What Is PHP (Partial Hospitalization Program)?

Partial Hospitalization Programs (PHP) were treatment programs originally developed to help people struggling with mental illness. Initially called “day hospitals,” these programs were designed in the 1960s to help those who needed an intensive level of psychiatric care but who would also benefit from living in the larger community as well as those who had stable, safe home lives to return to after a full day of treatment ended.After changes to Medicaid laws in the 1980s, Partial Hospitalization options expanded rapidly, until financial restrictions were placed on them in the late 1990s. As the idea that addiction is a mental and behavioral illness with biological roots, rather than an issue of willpower, took hold, PHPs began to develop for people struggling with substance abuse issues.

PHPs still exist primarily to work with individuals who struggle with mental illness, but many subsets of these programs across the country exist as an in-between, or even outpatient, method of helping people who want to overcome substance addiction and abuse. These programs come in many ranges of options, from flexible outpatient to full-day intensive programs, but they have several core tenets in common. The most important common factor among all PHPs is the desire to find a way to prevent people overcoming substance abuse from becoming a patient in a hospital.

How Partial Hospitalization Works

Partial Hospitalization is a highly structured psychiatric treatment program which, in the case of substance abuse prevention, also offers some medical oversight. Typically, a PHP is an option for treatment after a person has been hospitalized due to substance abuse issues, and the person is deemed fit to be discharged from the hospital. PHPs are often used as steps between inpatient and fully outpatient programs for substance abuse as well.

Some general criteria for Partial Hospitalization include:

• A current, documented diagnosis of a substance use disorder from a medical professional is needed.
• The individual needs consistent medical monitoring, but is stable enough to go overnight without monitoring.
• The individual is not at risk of self-harm.
• Detox symptoms are considered to be mild or moderate, so the individual can manage them at home for part of the day.
• The individual is physically, emotionally, and mentally able to tolerate several hours of therapy, both group and individual, several days a week.
• The individual is still not deemed able to function on a daily basis, but has enough community and familial support to avoid relapse.

For substance use disorders, Partial Hospitalization does offer medical detox, but only to people who do not face life-threatening withdrawal symptoms. Withdrawal is rarely life-threatening for many substances of abuse, especially with a medical professional’s oversight; however, withdrawal from some substances – like alcohol and benzodiazepines, for example – requires 24-hour medical monitoring to ensure clients do not suffer from seizures, heart attack, or other severe side effects.

For individuals working on a tapering regimen, and who will benefit from intensive therapy sessions for several weeks to change their behaviors, Partial Hospitalization is a great option. It is also a perfect step between completely inpatient and completely outpatient programs.

Treatments Offered in Partial Hospitalization

While PHP options vary between hospitals and other facilities, there are several basic services in common. Some of the professionals who work in PHPs include:

• Psychiatrists
• Social workers
• Nurses
• Occupational therapists
• Pharmacists
• Psychologists
• Peer support workers
• Recreational therapists

Schedules of therapy and medical appointments can vary across PHPs, and they often change as the individual’s needs change. The required number of therapy sessions can range from two hours per day, three days per week, to eight hours per day, five days per week. Most PHPs require 4-5 days of therapy per week, with scheduled breaks, for 4-8 hours per day. The minimum number of hours for a PHP program is 10 hours per week, with the most hours reaching 50; the average, however, is 20 hours of therapeutic treatment per week. Once treatment is over for the day, the individual is able to return home. For many, this is a chance to practice new skills learned in therapy sessions in a supportive community environment.

PHPs bring in people who would otherwise be hospitalized, or people attend right after they leave an inpatient treatment program. New clients should have their medical needs evaluated by the PHP in the first 2-3 days of their admittance, and they should receive a psychiatric evaluation in the first three days. Clients return home for evenings and weekends.

People participating in a PHP typically stay between three and five weeks, then transition to an outpatient program. However, some individuals have stayed for as little as one week and as long as six weeks. Regardless of length of stay, a PHP is designed to be an intensive learning program, and it is not set up for longer residential-style treatment, which often lasts for three months.

When the individual leaves the PHP, they should have detoxed from their substance of abuse, and they should be able to function on their own. They should have a thorough understanding of their addiction and how to appropriately deal with triggers that might otherwise lead them to relapse.

Who Benefits from a PHP?

There are many people who can benefit from a PHP. Here are a few:

• People who struggle with substance abuse, but who have a supportive community and/or home environment
• People who are not likely to suffer dangerous withdrawal symptoms, like delirium tremens
• People who will benefit from some flexibility in their personal schedule
• People who are ambulatory (i.e., physically capable of transporting themselves to and from the program)
• People who are able to work intensively in group and individual therapy sessions
• People who are capable of self-regulating prescription medications, if needed

Who Might Not Benefit from a PHP?

Although there are several groups of people who can benefit from a Partial Hospitalization Program, not everyone can benefit from some schedule flexibility. Some people need constant monitoring for a variety of reasons, and some people have other needs, like housing or transportation, which cannot be immediately met. Here are some types of people who should not enter a PHP, as an inpatient setting may work better:

• People who are homeless
• People who have access to drugs in their homes or communities
• People who are victims of violence or domestic abuse
• People who need 24-hour medical oversight for the aftereffects of overdose; whose withdrawal symptoms might become dangerous, such as in the case of alcohol use disorder leading to delirium tremens; or those who need methadone treatment
• People who have organic structural problems in their brain or learning disabilities, who will not benefit from intense therapy sessions
• Those who do not have family, social, or community support outside of the treatment setting

On the other hand, there comes a time when a person has done a great deal of hard work and does not need the intensive level of therapy of a PHP. Often, these individuals will graduate into an outpatient treatment program, so they can find social support for maintaining their sobriety. These individuals will do better practicing the skills they learned in therapy in the larger world. Ultimately, reaching this level of self-understanding and self-sustainability is the goal of a Partial Hospitalization Program.