What are Partial Hospitalization Programs?
A partial hospitalization program(PHP) is an option for those struggling with an eating disorder whose health status doesn’t necessitate an inpatient hospitalization, but yet a person needs a higher level of care.1 Medical experts may also call partial hospitalization programs “day hospitals”. Sometimes, a person will choose a PHP after they completed an inpatient hospitalization or residential treatment program.
A partial hospitalization program is a good fit for a person who fits the statements:
- I feel like I need to be monitored closely during the day and also need help and support for my meals.
- I have tried outpatient care before, and I have relapsed with my eating disorder and/or mental illness.
- I am currently medically stable.
- I have just completed an inpatient hospitalization stay and would like further support.
- I have a supportive family or other social support system where I can stay at night.
Some of the key aspects of a PHP may include eating two supervised meals and snacks daily, participating in nutritional counseling, and participating in individual and group therapy sessions. The behavioral health approaches used in counseling will often depend upon the facility type providing care. If a minor is participating in this type of care, a person’s parents may also participate in therapy sessions for about 10 to 15 hours out of the week.
Does PHP Take Place at a Hospital?
A partial hospitalization program does not usually take place at a hospital, unless the hospital also has day programs as a part of its care offerings. This may be the case with some larger, academic facilities. For the most part, partial hospitalization programs will take place at a treatment facility.
Dual Diagnosis: Eating Disorders
Often, when a person struggles with an eating disorder, they will also struggle with a mental illness. According to the National Eating Disorders Association, the following patients with eating disorders also struggle with a mental illness:2
- 56 percent of people with anorexia nervosa
- 79 percent of people with a binge eating disorder
- 95 percent of people with bulimia nervosa
Depression and Eating Disorders
Of women struggling with an eating disorder, an estimated 92 percent were struggling with a depressive disorder, according to the National Eating Disorders Association.2 However, depression is not the only mental illness that can affect those with eating disorders. Obsessive-compulsive disorder (OCD) is also a common co-occurring disorder. An estimated 69 percent of people with anorexia nervosa and 33 percent of patients with bulimia nervosa suffer from OCD.
Anxiety and Eating Disorders
Another common co-occurring mental health disorder with eating disorders is anxiety. An estimated 54 to 81 percent of people with bulimia nervosa have an anxiety disorder. The next-most affected with anxiety are those with a binge eating disorder, of whom 55 to 65 percent are affected.2 Also, an estimated 48 to 51 percent of people with anorexia nervosa also have an anxiety disorder.
When a person suffers from these disorders together, it’s important they seek treatment at a facility that can care for both disorders. Partial hospitalization programs can help many people who are struggling.
How Is PHP Different From Other Treatments?
When a person wants to seek treatment for an eating disorder and mental health disorder, there are many options for treatment. Some examples include:
An inpatient treatment program involves staying at a treatment facility. This may be a hospital when a person is experiencing significant threats to their health. This can include severe weight loss, changes in heart rhythms, and thoughts of self-harm, such as suicide. Inpatient treatment is the most intensive level of care provided for those struggling with eating disorders.3 Usually, a person will only participate in this level of care for one to three weeks until their health is more stabilized.
Residential treatment involves seeking care at a full-time treatment facility. The facility will usually have medical providers, but is not a hospital. A person will live at the facility full-time and participate in a variety of treatments. A person may need residential treatment if a person desires structure and support to maintain their eating habits. A person will usually participate in residential treatment for between six weeks and three months.
Intensive Outpatient Treatment:
Intensive outpatient treatment is a step under a partial hospitalization program. This involves attending therapies at a treatment center for about three hours a day. Some people may attend these programs every other day or for another pre-determined length of time. A person must be medically stable to participate in this treatment program type. Additional examples of services provided include nutritional counseling, individual therapy, family therapy, or group therapy.
