I’ve driven from house to house to house daily, since 2004, supporting clients and families fighting for their mental health and substance use recovery. We’ve worked with countless dozens who’ve spent hundreds of thousands of dollars on treatment, have endured year-after-year hospitalizations and psychiatric holds, only to end up back home or back at their parent’s homes unwell, using, and often hopeless. When many of our clients or families call, they are out of money or out of hope, or both. This is where our work begins.
We recently started working with a family who’d spent 90 thousand dollars, desperately, on another treatment program. Only to have limited communication with their daughter and two days notice of her discharge back to her home. They voiced anger and frustration at the glossy brochures, the convincing sales reps, the promises of healing, only to end up where they started, but with less money and less hope. In working to coordinate care and obtain clinical collateral, I didn’t hear anything about discharge planning or aftercare support, but blame aimed at the client and the family.
Depending on the population and diagnosis, a significant percentage of people relapse within the first 30 days after treatment. By six months, many estimates land north of 50 percent. Within a year, the majority of people leaving substance use or mental health treatment will struggle again in some meaningful way. Engaging websites, smiling business development reps, glossy brochures or not, without a focus on community-integrated support, this is the unfortunate reality that so many face. Until we stop pretending recovery happens in isolation, and start building systems that help people where they actually live, these numbers are unlikely to change.
The “house” that loses, is the treatment center that treats the discharge as the finish line rather than the crux or the crucible, the pivotal moment. The “house” that always wins harkens back to the old days of medicine, where doctors came to your home, to support you in times of need. Before the term “concierge” ever existed, this level of care was the standard. It’s not the easiest work nor the most profitable business model, which is why the rare few do it, but it’s what our clients and families need to inspire hope, courage, dignity. So we march on.
“The House Always Wins” is a lens I’m using to frame how we can do the in-home work we do even better, every day. It’s also an invitation for all of us to look honestly at “the game” we are all playing in this helping profession, and how we can do it better. And it starts with programs understanding the need to prioritize community-integrated, post-discharge support, upon admission.
For more than 20 years, our work has focused almost entirely on this space. The space after treatment. The in-between where the baton is most often dropped. The daily, unglamorous work of coordinated care and continuity. Of micro-interventions, of supporting ADL’s, of medication checks, of recovery monitoring, and family support. Therapeutic coaching in real life, in the trenches, not just in theory.
I’ll be sharing more reflections on this in the coming months.
And one final note; the work that we are all doing is good, and hard. And while we’re all doing our best – let’s keep striving and supporting each other to do even better.