The Long Course of Care

On December 5, 2024, leading experts, clinicians, legal professionals, and advocates attended The Long Course of Care: Interfaces of Multiple Systems and Stakeholders, a remarkable conference hosted by the Center for the Treatment and Study of Neuropsychiatric Disorders in partnership with the Silver Hill Academy for Research and Education (SHARE).
The conference, organized by Rocco Marotta, MD, PhD, and moderated by Sophia Walker, MD, was a day of collaboration, exploration, and hope. The discussions centered around advancing care systems for individuals with severe psychiatric disorders, including residential treatment and accessibility of care.
The Silver Hill Hospital Center for the Treatment and Study of Neuropsychiatric Disorders and Silver Hill Academy for Research and Education (SHARE) announce our upcoming conference, Changing the Narrative of Neuropsychiatric Brain Disease: Rebuilding Lives through Medicine, Treatment, and Personal Relationships.
Onset of Illness: The Changing Face of Severe Psychiatric Illness in the early 21st Century
The conference began with a presentation by Dr. Marotta, highlighting the increasing role of cannabis and stimulants in intensifying symptoms and resistance to interventions, emphasizing the need for innovative approaches to initial treatment.
“Prevention is critical, but so is long-term care. If you’re interfering with development at a critical period, you’re not going to just reverse it by taking a medicine, you must change everything, which is why it can take years to get somebody better.” – Dr. Marotta
Acute ER Psychiatric Hospitalization and “Stabilization” vs. “Appropriate” Treatment
Rocco Marotta, MD, PhD; Amy Swift, MD, Deputy Chief Medical Officer, Silver Hill Hospital; and Ryan Wade, MD, Director of Addiction Services, Silver Hill Hospital
This panel addressed the balance between stabilization and appropriate treatment in acute psychiatric care. The discussion highlighted the growing necessity for extended hospitalization stays and the importance of highly organized, intensive care environments to foster long-term stabilization for patients.
Dr. Wade introduced the Silver Hill Hospital DBT-S Residential program, which focuses on patients who, while no longer requiring acute inpatient care, continue to face challenges of long-lasting psychotic symptoms. He noted the difficulty of managing symptoms in a residential setting, where patients must coexist while still contending with the lingering effects of their conditions.
“We see many cases that don’t fit the traditional model of schizophrenia,” Dr. Wade explained. “Patients often retain much of their social functioning but continue to experience persistent psychotic symptoms that are unresponsive to typical medication management.”
Dr. Swift identified a twofold approach to addressing these challenges. The priority is symptom stabilization, particularly those symptoms that impede the patient’s ability to function. On the acute care unit, the focus is on alleviating paranoia to prepare for the next phase of care. This involves determining whether the patient can transition to a residential setting where they can engage in group therapy and benefit from a structured support system. Such decisions, Dr. Swift emphasized, rely heavily on the judgment of the clinical team and the patient’s ability to thrive in a communal therapeutic environment.
The Critical Role of Sub-Acute Residential Care: Clinical Effectiveness versus Cost/Benefit
Rocco Marotta, MD, PhD; Andrew J. Gerber, MD, PhD; President and Medical Director, Silver Hill Hospital; Donna Anthony, MD, PhD; Director of the Neuropsychiatric Residential Program, Silver Hill Hospital; and Ryan Wade, MD.
This panel highlighted the essential role of maintaining sobriety, adhering to long-term medication regimens, and addressing patients’ tendencies to minimize or deny the severity of their illness—all within a structured, supportive care environment.
Dr. Anthony opened the discussion by sharing insights into the Silver Hill Residential Treatment Program for Neuropsychiatric Disorders, which takes a more generalized approach to expanding access to care for a broader range of individuals. She emphasized that effective residential treatment programs must focus on:
- Diverse Options: Providing a range of therapy programs, settings, and patient-focused features to address varying needs.
- Effective Treatment Outcomes: Reducing relapse rates, relieving symptoms, and ensuring sustainable recovery.
- Collaborative Staff Efforts: Ensuring active staff involvement and strong team communication for comprehensive care.
- Patient Assessment and Discharge Planning: Preparing patients for discharge into environments that support independent growth and long-term stability.
Dr. Gerber furthered the conversation by addressing the critical issue of cost coverage and accessibility for patients and their families. He underscored the importance of mental health advocacy at both state and national levels, calling for a unified effort to pressure insurance companies into providing comprehensive mental health coverage and increasing financial assistance for those in need.
“Access to mental health care shouldn’t depend on financial status,” Dr. Gerber stated, emphasizing that equitable treatment options are crucial for achieving meaningful outcomes for patients and their families.
Legal complications: Personal Autonomy vs. Survival
Laura Brancato, JD
In this session, Ms. Brancato presented the intricate legal challenges families and providers face in psychiatric care. She emphasized the complexity of navigating legal frameworks in cases where personal autonomy conflicts with the need for survival and proper care.
Brancato highlighted the singularity of everyone’s situation, noting that no single legal plan can accommodate the diverse profiles of neurotypical or neurodivergent individuals. While the law is designed to be applied equally, she explained the difficulties that arise when this principle fails to address the nuanced needs of those with psychiatric diagnoses.
Additionally, Brancato provided insights into how individuals with psychiatric conditions can protect themselves from unnecessary guardianship and loss of autonomy. She discussed the legal criteria used to declare someone unfit to make decisions for themselves and the critical importance of balancing protection with respect for personal rights.
Long-Term Residential Programs and Family Involvement
Moderator: Jacqueline Ordoñez, LCSW, Neuropsychiatric Program Social Worker; Panelists: Virgil Stucker; Kristen Weber, MSW, Partners Creating Community; Rachel Stark, Spring Lake Ranch; Amanda Fialk, PhD, LCSW, LICSW, The Dorm
This panel emphasized the importance of family involvement, education, vocational goals, and fostering interpersonal relationships as key factors in patient success.
Virgil Stucker, internationally known for his work in developing long-term programs and family support networks, emphasized the transformative power of therapeutic communities, highlighting their role in fostering environments that help residents achieve and sustain their highest levels of functioning and personal fulfillment. He stressed the importance of structured, supportive settings where individuals can develop the skills, relationships, and confidence needed to thrive both during and after their time in care.
“Together we can create robust communities that foster healing and hope, for the vulnerable, for all of us, for all of the US” – Virgil Stucker
Key Takeaways
The Long Course of Care was a testament to the power of collaboration among clinicians, legal experts, and care advocates. The discussions sparked new ideas and the importance of hope and humanity in the face of complex challenges.