Many people who have been in an eating disorder treatment program—particularly a residential program—have found those next steps for recovery to be very challenging. Generally, programs focus on measurable goals, like weight indicators, and use those metrics to determine when a patient is ready to step down into a “partial hospitalization program” (PHP) or to begin the process of returning to life outside of the treatment facility. But sometimes, perhaps more often than anyone would like to discuss, patients are stepped down before they are truly ready—while the physical recovery has begun, the journey of healing the underlying psychology behind their disorder has only barely started.
This type of stepping down is also rather common for those who have spent time in inpatient behavioral health treatment facilities—there has been some adjustment of medication, but the work has only just begun and the sudden return to the patient’s previous life can feel jarring and overwhelming. This is where assertive community treatment, when it is available, can make a profound difference in recovery and quality of life.
What is Assertive Community Treatment?
Beginning in the 1950s, the model of care for those with severe mental illnesses changed from institutionalization in hospitals to clinical care within communities. By the 1970s, it had become quite clear that, while there were positive aspects to that change, serious challenges remained. Robert E. Drake explains:
Early experiences in the community showed, however, that the relevant service system, which included general medical care, mental health treatment, substance abuse treatment, vocational rehabilitation, and housing services, among other support services, was complex and fragmented. Moreover, persons with Severe Mental Illness demonstrated a limited ability to advocate for themselves or to initiate and coordinate contacts with multiple service providers. Consequently, they had great difficulty getting needed services. (American Psychological Association)
By the early 1970s, a group of care providers in Madison, Wisconsin began to outline what would become known as the Program for Assertive Community Treatment (or PACT) to “ensure that the patient received all services needed to remain in the community and function optimally with the highest possible quality of life” (American Psychological Association). In this system, patients would have access to “a multidisciplinary team (including some combination of psychiatrists, nurses, social workers, vocational rehabilitation specialists, and case managers) that was available 24 hours per day and provided services to the patient for an indefinite time” (American Psychological Association).
Programs rooted in the PACT methodology grew in number—but still remained elusive to many of the individuals they were meant to serve. They became more common in areas with publicly-funded mental health programs, but eligibility restrictions (these programs quickly fell under the aegis of Medicaid) or simple geography prevented some who needed these services to get them. This has led some treatment facilities to build comparable programs for those they treat.
A Community For Integrated Wellness in Coral Gables, Florida
Seeing the need to better support those recovering from eating disorders and other challenging mental health diagnoses (such as schizophrenia or bipolar disorder), and others who may need additional help living in their communities for other reasons, Galen Hope’s treatment facility in Coral Gables, Florida features a community for integrated wellness. Building off of the PACT methodology, Galen Hope’s practice includes a system of “Care Partners” who work directly with patients in that ongoing (and open-ended) caretaking capacity. These Care Partners can help in any number of ways—from dealing with finances to negotiating a re-entry to school after a medical withdrawal. For an individual in Galen Hope’s PHP, a Care Partner may work with them on cooking meals, or on visiting a restaurant that has triggering connotations. They may take the individual shopping for clothes that fit perfectly. The end goal, as with PACT, is to help create success through support.
At Galen Hope, every client has a dedicated case manager to meet with throughout the week based on their specific areas of growth. For example, this might include assisting with self-care practices, helping a client find a volunteer activity in the community, or working with them on ways to create more order and organization in their environment. If an individual is struggling with executive functioning issues, and/or have a need for increased connections with others (often seen in Attention Deficit and other mental health conditions), the case management team will develop a protocol specific to them. Together, provider and patient can build routines and conditions that optimize effective problem solving and improve functioning in activities of daily living, self-care, and academic/vocational/social experiences.