Austen Riggs Center: Fostering Self-Direction through Understanding and Connection

Riggs was founded over 100 years ago, and it has had all that time in human nature to develop its program. It's located in a small, friendly town on Main Street, and it's a community that patients can be a part of and participate in at the same time as they're carrying out their treatment.

So, what's unique about Riggs is us having the time and resources to slow down and really take the time to look at the root of people's troubles, not go for quick fixes, but instead to understand what kept people stuck, and then also to take time to help them get better. And the system of step-down programs at Riggs, in combination with four times a week individual psychotherapy with a doctor on our staff, is really set up to help somebody take that time and make those adaptations in an environment that is supportive and nurturing.

Many of our patients come to Riggs taking a large number of medications. Medications are useful for reducing symptoms, but they also have meaning. Sometimes patients rely on medications not so much for their biological effect, but for their meaning. And sometimes, a large number of medications can actually get in the way of a patient gaining perspective on their life. We work on both sides of the patient's problem, the biological and the psychological. It's easy enough to separate biological and psychological into two different domains, but of course, they really exist on a continuum, and we focus on both the ends of that continuum, but also on the middle to try to describe and understand, in part, what makes a person who they are.

The Austen Riggs Center really looks at each individual to see if this would be a good fit. Commonly, we see patients with maybe co-occurring mood and personality disorders, perhaps a history of substance use, often in the form of self-medicating their mental health issues, but someone who's motivated for treatment, who has found that other treatments just really haven't been enough for them.

At Austen Riggs, when a patient is admitted, they are assigned to a nursing care coordinator who stays with them over the course of their treatment. So, the opportunity to get to know somebody and work with somebody over a long period of time, that's definitely a different experience as a nurse here at Austen Riggs.

All patients start at the Inn, in the Inn Residential care with a 24-hour nursing available and all the supports there when the patients need it. When they are ready to move towards more independence, we have the outer programs where patients both work on living independently and also work on certain other tasks. And then when they're finally ready to move out of Riggs more into the community, we have Day Treatment Program and Aftercare, so they live off campus but still come to Riggs for services.

In our open setting, patients are free to come and go. There's no seclusion, no restrictions. Their safety is the product of a negotiation between them and their treatment team. The patients take increasing authority in their own lives, and they also develop a language for understanding the struggles that they came with. This helps them to make more coherent decisions regarding the direction of their life, and that is part of the process here at Riggs.

Riggs is really different in a lot of ways. One is the open setting. It's to be in treatment at a hospital, and yet have the freedom to walk down the street and get an ice cream cone, or go get dinner with a friend, or take a walk. And this is, I think, a really radical difference from most lock units, which is where I was before Riggs. You can't tell who the doctors are and who the patients are, or who the nurses are and who the patients are. That sense of we're all sort of in this togetherness is really different than in any other place I've been to.

As you might imagine, people do ask us, "How do we know that this investment in our family member, in ourselves, is going to have an actual impact?" So, we have done a careful follow-along study to answer that question. We have found that a large number of our patients, maybe greater than 85%, have experienced an increase in resilience, an increase in reasons for living, a decrease in suicidal ideation, and a decrease in emotional pain and anguish.

Because we have the ability to work with people over a long period of time, we see the ways that the treatment has ebbs and flows, and so I do see people get better, feel better, understand things about their troubles, what brought them here, and find ways to tolerate sometimes what feels intolerable.

One thing that makes me excited about this place is the opportunity to slow down and do deep transformative work. Another aspect of it is the community is really vibrant, and that's both patients and staff.

At Riggs, we take seriously the idea that psychological struggle, mental illness, is pervasive in all of us. Some may have more trouble than others, but we all deserve the respect that being part of the human condition confers upon us. We talk about the nature of our work. We write it up, we publish it. We are carrying the mission that patients be treated with respect. We help patients take charge of their lives, and we help them try to emerge from the dangerous stigma that can be laid on psychiatric illness by all of us, really. But we learn from our patients to try to convey the kind of respect and appreciation for the human struggles that we all grapple with.

(Note: No current patients or family members appear in this video. To protect privacy rights, these roles are portrayed by actors.)