Levels of Mental Health Care
Not all mental health care is created equal. Our industry is designed to assess the client’s current level of functioning, and then meet their needs at that level. If you are wondering what care level is right for you, think about your daily functioning capacity.
Functioning means your ability to carry out activities of daily living as well as occupational, emotional, and social domains. Activities of daily living are things like eating, sleeping, bathing, cleaning, managing medications, etc. Occupational, emotional, and social domains are things like maintaining work or education, having social and/or romantic relationships, interacting with others appropriately, effectively managing emotions, handling setbacks and difficulties, etc.
Are you unable to go a few hours to a day without using substances or wanting to act on suicidal ideation? You need the highest levels of care.
Are you able to work, love, and play, but would like to learn how to better handle anger and conflict? You’d be well suited for the lowest level of care.
What levels of care are available?
Outpatient: You can find me here! This is the lowest level and provides the most independence for the client. This is where you would meet an individual therapist (like me), couples therapist, family therapist, etc. You visit them at their office or via telehealth for one hour, and schedule weekly appointments at most. This is well suited for clients who are high functioning but need support and guidance.
Self-help group: These groups are not run by a therapist, but instead by a group of peers who are sharing in the same experiences. Examples would include Alcoholics or Narcotics Anonymous, or grief & loss support. You may attend as often or as little as you like. Attendance is limited to those directly experiencing the issue at hand. The goal is to gain community and fellowship as well as emotional support.
Support group: These groups are run by a therapist who has not necessarily experienced what the group members are struggling with, but has clinical training in group support. These groups may be structured with a set number of sessions. You may be able to start and stop at any time, or you may have to wait for another round to open before you join. Example topics may be cancer, infertility, weight loss, etc. The goal is to gain emotional support, camaraderie and bonding, and therapeutic coping skills.
Group therapy: This is a structured therapeutic environment run by a licensed therapist. The group will have a goal to engage with a certain mental health issue or modality, such as managing depression, learning Dialectical Behavior Therapy, or preventing relapse in addiction. Group members have permission to give one another appropriate feedback, and you will be expected to share openly. Similar to support groups, you may be able to start and stop at any time, or you may have to wait for another round to open before you join. Some clients go to group and individual therapy at the same time.
Intensive outpatient program (IOP): This is an all-in-one treatment program that includes group, individual, and psychiatric appointments housed in the same place. Clients will see an individual therapist, have group therapy multiple times a week, see an on-site psychiatrist, and may attend other sessions such as art or music therapy, life skills groups, and support groups. IOPs are frequently designed to treat substance abuse, but can be effective for an array of mental health concerns. The time commitment is designed so that the client can maintain a mostly normal routine; you might attend the program 2-3 days a week for a few hours at a time.
Partial hospitalization program (PHP): This is similar to what you may find in an IOP, but there are notable differences. This is typically the last step taken to avoid completely hospitalizing a client. The time commitment looks more like 4-5 days a week for 7-9 hours a day. You will attend individual and group therapy more often, see your psychiatrist more frequently, and have more supervision from staff. This is ideal for the client who is lower in their functioning and stability levels.
Inpatient: This means you do not leave the facility at the end of the day and come back - you are sleeping here. Inpatient is like taking everything included in a PHP and adding on the overnight aspect. You will have 24/7 monitoring just as you would in any medical hospital setting. Your stay may be as brief as 1-7 days, or 21-30 days. Sometimes your symptom severity determines the length of your stay, and sometimes your insurance company determines how long of a stay they will pay for.
Can I be held against my will? 72-hour psychiatric holds do exist, but laws vary by state and are quite complex. An in-depth explanation is beyond the scope of this blog post.
Residential: This is similar to what you will find at the inpatient level. You will receive individual therapy, group therapy, support and life skills groups, psychiatric and medical care, and 24/7 supervision. Residential will feel more “home like” instead of like a hospital. If the program is designed for youth, classrooms may even be present. The biggest difference is your length of stay. Residential stays can be anywhere from 3-9 months. They may also include their own step-down level where you transition to community housing but continue to attend their mental health programming.
Detoxification: This is an acute level of care for substance abuse clients only. This applies when a person cannot safely stop the use of a substance without going into potentially fatal withdrawal on their own. This will take place in a medically supervised setting and usually takes one week or less depending on severity. It is important to note that a client is typically expected to enter residential, inpatient, or another higher level of care immediately after finishing detoxification.
It is important to note that this is not an absolute comprehensive list. There are levels that include screening and intake (before you enter any level of treatment at all), levels that include some community engagement while maintaining program participation, acute emergency situations, and more. These levels are broad entry points and are the most common and most applicable.
What questions do you have about levels of mental health care?
