If you (the patient) are in grave physical danger and cannot be treated or maintained safely without immediate medical interventions, the mental health professional who is examining you may arrange for intensive treatment. Treatment in a more intense structured setting may also be required if your symptoms are out of control and danger appears immanent. Inpatient treatment involves twenty-four hour care in a medical or psychiatric facility (e.g., an inpatient hospital setting) designed to treat medical complications and restore weight, as well as provide limited therapy.
If you are uncooperative with treatment recommendations and doctors feel that your life is in jeopardy unless you receive intensive intervention immediately, you may be admitted to the hospital against your will in a process known as "involuntary commitment". If you continue to refuse food and nutritional supplements while in the hospital, you may need tube intravenous (I.V.) feedings in order to save your life. Though hospitalization may be involuntary, it does not typically last for long periods of time. The goal of hospitalization is to physically stabilize you, and prevent serious medical complications and death. Insurance companies cover the cost of brief admissions to the hospital only when medically indicated, and justified by qualified physicians.
Sometimes, when you need more support than can be offered through outpatient therapy but less supervision than an inpatient program, you may be advised to attend a partial hospitalization or day treatment program. Although there are few partial and day treatment programs designed specifically for those with eating disorders, these programs are becoming more popular as a alternative to the very high cost of inpatient programs. When attending one of these programs, you attend treatment at a hospital or clinic several days per week for a few hours each day. You will not sleep at the hospital, however, but return to your home in the evening.
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Residential facilities offer 24-hour care to patients who may not be in acute medical danger but who continue to engage in eating disordered behaviors and as a result need intensive support to continue functioning on a daily basis. For example, people who use binging, self-induced vomiting, laxative abuse, compulsive exercise, and restricted eating and who don't have serious medical problems (yet), and who cannot stop these behaviors without intensive supervision, may be recommended for residential treatment. These programs generally offer specialized treatment, including supervision of behaviors and daily living activities, while still providing patients with opportunities for increasing responsibility for their own recovery. Such programs are often located in medical hospitals or exist on campus-like grounds, estates, or renovated houses. It is rare that insurance companies offer residential benefits to their customers. Often, you and your family must pay "out-of-pocket" (on your own, without insurance benefits) for residential care.
In some circumstances, you may live in a halfway or recovery house, which provide support and relapse prevention within a less structured setting than a typical residential program. These programs offer transitional situations (e.g., between hospital and regular environments) where residents can live with others who are also in recovery. Residents attend group therapy and recovery meetings, and participate in individual therapy either as part of the house program or with an outside therapist. Residents of recovery houses are typically generally free from the worst behavioral, physical and medical eating disorder symptoms and are working toward living in the community again.
Typically, care progresses along a pattern from immediate, life saving interventions in a hospital setting, to partial or residential programs and intensive therapy, to less frequent outpatient therapy sessions. As you gain physical and emotional health (or if your treatment started at a less severe stage), you will then transition to a recovery program or to outpatient services while living at home again. As needed, you may return to more intensive levels of care if your symptoms resurface or you feel out of control once again.