One of the most promising options for treating behavioral health problems is psychiatric partial hospitalization. Based on the philosophy that patients should have access to a continuum of care and level of psychiatric treatment appropriate to their needs, a Partial Hospitalization Program (PHP) allows them to attend a structured therapeutic mental health program during the day and return to the familiarity of home and family at night.

For many patients, leaving the security of inpatient medical services and testing the waters of independence can be a scary proposition. "Our psychiatric Partial Hospitalization Program (PHP) helps patients make the transition from an inpatient psychiatric hospital to their homes and community more quickly, while still taking advantage of the gains they have made during hospital care," says Ann Dooley, R.N., team leader for the psychiatric PHP at the John Muir Behavioral Health Center in Concord.

Multidisciplinary Team Approach

Primary care physicians conduct an initial physical and take a medical history for each patient. A multidisciplinary team including registered nurses, psychiatrists, psychologists, marriage and family therapists, and occupational and recreational therapists supervise the six-hour-a-day, five-day-a-week program.

"One of our primary objectives is to ensure that once patients leave the hospital, they are returning to a safe environment with coping skills that help them manage their mental illness," say Hinda Brush, a marriage and family therapist and PHP program counselor. "Our patients are taught to recognize early symptoms of their disease and to seek help before symptoms become severe, cause a relapse and require re-hospitalization."

Under the direction of psychiatrist Nagui Achamallah, M.D., medical director of the Partial Hospitalization Program, the short-term, intensive program blends its multidisciplinary care team with many therapeutic modalities, including cognitive, behavioral, brief problem-solving and symptom management. PHP is geared towards adults who are experiencing psychoses, drug dependency, depression and anxiety, and can benefit from intensive outpatient therapy in a group setting.

"The fact that we provide many interventions ensures that something will work for each patient," says Ms. Dooley. She values the multidisciplinary program's group approach, which provides a much higher level of engagement and more peer support than a person would receive from individual therapy or in a hospital setting where interaction is limited and patients are more severely ill.

Socialization and Interaction

Ms. Brush agrees that socialization and interaction are key to improving participants' moods and enabling them to look carefully at their own behavior. "If they did not have our program, many of these patients would stay in their homes and become more and more isolated, causing symptoms to escalate," she says.

To achieve the program objectives, daily therapeutic interventions feature a traditional group therapy session; creative arts therapy such as music, art or exercise; and a variety of educational/discussion topics. These topics include nutrition, signs and symptoms of behavioral problems, medication management, anger and stress management, assertiveness training, coping skills and mood changes management. Participants set individual goals and their progress is evaluated throughout the program.

Family members are encouraged to participate in meetings with patients and therapists to learn more about patient problems and to better serve as a support system once the family member returns home. Patients develop goals, and individual progress is measured throughout the program.

Most patients, Brush says, stay in the program for two to six weeks and when they are discharged, return to their jobs or former activities. Length of participation is based on the severity of a person's symptoms. Although some patients may repeat the program, their stays are shorter. PHP also helps patients find support groups, individual therapy and other services, if needed.

Patient feedback indicates long-standing improvement in symptoms of depression, anger, anxiety and panic. "Not only have we seen a reduction in the number of people readmitted to the hospital, but the program has allowed them to live a happier life and to return to more normal functioning," Brush says.