A message from Dr. William Beecroft
Psychiatric residential treatment: What it is and isn’t

Over the past two years, we’ve seen an increase in the use of psychiatric residential treatment. We’ve also noticed a great deal of misunderstanding about what this level of psychiatric care involves. With this column, I hope to clear up some of the confusion and provide a better understanding of what this type of treatment is and isn’t.

Just as with the medical and surgical continuum of care, psychiatric residential treatment is a defined level of care. For individuals to be admitted to a psychiatric residential treatment facility, they must be sufficiently ill and need supervision 24/7 to ensure they don’t harm themselves.

A psychiatric residential treatment facility doesn’t typically include a locked unit, but it does have the ability to take care of patients who have been involuntarily committed. It’s less restrictive than a psychiatric hospital but more restrictive than a partial hospitalization or intensive outpatient treatment program where the member stays at home at night and participates in treatment during the day. It could be compared, on the medical side, to a long-term acute care hospital for a severe chronic life-threatening illness.

Since these facilities offer a high-intensity level of care, there are certain specifications or expectations that must be met, such as the following:

• A psychiatrist will be admitting the member and overseeing the care provided by the treatment team. 
• Nursing staff is available onsite during the day and able to get to the facility within an hour if there is a medical or behavioral emergency after hours.
• Psychotherapy and group psychotherapy occurs at least twice weekly. There are also other group therapy opportunities (12.5 hours to be exact) to learn about the issues causing or contributing to the illness, develop alternative mechanisms to deal with stresses, learn specific techniques to improve wellness and resiliency, and to develop contingency management skills to prevent reoccurrence of the disorder for which the individual is seeking treatment. 

In short, this is a lot of work. The whole process is overseen by Blue Cross Blue Shield of Michigan through a periodic review of the patient’s progress and consultation with the treating providers to eliminate barriers and develop discharge plans to provide continued programming when the member is discharged to home. 

The transition to home is a crucial step in the process and requires the involvement of families, significant others and caregivers to be successful. Family therapy in a controlled setting is crucial to successful transitions and the resolution of conflict in order for the patient to have the best possible long-term outcome. This level of care can be very helpful for people who have recently been hospitalized for a new onset of a psychological issue or for a person who is in outpatient treatment but getting progressively worse in order to avoid a hospital admission. 

Successfully utilized, psychiatric residential treatment can be a very helpful intervention when considering options for treatment intensification. Combined with our adult intensive services, child intensive services or other programs, it can provide a continuum of programming to help people return to a full realization of their potential and remain in remission of the symptoms of their disorder.

What psychiatric residential treatment is not
We have many members who understand this level of care as something much different than what is described above. They may think of it like a residential college where a member goes somewhere to live and takes some treatment, most likely at a similar frequency to what they could receive at home. Others believe that a change in physical location or environment will effect change. They think that programs emphasizing wilderness experiences, team building or camp-like activities will address the complex psychological needs of themselves or a loved one. If only this were true, but it’s not. 

You can take the person out of the situation that caused or contributed to their illness but that rarely changes the issues that drive the individual’s behavior. It might seem to be effective for a time at a new location but, ultimately, the person’s issues return and the time wasted in “treatment” that’s ineffective can result in more problems and a sense of hopelessness. 

There are many “educational consultants” or therapy advisers in our communities who make a living “consulting” and “advising” members about these types of facilities. Many of these types of facilities are out of network for Blue Cross or don’t participate with any insurance. They may say they accept insurance, but it usually doesn’t cover the entire cost and the member may be “balance billed.” This, at times, can amount to hundreds of thousands of dollars. 

How to get quality, affordable care for your patients
Your best first step for patients with Blue Cross or Blue Care Network insurance is to call us before making a recommendation for psychiatric residential treatment. We’ve spent a significant amount of time doing background checks on providers who offer this type of treatment, and our clinical experience with these providers can provide you with insights into what may be the best fit for your patient.

Psychiatric residential treatment is an effective treatment tool for patients with very specific treatment needs. Understanding what the tool is and isn’t can help you use this tool for the benefit of your patients.

William Beecroft, M.D., is medical director of Behavioral Health for Blue Cross Blue Shield of Michigan. He is board-certified in general psychiatry and was named a Distinguished Life Fellow of the American Psychiatric Association.

Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees of the Blue Cross and Blue Shield Association.