[crumpet]

I'm really sorry to hear you are going through a painful and difficult situation, only compounded by not having health insurance. This topic is sort of a specialty of mine so I'll give you my best input and hope it helps. Keep in mind some things may vary by state but for the most part what I can tell you will apply to most places.

First of all, even with insurance, inpatient treatment is only covered for acute cases and is intended to be short term, usually no more than a few days. The days of residential care at Shady Acres Recovery Center are pretty much over. To meet the criteria for acute inpatient care there needs to be evidence of imminent danger to self or others due to mental illness. What this means is if a person is not admitted right now there is a strong possibility of suicide attempt or other dangerous behavior (such as violence related to a psychotic episode). The inability to care for self or allow care by others is another part of the criteria. This would refer to someone who is unable to bathe, who is soiling themselves, not eating for an extended period of time. A schizophrenic wandering the interstate in August wearing a fur coat and snow boots would be a good example of this. Admission criteria for inpatient does not refer to a person not functioning at their optimal level or even just feeling really down. They have to demonstrate that there is no lower level of care that could meet the patient's needs safely and adequately. Lower level/less restrictive levels of care refers to not only outpatient (which may occur once or even twice per week depending on symptomatology and can include individual/family/group therapies) but also to partial hospitalization which generally consists of 3-5 hours per day approximately three days per week at the facility. It is not atypical for there to be a step down process where if a person is admitted they are discharged to a lower level of care as soon as they are stable (not well or cured, just stable). They may go to partial for a week or a few weeks then move to regular outpatient care. Your relationship with your provider is one of the most crucial elements in successful treatment. The psychiatrist relationship is not as important as the therapist relationship/connection because you don't see them as often (starting weekly then quickly moving to monthly or quarterly once a good med regimen is established). Of course it is important that they know medicines really well but the bedside manner/relationship is most important with the therapsit. In other words, you may have a great doctor who is very skilled with meds but don't dispair if he isn't warm and fuzzy with you as long as you feel he is competent. That doesn't mean he should be rude or dismissive, of course. Many doctors do not do therapy anymore and their focus is on med management. Some do not even have extensive training in talk therapy.

As far as substance abuse goes inpatient admissions are usually only approved for detox of substances where there is a risk of death or injury from withdrawal. Alcohol and meds like Xanax fall into this category. Withdrwal from opiates, cocaine, and most other drugs do not . Inpatient detox is still a short stay admission usually lasting about 3 days (although it varies).

As far as funding goes: if you lack insurance and other $$ resources, you will need to contact your local Community Services Board. That is your local/county mental health clinic. Sometimes there are funds allowed for indigent people but with the economy many agencies have had layoffs and much funding has been slashed (that's a whole other talk show). It is good that you ask the facilities themselves what your options might be. Inpatient care is ungodly expensive. It is also my understanding that there is not a great statistical difference in the success of treatment in outpatient vs. inpatient care.

Good luck and please keep us posted on how things are going for you.