Public and private rehabs – what’s the difference?
Yesterday Martin Peters, Program Director, joined a panel discussion about addiction treatment in the private and public sectors.
“There’s a huge disparity in the individual’s opportunities, depending on where they grew up. Clients who attend Lanna Rehab and DARA Rehab can, in some instances, be millionaires,” and in contrast people accessing public health care can have fewer resources – education and job opportunities. Many people land somewhere in the middle. This panel focused on Thailand’s health system, but drew on Martin’s international expertise.
So, how do these two sets of groups access and receive treatment differently?
Public compared to private rehab
Every year both the public and private treatment rehabs are kept busy. In Lanna Rehab’s case we have clients from around the world and typically they’ve tried rehab in their own countries before traveling abroad. In some instances they’ve tried public government funded options and we hear both good and bad experiences.
What’s the public healthcare system like for addiction treatment?
Publicly-funded addiction treatment in Thailand is 100% free, it can be court-mandated and often involves a 4-month stay.
Challenges for clinicians include – the large volume of clients (200-300 at any single time between 6-7 clinicians).
Because the majority of clients are there involuntarily, they can be resistant to help.
“The system in Thailand is, in my opinion, quite good compared to some places around the world,” says Martin.
For these individuals, their doctors, therapists, mental health care nurses, social workers and addiction specialists – they say that the circumstances leading up to addiction are really driven by social issues.
Three key social issues contributing to addiction:
1) Toxic relationships – Limited resources and support amongst other confines, can make it unlikely that women will leave their partners. Those partners can be drug-users themselves or commit domestic violence.
In the discussion, Martin Peters pointed out, “both of those examples create situations that are likely to result in a very negative cycle. Sadly, if a person has to return to that kind of relationship, the likelihood of them relapsing is very high.”
2) Lack of opportunity – With lack of education and lack of employment opportunities for people in lower-socioeconomic demographics, the future can feel bleak.
Around the world, governments are addressing these issues differently with publically funded programs, housing or education to support people.
Martin, who previously worked in the public health sector in the United Kingdom for over two decades of his career says, “I am a strong advocate for the public health system. I take a lot of pride in the years I spent there. Helping the masses, raises the standard of care for everyone the world over.”
How do addiction hospitals in Thailand address lack of opportunity?
“One way is by offering vocational training as part of rehab. This means people can leave with a new skill, or a more enhanced skill set,” says Martin.
“With this, they might be able to access a new career, leading to a better position in life. I think it’s wonderful and I applaud the approach. In Thailand many of the people who go to rehab, are younger. From what I’m told they typically are in their early 20s and that is a pivotal point in life. They have several years ahead of them, and if they left school at 13 years old, then this new access to education could completely transform and enhance their future prospects.”
3) Low self-worth – That’s a feeling that can impact anyone – despite socioeconomic advantages or disadvantages. “Rich or poor,” says Martin, “every single person can be subject to low self-worth and that’s tied closely with mental health and can result in addictive behaviour. After clients attend rehab with us at DARA Rehab or Lanna Rehab, they typically report higher self-esteem.”
Other phrases used by clients are ‘being more present’ or ‘experiencing self-love’. Anna attended Lanna Rehab, and is one client who reported a higher self esteem toward the end of her treatment:
How does the public and private rehab sector apply Cognitive Behavioural Therapy (CBT) differently?
CBT is the methodology preferred by both sectors. CBT is science-based, and has well studied and documented results the world over, making it a highly respected method of treatment.
“In the public sector there has to be more group work; because in contrast to private they don’t have the same resources. Our therapists at both our locations have the ability to meet their clients two to three times per week; but in the public sector there would be at best one one-on-one session per week with a client.”
Resources are key
Martin continues, “obviously the more individualised attention you can give to a single person can give them more advantage, but it’s still ultimately up to them to put in the work. As someone who has worked in this sector for just shy of three decades in both the public and private sector, I have a great deal of respect for my peers. I also greatly respect the individuals who overcome addiction – it’s not easy. It takes dedication and it’s ongoing work.”
We applaud anyone taking a step forward in their recovery. If you need support for yourself for your family member, please reach out.