Riggs’ Admission Waiting List: What is it and how does it work?



Eric Plakun, MD, DLFAPA, FACPsychby Eric Plakun, MD, DLFAPA, FACPsych

In admissions we are often asked by referrers, prospective patients and their families what the “waiting list” for admission to Riggs is all about, so it occurred to me it might make sense to explain what it is in a blog post.

The waiting list consists of prospective patients whose clinical situations I have reviewed and decided they are potential candidates for admission. They are waiting for us to schedule the several hour face-to-face admission consultation during which we make the actual determination about whether to offer admission—and admission is offered about 90% of the time in the admission consultation. 

Because of the open setting and our focus on intensive psychodynamic therapy, we need to be sure a patient seems like a reasonable candidate before moving to the admission consultation, which usually occurs on the day of admission. Does their history of suicide suggest they could be workable in a setting in which they are expected to take responsibility for keeping themselves alive? Have they been able to remain abstinent from substance use that may be confounding their treatment? Is there a complicating medical or pain related condition we need to understand more fully so we can treat it at Riggs? Are they interested in treatment or just passively going along with someone else’s suggestion? Does a different form of treatment other than ours seem like it should be tried first? We also try to ensure that funding is in place to support the minimum 6-week initial phase of evaluation and treatment—either through insurance or personal resources—before putting someone on the waiting list. 

We have been managing a waiting list for over a decade and find the length of the list to be quite variable. Sometimes the wait has been a couple of months because we have learned to limit admissions to 2 or 3 patients weekly in order to help them acclimate to the open setting and community and to help us to get to know them. At other times, like now, the list shrinks to just a week or so. As Director of Admissions, I prefer a shorter rather than longer list. I dislike asking prospective patients to wait because I understand that they are genuinely struggling. All of us in admissions want to offer admission as soon as we can. And I worry that long delays force patients to go elsewhere, or that clinicians and treatment centers that make frequent referrals to us will come to feel we are always full and unable to respond to their patient’s need in a timely way. However, as a therapist at Riggs for over 35 years, I also value some short period of waiting during which a patient can sustain substance abstinence or demonstrate some capacity to refrain from acting on suicidal or self-destructive impulses. This can give them a running start once they get to Riggs.

The waiting list is managed strictly on a first come, first served basis. I long ago realized I lacked the wisdom of Solomon that would be required to determine who was more in need than someone else. And I have learned over the years what most in the field know—that VIP treatment that makes exceptions and bends the rules is usually worse treatment, not better treatment. So, with three exceptions, everyone waits their turn. Here are the exceptions, which together account for about 5-10% of our annual admissions:

  • Former patients, who may have had to move to a locked setting for a period, or may have tried and failed at outpatient treatment, move to the top of the list.
  • Prospective patients who are college students at Williams, Bennington or Dartmouth—the only schools with which we have negotiated this specific arrangement so far—get their admission “fast tracked” and move to the top of the list in the hope they can be admitted quickly enough to use a limited period of medical leave optimally.
  • If a prospective patient suddenly cancels their admission consultation on short notice, we will offer that admission consultation slot to the next patient who can make travel arrangements in time to get here for it—even if they are not next on the list. 

It’s important to me, personally, that the waiting list operates with what I intend to be transparency and integrity.