When Penn Medicine Princeton House Behavioral Health first opened its doors in July 1971, the way mental health care was delivered was dramatically different than it is today.
Treatment for behavioral health conditions, such as depression, anxiety, and substance use, typically involved an extended stay in the hospital — normally at least a month — until the patient was well enough to return home.
That was 50 years ago.
Today, individuals not only have access to high-quality inpatient care, but also a full spectrum of evidence-based, intensive outpatient programs specifically designed to meet an individual’s unique needs with the goal of providing treatment in the least intensive, most clinically appropriate setting as soon as possible.
In this Q&A, Marguerite Pedley, PhD, senior vice president at Princeton House, and Peter Thomas, PhD, vice president of outpatient services at Princeton House, reflect on this milestone moment and discuss how treatment for mental health conditions has evolved over the past five decades and how attitudes toward mental illness are changing.
How have attitudes about mental health changed over the past 50 years?
Marguerite Pedley, PhD
Pedley: Stigma around mental health disorders continues to exist, but there seems to be a broader acceptance that everyone struggles from time to time, and everyone needs some level of support at some time. A social media savvy generation is changing the conversation through a generational willingness to discuss mental health and substance use challenges openly.
The language used to talk about mental health conditions is shifting, which can help address stigma. For example, the most recent edition of the manual experts use to diagnose mental health conditions replaces substance abuse disorder with substance use disorder. It is a small, but meaningful difference that takes the judgment out of the language.
Thomas: Today, substance use programs are increasingly focused on harm reduction. For instance, under the harm reduction model, rather than expelling people from support programs if they relapse, there is instead a focus on helping people understand what happened and equipping them with the tools to get back on track. It is more compassionate to try to meet the patient where they are rather than judging where they aren’t.
How has Princeton House grown since it opened in 1971?
Pedley: Princeton House has grown from a single inpatient campus to a comprehensive, acute behavioral healthcare provider with locations throughout Central and Southern New Jersey as well as a Center for Eating Disorders, a dedicated unit in the Emergency Department and a state-of-the-art electroconvulsive therapy suite (to help treat patients with severe major depression or bipolar disorder).
We were one of the first behavioral health care providers in New Jersey to adopt a dual diagnosis model that addresses mental health and substance use disorders concurrently, and we continue to advance that long-standing focus on treating the whole person.
Thomas: As behavioral health care has become more evidence-based and systematic in how it is delivered, Princeton House has expanded to offer more than a dozen specialty programs and tracks to meet unique developmental (child, adolescent, young adult, adult, older adult) diagnostic, and gender-related needs. In essence, we now try to provide the right treatment for the right patient based on these various factors.
Can you tell us more about the specialty programs Princeton House offers?
Peter Thomas, PhD
Thomas: We offer a variety of specialized services for women, including a Women’s Trauma and Addiction track and an Emotion Regulation track. Care is typically rooted in dialectical behavior therapy, which helps patients tolerate distress, regulate emotions, and interact effectively with others. Having services specifically for women promotes feelings of safety and trust, helping women achieve a sense of belonging and realize they aren’t alone. Women have an easier time opening up and connecting in a group setting that is specifically for them.
We also offer a Men’s Program to provide men who have experienced traumatic events in their lives a safe and trust-filled environment to share their experiences, learn from one another, and recover. It’s becoming more common for the signs of past trauma in men to emerge later in life as depression, anxiety, anger, frustration, chronic fatigue, and physical ailments. Too often, men view these signs as weakness, but the Men’s Program helps to change their perspective.
Our Older Adult Program was one of the first specialty programs to be established at Princeton House. Older adults typically experience different life challenges than younger adults — for instance the death of a spouse or loved one, and loss of independence — so it makes sense to have a program specifically tailored for their care.
Pedley: Princeton House was also the first in New Jersey to provide specific inpatient addiction treatment and mental health services to address the unique needs of first responders. Given the nature of their jobs, first responders face constant exposure to tragedy and stress, which can transcend into problems like post-traumatic stress disorder and substance abuse.
Princeton House celebrates 50 years during a unique time in health care. How have you seen the COVID-19 pandemic affect people’s mental health?
Pedley: The pandemic both challenged us and presented unique opportunities. It turned what was already a national crisis of access and equity into a virtual tsunami of need. For example, at Princeton House, inpatient and outpatient divisions rose to the occasion, inventing novel ways to deliver care safely. A telehealth program was designed and implemented by our outpatient team within two weeks of the state lockdown.
Thomas: Children out of in-person school, people being isolated, financial challenges, and family members becoming ill and perhaps dying are all factors that can take a toll on mental health. Studies have shown that stress and anxiety increased during the pandemic, but society is unlikely to fully understand the mental health fallout for months and even years.
In response, telehealth therapy has been a valuable resource for so many. For example, since March 2020, our virtual intensive outpatient program provided more than 125,000 telehealth visits. This pathway to care is one that will continue, and hopefully will continue to provide more access to patients.
Mental health care is incredibly important, and the pandemic is a stark reminder of this. People should seek help if they need it for navigating any challenges that still lie ahead.