addiction.
Our Phoenix House clients with co-occurring mental health conditions are the lucky ones—they’re in treatment. Far too many of their addicted and/or mentally ill peers never make it this far; instead, like the woman who ate cutlery, they shuttle back and forth between hospitalizations (overdoses/detoxes) and active use. They’re never given the tools or resources to stay clean out in the “real world,” nor are they given long-term monitoring or outpatient care. For many of those folks, it’s only a matter of time before they overdose.
That’s why treatment is so crucial, and why many treatment organizations, Phoenix House included, are becoming comprehensive behavioral healthcare facilities, rather than just substance abuse treatment providers. We want to get involved in clients’ lives and recovery, and refer them to social services that will increase their likelihood of success. Our goal is that no substance abuse problem or mental health issue, however minor, should go untreated.
I always tell my clients: mental health provides the foundation for recovery. Alongside individual and group therapy, medication can help clients establish and nurture this foundation. That’s why we encourage them to talk to our psychiatrist or psychiatric nurse practitioner about the potential benefits of medication-assisted treatment. Medication can help establish more normal feelings, but change can be uncomfortable. Someone with bipolar disorder, for example, is used to feeling high highs and low lows. Without help adjusting, many clients discontinue their medication and relapse with symptoms and substances. For this reason, ongoing care is critical.
Without ongoing care, someone might also be operating with an antiquated diagnosis. For example, many children who have been diagnosed with ADHD end up with a bipolar diagnosis in adolescence or adulthood. If those individuals aren’t linked to long-term care, they might still be taking ADHD meds to “treat” bipolar, and that just won’t work.
We know that individualized treatment is key, and you can individualize so much more in long-term outpatient care than in sporadic hospital admissions. An outpatient treatment team would better understand a client’s baseline; if a person is acting out in the ER they’re likely to be restrained, whereas the individual therapist will know less invasive de-escalation techniques that work for that particular person.
Without a doubt, behavioral health treatment saves lives, and it also saves cost. As the Times author points out, “a single hospital admission…costs more than a year of private outpatient care would.” Plus, a patient may leave the hospital without viable referrals to a primary care physician or mental health provider to follow up with. Discharge planning is so much more inclusive in behavioral health treatment programs; we talk about transition plans, harm reduction, and primary care, and link clients to available services in their community. We can even help them attain and maintain insurance benefits. When someone is served on that level, the outcomes are much more positive in the long run—they have more investment in physical wellness, they’re on the right medication if necessary, they’re more balanced, less impulsive, and less likely to use.
The cutlery client likely gets four 20-minute meetings with an ER psychiatrist per year. Someone in ongoing outpatient treatment, however, would likely get two hours of one-on-one time with a clinician, plus 16 hours of group therapy per month. The greater intensity and holistic nature of services in outpatient treatment will make a difference. One of my clients was struggling in long-term recovery from substance abuse before she discovered our mental health services; they were the “missing piece” that she needed to feel truly comfortable and succeed in her recovery.
A behavioral healthcare approach seeks to decrease the marginalization of vulnerable people, and to provide these people and their families with an understanding of their issues so that they’re not afraid to reach out for help. Unfortunately, in our society, it’s more socially acceptable for someone to deal with a stressful day at “Happy Hour” than it is for them to utilize professional help for a problem like depression, anxiety, or substance abuse. We need to flip that norm on its head.
Shaun Willis, LMSW, Director
Long Island Substance Abuse Outpatient Programs