Which patients for partial hospitalization?
Patients who can verbalize thoughts and feelings tend to improve in a partial hospitalization program
Partial hospitalization programs (PHPs) are a good alternative to inpatient treatment for many patients who do not pose an imminent risk of harm to themselves or others.1 PHPs provide:
- equivalent or superior recovery-based care at a lower cost, and patients are satisfied with the treatment 2
- clinical services such as crisis stabilization, symptom management, and structured socialization within a stable therapeutic milieu, without the increased dependence on clinicians and loss of function of hospitalization.3
PHPs can be used in lieu of an inpatient admission or as an intermediate step to shorten a patient’s inpatient stay. Close proximity to and coordination with an inpatient setting can facilitate transition of care and may reduce patient drop-out rates. In addition, PHPs often allow extended evaluation of psychiatric symptoms and functional ability and may help you reach difficult-to-engage patients. Keeping patients in the community might help preserve patients’ self-esteem.
PHPs focus on behavioral activation skills and encourage patients to participate in treatment planning and intervention. Using a “pressure cooker” technique, treatment encourages patients to mobilize themselves within a limited time frame.
To determine which of your patients are likely to benefit from PHPs, we use the mnemonic MOTIVATES:
Motivated. Patients who are motivated to participate in daily programs are the best candidates for this level of care.
Organized. Individuals must be able to benefit from psychoeducation and skills-building groups. Patients who are grossly psychotic or delirious are not candidates for PHPs.
Tolerate a milieu or group setting. Floridly antisocial or manic patients may be disruptive and could negatively affect the milieu.
Interested in recovery. A patient who does not want to get well or stay sober usually relapses and drops out of treatment.
Verbal. Patients who can verbalize their thoughts and feelings tend to do better, although this skill can be developed while in a PHP.
Ability. Patients must be able to participate in their vocational and social rehabilitation.
Treatment adherent. Patients who are not adherent often don’t improve in PHPs.
Experience. Look for patients who have had positive experiences with milieu treatment settings.
Safe. PHP patients must not pose an acute risk of harming themselves or others.
The Association of Ambulatory Behavioral Health encourages PHPs to embrace the concept of recovery, which encourages the patient to be an active and empowered participant in treatment. Instilling hope is one of the cornerstones of the recovery movement.
1. Horvitz-Lennon M, Normand SL, Gaccione P, Frank RG. Partial versus full hospitalization for adults in psychiatric distress: a systematic review of the published literature (1957-1997). Am J Psychiatry 2001;158:676-85.
2. Hoge MA, Davidson L, Hill WL, et al. The promise of partial hospitalization: a reassessment. Hosp Community Psychiatry 1992;43:345-54.
3. Dick P, Cameron L, Cohen D, et al. Day and full time psychiatric treatment: a controlled comparison. Br J Psychiatry 1985;147:250-3.
Dr. Khawaja is staff psychiatrist/medical director of psychiatry partial hospitalization program; Dr. Dieperink is medical director of the Posttraumatic Stress Disorder Clinic; Dr. Schumacher is the program manager of psychiatry partial hospitalization program at the VA Medical Center, Minneapolis, MN