"The first private rehab, the Betty Ford clinic, was designed to give people a sense of anonymity, but now you might as well issue a press release."

But, as many Australians can testify, rehab is far from a deluxe retreat or relaxing holiday. More and more people in this country are choosing - or are forced - to face their demons by checking out of real life for a while and checking into a residential psychiatric facility.

In 2004-05, there were almost 200,000 admissions to hospital for mental disorders, the Australian Institute of Health and Welfare says.

Of these, three-quarters of patients were placed in a psychiatric ward of a general hospital, 7 per cent were sent to one of 20 dedicated public psychiatric hospitals and 19.2 per cent were lucky enough to be able to afford a private facility.

For those with cash to burn, the Sanctuary in Byron Bay is the most luxurious rehab in Australia. Run by former heroin addict Michael Goldberg, it costs up to $28,000 a week. Patients have an army of therapists at their disposal, from yoga teachers to personal chefs, fitness coaches, psychologists and chauffeurs. Naomi Campbell was rumoured to have made a visit last year.

The US has always led the way in rehab, spearheaded by the celebrated Betty Ford Centre, the clinic for alcohol and drug dependency set up by the former US first lady in 1982, and the Meadows in Arizona, which has treated celebrities including Elle Macpherson, Moss, Williams, Mike Tyson, Whitney Houston, Amber Valletta and Donatella Versace.

Patients spend the first seven to 10 days drying out from their poison of choice, supported by medication to curb the terrible withdrawal symptoms when necessary.

Those with non-substance addictions - such as gambling, shopping and sex - are removed from the temptation of pokies, department stores and brothels.

Then a team of doctors, therapists and counsellors endeavours to uncover the unresolved emotional issues that drive the addictive or compulsive behaviour, whether they derive from childhood experience, marital problems or are a crutch used to mask

underlying depression and anxiety disorders. In Australia, this treatment model is offered in various forms by 26 private hospitals, such as South Pacific Private at Curl Curl, the Sydney Clinic at Bronte and Northside at Greenwich.

Each charges about $600 a night and patients stay between three and seven weeks before graduating to day "step-down" programs, which can continue for months.

When the gossip magazines breathlessly announce that yet another celebrity is going into rehab, it sounds as if it is as easy as going to a day spa or getting a top-up of Botox.

But Dr Ben Teoh, consultant psychiatrist and specialist in addiction medicine at South Pacific, says that, despite the idyllic beachside location, the facility is definitely not a spa.

"It is a fully recognised hospital and it's run like a hospital," he says. "It's not just a seaside resort."

The 34 patients share sparse but functional rooms. They must make their own beds and, aside from the nightly news, all media is banned. Every minute of the day is accounted for, starting with a supervised walk along the beach at 7.10am, and ending at lights out at 11pm. Recent patients include surf champion Tom Carroll, who was admitted this year for an unspecified condition.

Teoh says patients must be fully committed to the program, which includes compulsory attendance at lectures on relationships, mindfulness workshops and alcoholics anonymous or narcotics anonymous meetings where appropriate.

"The person has to be ready to change, otherwise you can have the best service but it's not going to make any difference," he says.

Former South Pacific patient Cath Dombroski, 42, credits rehab for saving her life, but she is the first to admit it's a hard slog.

Battling severe depression and anorexia when she checked into South Pacific in 1999, she says the seven-week stint was the first step on a long and harrowing journey of self-healing.

Even though it gave her the courage to confront her father about the years of sexual abuse he inflicted on her and her older sister, her lowest moments came after therapy.

"People expect you to go into rehab and come out all fixed, all better, but that's not how it works," she says.

Intensive psychotherapy, exploring how childhood experiences determine beliefs and behaviour as an adult, began to build her fragile self-esteem.

It also forced her to relive her horrific childhood in which her father would come into her bedroom and do "the thing" to her "every opportunity he got".

Food had been an issue since before puberty, so the symptoms of her eating disorder were treated by a team of dietitians, psychiatrists and counsellors.

The unresolved emotional issues underlying her anorexia were gradually peeled away through group and individual therapy, exposing her deep-seated fears that she was a bad mother and unlovable.

"Being able to walk around crying for no reason in particular and nobody judging you or telling you to get over it is very powerful," she says.

Over the next few years, Dombroski took her father to court in her native New Zealand where he pleaded guilty and was jailed. She also survived two more suicide attempts and found herself back in rehab two more times.

She eventually separated from her husband, though they successfully co-parent their two children, aged 13 and 11.

Dombroski is adamant rehab is the best thing she has ever done.

"It's very painful, it's very confronting, it's hard being honest with yourself about things you've done but it's definitely worth it," she says.

IN THE Australian mental health survey, about one in four people with a substance abuse problem was found to have a comorbid mental illness, but experts believe the rate could be as high as 80 per cent.

Addiction specialists say best-practice rehabilitation is to identify and treat substance abuse and comorbid mental health problems simultaneously.

