The quality of the oxygen

The decision of which residential treatment facility to choose gets a lot of attention. These clinics have lots of reasons why you should choose one over another, and people debate this issue pretty emotionally. But here's the only question I want to know: what happens afterward?

Residential care without a real discharge plan for ongoing care is meaningless and dangerous. It doesn't matter how good the care is in a hospital or residential center if it ends without continuing the care in a consistent way at home. It's like debating the quality of oxygen you use to resuscitate the patient. If you're just going to throw them back in the water when they regain consciousness it really doesn't matter.

It takes a long time, many months, to begin recovery and get started on living a life free of relapse. Residential care doesn't last that long. No matter how perfect the placement and ideal the therapies in the center what matters is what is going to happen at home. Instead of focusing on what happens in the center, I believe the best center is the one that focuses on assuring a well-trained, safe, and nurturing home and family to come back to - one with the very same protections and supports and messages as were offered in the center.

Here's the story I hear over and over: "She was doing so well there and really wanted to get well. She was motivated and ready. Within a week of coming home she started losing weight. The center won't take our calls now, and our therapist here says it is up to our daughter to 'work the plan' and 'use her tools.' We feel even more helpless than before she went in. She says we're too critical and that we stress her out. We don't have money or insurance coverage to go back and she says 'I'm fine.' We don't know what to do."

We can't send our kids off thinking that they'll come home and teach US what we need to do. We can't think that residential care will fix the problem or do our jobs for us.

ED has a long-term discharge plan, believe me. The time to decide our family's plan is when deciding on treatment, and the time to put that in place is from the first day.

Comments

  1. Terrific post, as always, Laura. ED indeed has a long-term discharge plan. May I offer some thoughts about what comes next at http://desertdwellergettingon.blogspot.com/2010/11/team-approach-how-to-keep-recovery.html

    Jennifer

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  2. We heard just that following TWO stays in a treatment facility -- three weeks each, almost exactly a year apart.

    Thank heavens we found help and a FBT therapist/plan before the following year!

    One of the few valid things we took from the experience, however, was that "fine" meant "F***, I'm Not Eating."

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  3. Well said, Jennifer and the word "FINE" will never be the same HDIGH!

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  4. Very true. The hardest part for me during my more acute phrases of this illness were after discharge. I not only had no back up and no support, but it felt like everyone assumed that because I looked better I must BE better on the inside. I usually lost all the gained weight plus interest within a week.

    Not only do patients struggle when they are not properly prepared for discharge, but when you take someone out of society for any length of time they become institutionalised, they forget how to function at all. The world becomes hugely overwheliming. All the problems that they had before are still there, except now they have also lost the only 'coping' skill (their eating disorder)that was working for them before (or at least they thought so because it wasn't really working. But it helped them feel that they were in some sort of control and now that's gone too.) Throw them back in the big chaotic world with no support or preparation and you have a disaster waiting to happen.. I believe this is the main reason those who relapse and become chronic 'cyclers' in and out of treatment, do so.

    I think there should be a LOT more programs, yes, but I think they should be mostly day programs if possible. That might be less expensive so there could be more places and it doesn't take the person 100% out of the world but provides support for meals and structure and activities, such as social rehab, groups, therapy...

    I think that inpatient treatment should only be used for those who ARE medically in danger because hospital IS like 'anorexia university' in so many ways. I think there should be some kind of 'halfway house' kind of supervised accomodation to help people who need more support than day programs because sometimes we do need more support. I and most of my friends DONT have families to support us or our families are so dysfunctional or abusive that it's part of why we got sick in the first place. Yet a lot of us, realising we needed nutrition in order to be able to think well enougth for therapy but still unable to actually meet those requirements orally undertake our own ng or peg feeds overnight at home. Often we need more support at times or when we begin and it just isn't there.

    Too many people don't believe eating disorders are a real illness and I think that's why there's so little support and treatment options at the moment.

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  5. Very true. The hardest times for me were after discharge. I not only had no back up and no support, but it felt like everyone assumed that because I looked better I must BE better on the inside. I usually lost all the gained weight plus interest within a week.

    Not only do patients struggle when they are not properly prepared for discharge, but when you take someone out of society for any length of time they become institutionalised, they forget how to function at all. The world becomes hugely overwhelming. All the problems that they had before are still there, except now they have also lost the only 'coping' skill (their eating disorder)that was working for them before (or at least they thought so because it wasn't really working. But it helped them feel that they were in some sort of control and now that's gone too.) Throw them back in the big chaotic world with no support or preparation and you have a disaster waiting to happen.. I believe this is the main reason those who relapse and become chronic 'cyclers' in and out of treatment, do so.

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  6. I think that long term day program style treatment and halfway house supported accomodation would be a really good idea. They'd provide support for meals and support for learning how to actually live - do the activities that having an eating disorder crowded out of life. Social rehab is very much needed.

    I also have a lot of friends and myself in the past, have chosen to do our own ng or peg feeds overnight at home as we have at that stage been unable to orally take in what we needed but knew we needed the nutrition to engage in therapy. If there had been the support available at supported accomodation I know I would have probably been able to continue, myself, rather than giving up.

    The problem for a lot of us is that we don't have supportive families. Or we have abusive families. So there's no support to come home to and even if there was, they need support. Eating disorders are an exhausting 24/7 battle for everyone concerned.

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