Outpatient care is usually the last step of care for a person seeking eating disorder treatment. This involves a variety of therapies, which include therapy, support groups, and continued nutritional counseling. A person may participate in these care types for several months to the rest of their life to ensure they make healthy choices.
Sometimes, it can be difficult to determine what treatment program type is best for a person. Fortunately, they don’t have to make the decision alone. An intake counselor at a treatment center can help a person decide the best option to start. Examples of some of the questions and components a counselor will consider include:
- Current weight and diet history
- Family life and social support structure
- History of mental illness, treatment, and any symptoms a person is currently experiencing
- History of when a person’s struggles with food and weight began
- Any other medical history it would be good for a specialist to know about
An intake specialist will consider each of these factors before making a recommendation. It’s important for a person to remember that if they start this treatment program and it doesn’t work well for them, there are other options available.
How Might This Impact My Family?
An eating disorder can impact a person and their family in a variety of ways. A person’s family may respond differently given the stresses of seeing their loved one struggle with an eating disorder. Usually the emotions will include a combination of the following:
Sometimes family members may not understand the type of eating disorder and/or mental illness a person has. They may also be uncertain as to what to say to the person or how to best support them.8 Often, their intentions are good, but they may be unaware as to how to proceed.
It can be difficult for family members to see a loved one struggling with an eating disorder. They may struggle with a person’s refusal to get help for their disorder or with the changes the eating disorder has made to their family relationships.
Guilt and Fear
Sometimes, family members will blame themselves as to why the person developed the eating disorder. They will wonder if there were things they could have done differently to help a person. They may have questioned if they should have recognized the symptoms sooner or if they had supported a person more, perhaps they would not have been in this situation. Family members may also worry that a person may not recover from their eating disorder and could potential succumb to the side effects from struggling with the disorder.
Fortunately, many partial hospitalization programs offer support not only to the person struggling with an eating disorder, but also their family. Through family therapy and education, family members are offered an opportunity to learn how they can support their loved one as well as work through their own personal emotions about seeing their loved one struggle.
How Long Does a PHP Program Last?
Partial hospitalization programs can vary in length based on the center providing care and a person’s unique needs. A person may attend the program anywhere from five to seven days a week for a time period of 6 to 10 hours a day.1 Some people may participate for two weeks while others may choose to continue in the program for many weeks. A person can ask their intake counselor about how long they may expect to stay in the partial hospitalization program, all with the knowledge that they could require more or less time depending upon their progress.
What Is The Intake Process Like?
The intake process is often the first meeting between a center’s medical professionals and a person struggling with an eating disorder and mental health condition. If a person is a minor, their family may also participate in the intake process. While the order may vary based on the individual’s center’s policies, here are some of the steps that will occur during an intake process.
Assessing the Degree of Malnutrition
Knowing the level of malnutrition is important for a person because those who are less than 70 percent of the expected body mass index (BMI) for their height and weight are severely malnourished (4). They will need care at a medical facility until they can achieve a healthier weight.
Identifying Eating Attitudes and Behaviors
An intake specialist will also identify a person’s patterns of behaviors and attitudes toward eating. They will ask about their history of dieting, exercise levels, if they binge or vomit, if they have used diuretics or laxatives as means to lose weight, and how a person feels about their weight and body overall.
Medical Health Assessment
An eating disorder can affect a person in many ways. Lack of food or chronic vomiting can lead to electrolyte losses. These can impact a person’s muscles and heart rhythms, sometimes causing bradycardia or a slowed heart rate. Sometimes, a person may experience impaired sexual development, such as failure to start a period.4 A doctor will also consider any psychiatric and chronic medical health conditions, such as diabetes.
These are just some of the examples of the intake process involved in helping a patient who is going to seek care for their eating disorder. While it can be understandably difficult to talk about a person’s history of eating patterns and mental health struggles, being as honest as possible is vital to helping an intake coordinator develop the best possible program.
How Can I Make My Treatment a Success?