For those who can afford it, a private rehab centre is usually the best option, says Jamie Houlahan, clinical nurse consultant at St Vincent's Hospital, Darlinghurst.

But for those without private health insurance the various services on offer can be a battle to negotiate. It's Houlahan's job to find a suitable place for patients who come through the emergency department.

As well as hospitals, there's the hotchpotch of 234 government-operated community and residential mental health facilities nationwide.

"There are lots of people trying to get into these places and we try to place them according to their needs - their life skills - but of course it's also dictated by their socio-economic status," he says.

At the other end of the rehab spectrum from the Sanctuary is Odyssey House at Campbelltown in Sydney's south-west, one of Australia's largest residential facilities and based on the US model of a "therapeutic community". The 100 patients and their families learn to live together in a functional society for up to 12 months.

A contribution towards the cost of treatment comes out of Centrelink benefits and James Pitts says the rest of the funding is a mix of federal and state grants as well as fund-raising to make up the annual $500,000 budget shortfall.

He says fewer than 1 per cent of patients have a tertiary education and the bulk have poor work histories and a limited education, so, as well as addressing psychiatric disorders, basic skills such as cooking and gardening are taught."It's a very different scene to $25,000 a month and private rooms - here they do manual labour," he says.

Dr Sam Roberts is a consultant psychiatrist at the Sydney Clinic, Northside, and also for the NSW prison system. He says the problem in the public sector is the artificial distinction between drug and alcohol services, and psychiatric services.

He says the lack of integration between the two specialties means patients are constantly shifted between the two, with substance abusers not allowed in psychiatric facilities and underlying mental illnesses not addressed in detox facilities.

"In Rozelle Hospital the drug and alcohol ward is run by a psychiatrist but it won't accept people with significant mental illness so they are referred to another ward where the psychiatrist might not have alcohol and drug training," he says.

The NSW Government says there has been a "dramatic improvement in the availability and quality of drug treatment services" since the 1999 Drug Summit and 2003 Alcohol Summit.

The Drug and Alcohol Plan 2006-2010 lists the establishment of comorbidity liaison teams, comprising a GP, a mental health specialist and a drug and alcohol specialist, which aim to ensure better identification, referral and treatment of clients with a comorbidity.

Residential rehabilitation treatment services have been expanded through the provision of an additional 62 beds, it says.

But all those who work in the rehab field agree the cost of providing best-practice treatment means it is the most ill and the most acute who take up the resources of the public system, leaving the for-profit facilities to cater for the growing number of wealthy Australians who find they are unable to cope.

Lynne Fishwick, chief executive of the South Pacific Private and a former executive in business finance, says she has come across several people from her former life who have checked in as patients, including her anaesthetist and a teenage girl who attended the same private school as her daughter.

Fishwick says the constant stream of high-profile people heading to rehab doesn't trivialise the process but legitimises it.

"It makes people realise that everybody has problems, even those people we idolise," Fishwick says.

"It helps the average man on the street to know it's OK to reach out for help because there are so many people out there who are struggling."

But even for those with money to pay for private rehab, there is no guarantee of a happy ending. As Teoh of South Pacific says: "Rehab is just the first step. That's the easy part. The hard part is to get well, and remain well."

Dombroski agrees that rehab is a step-by-step process that lasts a lifetime.

"When I first came out, people looked down on me and judged me because I was changing and I conflicted with people who expected me to go back to being the old Cathy," she says.

"Before, I was desperate for people to love me. I'd do anything, be anything you wanted me to be.

"Now my attitude is: this is who I am - take it or forget it. My life is not perfect but I'm very happy and without [rehab], I would not be here."

CELEBS IN REHAB

In Australia

* The Sanctuary, Byron Bay, NSW.

$28,000 a week.

CLIENTS: Naomi Campbell.

* South Pacific Private, Curl Curl, Sydney.

$20,000 for five-week stay.

CLIENTS: Surfer Tom Carroll; former model Lorraine Pritchard, wife of prominent barrister Alexander Shand, QC.

* The Sydney Clinic, Bronte, Sydney.

$600 per day.

CLIENTS: Nicole Kidman's brother-in-law Angus Hawley; former Supreme Court judge Jeff Shaw, QC.

Overseas

* The Meadows, Wickenburg, Arizona.

$160,000 a month or $4700 to $5300 a night.

CLIENTS: Elle Macpherson; Kate Moss; Robbie Williams; Mike Tyson; Whitney Houston, Amber Valletta; Donatella Versace.

* The Priory Hospital, North London.

$37,000 a month.

CLIENTS: Pete Doherty; Ronnie Wood; Kate Moss.

* Betty Ford Centre, Palm Springs, California.

$27,000 a month.

CLIENTS: Billy Joel; Mary Tyler Moore; Johnny Cash; Anna Nicole Smith; Elizabeth Taylor, Ozzy Osbourne; Keith Urban.

* Crossroads Centre, Antigua, West Indies.

$22,500 for 29 days.

CLIENTS: Britney Spears.

Source: Sun Herald