Unique Approaches to Treat Mental Illness and Substance Abuse
Photography by Wes Battoclette
Anna Krause, 21, of Delhi Township is typical of many young people who suffer from an eating disorder. She needed help, yet she fell short of the criteria for hospitalization. She discovered that the Adult Partial Hospitalization Program (PHP) at the Lindner Center of HOPE in Mason was just what she needed to get the tools to cope with her disorder.
“I didn’t realize there was this kind of help available,” says Krause, who has been suffering with bulimia since she was a child and began chronically purging when she was 18. “I learned how to trust my team of counselors. They gave me so many ways to cope. It was a place to retool, learn what you are doing wrong and how to get out of it.”
The Lindner Center of HOPE, which opened in 2008 and is affiliated with UC Health, offers patient-centered, scientifically advanced care for individuals suffering with mental illness, addictions and other disorders. The Lindner Center calls its partial hospitalization program Mindful Transitions, designed to fill that gap where a patient might need more intensive care than they would get in an outpatient setting, yet do not require hospitalization.
The Mindful Transitions PHP operates five days a week with patients in an intense therapeutic program from 9 a.m.-3 p.m. (although eating disorder patients, like Krause, sign up for a longer day so they can build skills through breakfast, lunch and dinner).
PHP can benefit patients with a variety of disorders such as mood, personality, eating and anxiety disorders. Some of these include depression, bipolar disorder and post traumatic stress disorder (PTSD).
“Frequently our patients are referred from outpatient providers who want to avoid hospitalization,” says Lorene Walter, MD, a Mindful Transitions psychiatrist. “And we have a lot of people who are stepping down from inpatient care. There just aren’t many of these partial hospitalization programs in the region. When I was an outpatient psychiatrist, I didn’t have many options when I wanted to refer patients to a partial hospitalization program.”
For those battling substance abuse, the Lindner Center offers a similar Intensive Outpatient Program (IOP) that meets three nights a week for people in need of treatment at a moderately high level of care. Like the Mindful Transitions Partial Hospitalization Program, IOP is a unique middle ground for patients in recovery who might have been in a residential rehab setting or are looking for help for the first time with their substance use.
A distinctive focus of IOP counseling is treating co-occurring disorders, where addiction might be fueled by a mental health issue and vice versa.
“Our staff is trained in mental health and substance abuse. We pride ourselves in being able to address both issues,” says John Mallery, Lindner Center HOPE Center North supervisor. HOPE Center North is an outpatient addictions clinic. “Our focus on normalizing substance abuse as a medical condition helps destigmatize the issue. And our approach to addressing co-occurring issues in the program lends to self-discovery.”
The Partial Hospitalization Program, where patients work with a treatment team throughout the day, can involve meetings with a psychiatrist, nurses, mental health specialists and social workers. The day includes interactive activities and presentations, as well as patient-driven group discussions.
“It’s all about coping skills and symptom management,” says Eva Columbus, RN, a Mindful Transitions staff nurse. “After a hospitalization, patients may be returning to an unfavorable environment full of triggers and struggles, so this program teaches them how to cope and manage in those situations.”
Treatment relies heavily on dialectical behavior therapy (DBT), according to Columbus. DBT was originally developed in the ’70s to treat people with borderline personality disorder, but has proved useful in a wide range of mental health areas to help people increase their emotional and cognitive regulation. Patients learn about triggers and how to assess and apply coping skills to a variety of events, thoughts and behaviors.
“It’s aimed at people who have difficulty effectively managing intense emotions, by giving them a voice and giving them the tools to tolerate stress and thrive during difficult times,” Columbus says.
In fact, Krause found the DBT sessions so helpful she thinks they should also be offered outside of a clinical setting. “The DBT classes should be taught in high school. It’s so important to learn how to be stable, functioning people in society. If you teach these coping skills to kids, the world would be a better place.”
For patients with eating disorders, PHP counselors try a unique approach: they take people on field trips to shop and experience restaurants as a way to help manage day to day life in the community and to practice the skills they have acquired through the program. “I thought it was really cool they challenged us to eat in public,” says Krause. “That can be a huge anxiety. Eating in public is scary because you have this feeling that people are watching and judging you when it’s really all in your head, just your disease talking.”
