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Exploring Mental Health

Summer Solstice 2026

A Day in the Life: Inside a High Acuity Mental Health Treatment Center on a Farm

By Annie Boyle, LPC

Imagine waking up to the sound of roosters crowing, the smell of fresh hay and grass, and the sight of open fields and trees stretching to the horizon. This is daily life at Hopewell, where clinical care and communal living blend into a therapeutic model that is both structured and restorative.

Morning Meds and Community Breakfast

The day begins early, with residents rising around 7:00 a.m. Morning medication is taken under the supervision of staff, followed by a communal breakfast in the main dining room. Meals often include eggs gathered from the farm’s hens or vegetables from the garden. Beyond nourishment, breakfast doubles as a chance for residents to review the schedule and plan their days.

Chores as Therapeutic Interventions

After breakfast, residents head to morning work crews. On the farm, chores are more than tasks—they are therapeutic interventions. Residents might feed goats and horses, collect eggs, tend to the garden, or help maintain shared spaces. For individuals coping with intense symptoms, the rhythm of farm work offers grounding. Caring for animals fosters responsibility and connection, while repetitive tasks like weeding or sweeping reduce anxiety and open space for mindfulness. By late morning, the community gathers for a community meeting, checking in as a group before lunch. Lunch is then shared by staff and residents. Meals are crafted to provide both nourishment and practice for social skills, gently supported by staff who model communication and encourage connection.

Structure Therapeutic Programming

Midday brings structured group programming. In group settings, residents can utilize the support of the community to engage in development of useful skills and understanding. Some sessions are led by licensed clinicians and focus on evidence-based practices such as Acceptance and Commitment Therapy (ACT), Exposure and Response Prevention (ERP), and Cognitive Behavioral Therapy (CBT). Other groups focus on practical skills. A life skills workshop might cover budgeting or cooking, while expressive arts sessions invite residents to paint, write, or engage in music under the guidance of art and music therapists. Movement is also woven into the program: yoga, nature walks in the woods, or equine-assisted therapy with horses that mirror human emotions and require patience, calm presence, and consistency.

Individual Therapy and Psychiatric Appointments

Between groups, residents attend individual therapy and psychiatric appointments. In sessions, residents are supported in identifying and engaging restorative practices that benefit their overall recovery journey. This might look like creating an exposure hierarchy and being supported in utilizing it on the farm, engaging in EMDR (Eye Movement Desensitization and Reprocessing), zooming in on interpersonal effectiveness, or being given a space to grieve and experience their emotions without judgement. Because the program is high acuity, psychiatrists are closely involved in resident care, adjusting medications as needed and collaborating as a treatment team. This level of oversight provides a safety net that outpatient settings cannot always offer.

Building Self-Connection

Throughout the day, residents also have opportunities for reflection. Some journal under a shady tree, others rest in their rooms, fish in the pond, or hike in the woods. Staff encourage quiet moments as an essential part of the therapeutic process, recognizing that recovery is not only about activity but also about tolerating stillness and building self-connection.

Communal Dinner and Leisure Time

Dinner is another shared meal, with residents and staff reflecting together on the day. Sometimes there are short outings—to the library, a store, or a nearby park—before the farm settles for the night.

As the sun sets, leisure time begins. Residents might play board games, watch movies, or simply enjoy the calm of the countryside. While staff remain vigilant given the high acuity of the program, the atmosphere remains a hybrid of a therapeutic community and a working farm, where healing is interwoven with the rhythms of daily life. Before bed, medications are distributed and by 10:00 p.m., the farm is quiet, with only the sounds of crickets and animals carrying through the night air.

Structure, Connection and Nature

High acuity care requires intensive support, but here that support is softened by sunlight, fresh air, and community. For individuals in crisis, the combination of structure, connection, and nature offers something rare: the chance to heal in an environment that feels alive, hopeful, and grounded. The farm does not replace therapy—it enhances it, reminding each resident that growth is possible and that, like the nature and animals around them, healing unfolds with patience, care, and time.

Meet Annie Boyle, LPC

Anne Boyle has been with Hopewell since 2022. She holds a Master’s Degree in Clinical Mental Health Counseling from Kent State University. At an organization with several Anns and Annes, she is known as Annie B.

Prior to Hopewell, Annie B. worked for a community based mental health organization providing in-home therapy and case management for adults in Cleveland. She was intrigued when a position opened at Hopewell. “I wanted to work where a higher level of care was needed for severe and chronic mental health issues and I fell in love with Hopewell’s approach to residential treatment,” she said.

”Hopewell is so different from what I learned about residential care in graduate school. We see a resident as a whole person, not a problem to solve in a few days or weeks before discharge. A minimum 4-6 months stay at Hopewell allows for a timeline to address issues that affect a resident’s health and wellbeing. We help them identify what they find meaningful, discover multiple facets for managing their illness, and build a wellness kit with skills that allow them to manage life’s stressors and maintain overall wellbeing and health,” she stated.

Different Approaches to Treatment

“Primarily I use three approaches with residents. Exposure and Response Prevention (ERP) is primarily for Obsessive-Compulsive Disorder (OCD) and most forms of avoidance. Cognitive Behavior Therapy (CBT) is for cognitive restructuring and reframing maladaptive thinking patterns, specifically for someone whose baseline anxiety is high. Acceptance and Commitment Therapy (ACT) is for someone who struggles with accepting the discomfort of life. We also do a lot of work exploring values,” Annie explained.

“What we understand to be profound and meaningful change is not the social standard. Little steps mean a lot. Perhaps it is a resident moving to a slightly less supportive living environment. Someone who moves from Hopewell to the Cleveland Transition Program, where I spend a great deal of time, receives Hopewell support while living more independently. Maybe this person takes everything they have learned and apply it in a lower level of care. Maybe they will get a part-time job. Maybe they will go home and manage their ups and downs. I am deeply moved when I see them advocate for themselves.”

Working With Families

Another part of Annie’s job is working with families to the extent that the resident allows. “I advocate for the resident as I help a family understand what they feel is going on, especially when they struggle to communicate. Even if the residents do not want us to share personal health information (which is their right), I can connect families to resources to deepen their comprehension of the situation and provide support. My approach is more psychoeducation as opposed to family therapy.”

As part of their treatment, staff look at a resident’s support system to determine what they need when they leave Hopewell. For some, wellbeing will include living independently and working, while others will be discharged to a group home or a family environment. Annie stated, “When working with a family, I explain the anticipated prognosis and create a plan for warning signs of decompensation instead of waiting for a crisis.”

What motivates you to work with people with mental illness?

“Having been in my career for four years, what drives me is knowing that I can play a role in someone feeling safe and finding motivation to move forward despite real challenges. I am also very interested in human psychology. There can be hard days and weeks when you work with this population. I learned in graduate school that with traditional therapy, you should see progress at X number of weeks, a model that does not look the same in a residential setting. Instead, you want your client to get to the place that they want to be.”

Life at Home and Future Plans

Annie has two dogs, ages 4 and 8. She said, “If I have a difficult day at work, we emotionally regulate together. I do a lot of home improvement projects on an Amish home with 3 acres that I bought with no electricity, heating, or cooling. I value having a support system so a house with a huge kitchen and deck allows us to hang out together. I enjoy using my hands and I do a lot of yard work. Breaking down a wall or making an art piece are great stress relievers.”

Annie’s longer-term plans include gaining her independent social work licensure. She is also pursuing continuing education about OCD, which she is very passionate about. This summer, she plans to go to Gatlinburg with her friends and family – a welcome period of rest and relaxation.

Thank you, Annie B., for everything you do for Hopewell!

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