Being willing to seek and accept care is a major step toward making treatment a success. It’s important that a person approach eating disorder treatment with an open mind and a willingness to explore treatment. It’s important the person remember those at the treatment facility are medical professionals with specialized training in helping people struggling with eating disorders. A person can ask questions, participate in treatment sessions, and try to engage in behaviors they are learning that are healthy.
If a person continues in the partial hospitalization program and feels as if they aren’t experiencing results, they can talk to their therapists. They can set expectations and goals that are realistic. However, sometimes a program isn’t the right fit. When this is the case, a person can explore other alternatives, all with the goal of helping them achieve better health.
Effectiveness of Partial Hospitalization Programs for Mental Health and Eating Disorders
Some research studies regarding partial hospitalization programs have supported their use in treating eating disorders. For example, a study published in the January 2014 edition of The Lancet studied female patients ages 11 to 18 years old at six anorexia nervosa treatment centers in Germany.5 Patients were randomly assigned to participate in an inpatient treatment program or a day patient treatment one, which was equivalent to a partial hospitalization program in America. Participants engaged in three weeks of treatment. The researchers followed up with the participants for a 12-month period.
PHP vs. Inpatient Programs
At the conclusion of the research study, the researchers concluded there was no difference in the outcomes between the inpatient and day patient programs. Goals measured for the programs included restoration of weight and maintenance of weight up to a year after their initial treatment.5 The researchers called for a greater emphasis on partial hospitalization programs as they could be cost-saving compared to inpatient programs for many people.
A 2016 systematic review published in the journal European Eating Disorders Review studied the outcomes of several studies that compared residential and partial hospital-based treatment programs.8 The researchers studied 22 partial hospitalization programs and six residential treatment studies. The researchers concluded that higher levels of care, such as inpatient care, are essential to help reverse the symptoms of malnutrition. However, the researchers also concluded that partial hospitalization programs were largely as effective as residential programs in treating eating disorders. The researchers did note that researchers traditionally had difficulties in long-term follow-up with those who had received care for their eating disorders.
At the study’s conclusion, the researchers found those who participated in the day hospitalization program showed greater improvements in most psychological symptoms associated with eating disorder symptoms. Examples include reduction in binging and purging frequency, increase in body mass index, enhanced self-esteem, and reduction in depression. The researchers concluded that partial hospitalization programs were effective in helping those who are struggling with eating disorders.
PHP vs. Outpatient Programs
Another research study published in the May 2005 Journal of Advanced Nursing studied the differences between the results of partial hospitalization programs and outpatient treatment programs.7 This small study had 43 participants. The researchers assigned 21 to a partial hospitalization treatment group and 22 patients to a control group who received outpatient treatment that included individual psychotherapy, cognitive behavioral therapy, and medication management. The researchers collected data for a year in the study.
PHP for Eating Disorders
Another research study regarding partial hospitalization programs published in the June 2017 edition of the International Journal of Eating Disorders studied the effectiveness of partial hospitalization programs in treating different types of eating disorders.6 The researchers studied 130 patients who ranged in ages from 7 to 17 years old who were admitted to a partial hospitalization program. The researchers studied the outcomes of those with anorexia nervosa who participated in groups with only others who also had anorexia nervosa compared with those who participated in groups with those who had different eating disorder types. These include binge eating and bulimia nervosa disorders. At the study’s conclusions, the researchers determined that patients could receive successful treatment without being grouped by eating disorder type. 6
Partial Hospitalization Programs for Recovery
Partial hospitalization programs are effective ways for a person to seek treatment when they struggle with an eating disorder. They can be a cost-effective alternative for a person who is medically stable enough not to require inpatient care. A person can contact eating disorder treatment centers and participate in the intake process to determine if the partial hospitalization option is the best fit for them. Through participation in the several weeks-long program that often incorporates family therapy, a person can learn more about how their disorder affects them and healthy behaviors that can help them develop a healthier relationship with food.