Day programs help young adults adjust

Intensifying “thought loops of anxiety” during freshman year at a Massachusetts university left Dan M. feeling paralyzed as his 2015 fall sophomore semester was about to begin.

Dan, who spoke to Providence Business News on the condition his last name not be identified, said in late January that, since those feelings surfaced, he has learned to redirect his thoughts and structure activities to cope more effectively with the pressures of school and the transition to adulthood.

How?

A day, or partial hospitalization, program at Butler Hospital in Providence, which includes therapeutic visits with psychiatrists and therapists, as well as group therapy with young adults aged 18-26, helped. Though it typically runs for five to eight days, Dan took the program for a week, but in a few weeks found he had to take the program again to get the full benefits, he said. Now, he is taking classes at the Rhode Island School of Design and plans to return to school in Massachusetts in the fall.

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“One of the most important things [that helped] was having the structure that was pushing me toward recovery, whereas before I had an open-book day ahead of me and I was just trying to get to the end of the day,” he said.

Butler’s new day program for 18- to 26-year-olds began in October, on the heels of a similar program for 18- to 24-year-olds initiated in July within a partial hospitalization program for patients of all ages at Rhode Island Hospital.

A majority of the young people needing help are college students, says Butler Chief Medical Officer Dr. James Sullivan. At Rhode Island Hospital, Dr. Mark Zimmerman said college students represent the “vast majority” seeking help.

Patients enter the day program not only from full hospital stays as a transition to independence, but the emergency room or professional referrals – in Rhode Island Hospital’s case, often directly from counselors at Rhode Island colleges, including RISD and Johnson & Wales University, said Dr. Laura Whiteley, a Rhode Island Hospital psychiatrist who started the hospital’s young-adult behavioral health program three years ago on an outpatient basis.

“There are many resources available in our surrounding community, such as the day programs … which can be a beneficial complement to on-campus supports,” Danielle Stead Mancuso, RISD’s public relations specialist, said in an emailed statement.

Johnson & Wales did not immediately respond to a question about need for the programming.

In the day program, participants spend the better part of their weekdays in the hospital, but have their evenings and weekends free. They participate in activities and group therapy, as well as sessions with therapists, psychiatrists and social workers.

The day program is intended to help prevent inpatient hospitalization and worsening of symptoms ranging from anxiety and depression to psychosis, says Zimmerman.

Both hospitals have found a demand for these services.

“We were looking at the demand in our existing partial hospital programs and not meeting the needs of 18- to 26-year-olds who couldn’t relate to the older adults,” said Sullivan. “They would be better served if they were in a program where they could identify with the life-stage events of others going through a similar course of illness and experience. At this age, peer support is powerful.”

At Rhode Island Hospital, while some treatment and a therapy group are reserved for the 18- to -24 year olds, Zimmerman and Whiteley said those young adults are also mixed into the broader day program for all age groups, because doctors believe they can benefit from exposure to others.

At 19.8 percent, Rhode Island has the highest number of young adults aged 18 to 24 “likely to have serious psychological distress,” compared with the five other New England states and the country as a whole. That’s according to data compiled from a National Survey of Drug Use and Health and conveyed in “Rhode Island Behavioral Health Project: Final Report,” submitted to state health officials by Truven Health Analytics in September 2015.

Other states range from a low of 17.5 percent in Connecticut to 19 percent in both Maine and Massachusetts, while the national statistic is 17.9 percent.

“The main goal is for people to really manage this time period in their lives and the level of stress, sadness or thoughts they may be having and understand and help them to get better,” said Dr. Michael Wolfe, treating physician for the Butler program. “Almost everyone we’ve seen has been either transitioning in a school environment, or one job to a new job, or no job to a job and making the transition in the occupational world.”

Occupational therapy does not necessarily revolve around transitions to work, though it can; it is focused on activities, said Butler occupational therapist Lilly Ditto.

“This age group really isn’t sure what their goals are,” she said, “so we’re working to help them clarify that. Some come in and have far too many goals and we need to focus on one or two. Others say, ‘I don’t know what I want, what I’m supposed to be doing.’ What do they want out of life? We pose that and then we pare it down.”

For Dan M., group therapy helped the most.

“Everyone was going through similar struggles and I found myself belly-laughing during activities for the first time, and going to have lunch with kids,” he said. “[Now], I’m friends with them and we hang out.” •

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