Columbus says there are trips to such places as jewelry and clothing stores where patients are encouraged to point to items that bring out their personalities. Discussion with their peers and staff can help them identify skills to deal with any uncomfortable feelings or eating disordered urges they may have experienced during or after the outing. “Clothing and shopping in general can be a big trigger for people with a negative self-image,” she says. “We like to offer eating disorder patients real world experiences with staff guidance to provide support and encouragement.”
The average PHP stay is two weeks although it can last a month, as it did for Krause. “I loved that I got to set a date and decide when I felt I was ready to leave. That was very important to me.” She has graduated from the program and started a furniture sales job.
“Our patient satisfaction surveys rank our PHP program very highly,” says Dr. Walter. “People do feel that this is a very helpful transition period. The reality is that they can go home in the evenings and they are able to apply the skills they learned during the day.”
It is a similar approach at the Lindner Center’s six-week long Intensive Outpatient Program, which accepts patients battling substance use disorder.
Critical to the IOP approach is recognizing co-occurring disorders. It’s estimated that 60 percent of those with substance abuse also have psychiatric disorders. And, conversely, studies show anywhere from 35 percent to 56 percent of people with mental disorders also exhibit drug and/or alcohol disorders.
“We are very flexible in co-occurring treatment since we can help with medication assistance issues for mental illnesses,” says Rebecca Tuck, an IOP addictions therapist. “Some programs may not monitor mental health issues and treat the addiction as a separate or distinct issue. Our philosophy is more open in being able to meet the person where they are.”
Treatment sessions are customizable to individual needs, embracing several therapy tools including traditional 12-step techniques, cognitive behavioral therapy and DBT, individual counseling and group psychotherapy. The average size of IOP groups is 12 people.
“We look at trigger use, how to manage cravings and negative emotions without relapsing,” Tuck says. “We discuss spirituality and talk a lot about grief and loss, because if someone’s been using there is a lot of loss that is happening. In recovery you are losing a best friend, which is alcohol or the drug. Sometimes life happens while they are using and may have missed out on the chance to grieve the loss of something or someone.”
The IOP staff is being expanded to handle more people in response to the heroin and opiate addiction epidemic.
“We have had great success treating opiate addiction because of the opiate replacement drugs,” says Jolomi Ikomi, MD, an IOP psychiatrist. “The key is medication management and therapy. The medication-assisted treatment can lead to a pretty good outcome combined with learning coping skills.”
Dr. Ikomi believes the IOP counseling sessions are essential treatment for those coming out of a residential rehab experience or for people getting help for the first time.
“We talk about real things that happen that day. People find out how they can deal with an issue the next time it comes up,” he says. “A residential facility removes those triggers for a while, but it is not real life. IOP can handle day-to-day, real-life triggers.”
Mallery also takes pride in the program’s family support system that allows immediate access to counselors for family members if needed. And weekly after-care sessions are available to IOP graduates as often as they feel a need for continued therapy.
Whether it’s the Lindner Center’s Mindful Transitions Partial Hospitalization Program, or the Intensive Outpatient Program, mental health experts say both programs represent a trend in healthcare to fill that void between hospitalization, which takes time and can be a huge expense, and the routine psychiatric or counseling visit, which might not be adequate.
As Krause discovered, having a dedicated staff teach recovery skills and monitor your progress while still functioning in the real world can be the key to beating an addiction or mental health disorder.
“There were times I thought I would give up, but my team kept pushing me,” she says. “They knew how to differentiate when it was Anna talking or it was my illness talking. I was pushed hard and at times got angry at my team. Once I got through it, I realized how strong I was.”
The Lindner Center of HOPE is located at 4075 Old Western Row Road, Mason, OH 45040. You can reach them at 513.536.HOPE (4673) or visit their website at www.lindnercenterofhope.org. HOPE Center North is
located at 4483 State Route 42, Mason, and can be reached at 513.536.0050.