Treatment Resistance

It’s early on the weekday morning at one of the Anne Sippi Clinic treatment facilities as usual the residents press the snooze alarm, struggle to wake up, and start the day. This may appear commonplace, but for people struggling for the majority of their adult lives with treatment resistant schizophrenia, this is anything but commonplace.

Soon after breakfast and a shower everyone is gathered at the day center, where work schedules are handed out and group rehabilitation begins. It's a crew of 8 perhaps, that starts the process of building chairs and benches, which will soon be on patios at people's homes. The horticulture projects are ongoing as well, in groups of 10. Soon flowers will be delivered, and vegetables ready for harvest. And in the groups, real-life issues are challenged, and education his ongoing. Here at the treatment facilities of The Anne Sippi Clinic it is believed that once genuine successes are experienced and a sense of belonging becomes real, self-esteem begins to be restored and life becomes an adventure once again, rather than a prison sentence.

As Director of Programs for The Anne Sippi Clinic treatment facilities, I understand that the movement toward community-based treatment must be more than merely a philosophical ideal; this important movement back to the community represents an opportunity for a meaningful, productive way of life for the long-term treatment-resistant patient. Having worked with the mentally ill for the past 20 years, I consider the practice of bio-psycho-social treatment no longer just a philosophical concept, today at long last, some of our patients dreams can be realized. Our facilities represent comprehensive treatment environments, where state of the art components of bio-psycho-social treatment are brought together in open, vibrant, and aesthetically pleasing centers.

Alarmingly often, our telephones ring with desperate calls from parents, physicians, hospitals, social workers, case managers and mental health administrators. The message is clear: "My son has been in and out of hospitals for so many years; I've tried everything" or, "My daughter needs help, and nothing seems to work," or "This patient is difficult, this person is impossible." At a time when advances in medical treatment continue, and the institutionalization of the long-term mentally ill fades to a close, it remains true that, even today, very few solutions are provided for people who suffer with treatment resistance. In fact, the choices seem increasingly narrow: acute care or no care. This is the hard road traveled by this unique population. Effective alternatives can occur when treatment teams recognize that everyone comes to therapy with much, much more than just their diagnosis. Every patient we treat is an individual possessing genuine desires and strengths, which must be empowered. With this in mind the treatment team can accomplish more than a simple reduction of positive and negative symptoms. Listening to our clients, and joining with them as they construct and strive to achieve their personal treatment goals is always our focus. This effective therapeutic alliance is the working foundation for real treatment compliance. Emerging from such alliances is a worthy legacy of which we can be proud, especially as we look back and consider all that has been learned, changed, and achieved since the failure of traditional treatment environments.

Inasmuch as we have come to understand the path of the mentally ill person, and as we recognize the need for a professional commitment to change, our growth continues. None of us is immune; we must join forces to contribute to the development of this new therapeutic approach. There is no more urgent a cause in the mental health community.