Understanding Levels of Care in Mental Health Treatment

When a person seeks information about treatment for themselves or their loved one, the importance of connecting them with the appropriate level of care right from the start cannot be overstated. In mental health, the term “level of care” refers to the range of available psychiatric services varying in frequency, intensity, and duration. Often, the person calling needs to be made aware they have options because the levels of care that many callers have familiarity with are only outpatient and inpatient. Understanding the range of services between the lowest and highest levels can make a difference in one’s treatment journey. 

Inpatient Hospitalization 

Inpatient units are for individuals who are actively suicidal or experiencing a psychiatric (i.e. psychotic or manic) episode that poses a safety risk to themselves or others. The primary goals of inpatient treatment are safety and stabilization. For this reason, inpatient units are monitored 24 hours per day in a secure unit and are in a hospital or treatment facility. The typical inpatient stay is short, ranging from 3 -7 days on average, though some stays can be extended for significantly longer based on psychiatric and safety needs. 

Residential Treatment 

Like inpatient facilities, residential programs are also well-monitored but significantly less restrictive than inpatient. Critical differences from inpatient include the length of the program, the setting, and the treatment goals. Typically, residential treatment is long-term, with the average length of stay ranging from 30 days to 90 days or longer, depending on the program. In residential treatment, patients participate in group therapy, individual therapy, and individualized psychiatric care in a community like environment. In addition to working on personal treatment goals, residents learn the value of being part of a therapeutic community and improving interpersonal skills before returning to their home environment. 

Partial Hospitalization Program (PHP) 

Following discharge from a residential program, participating in a partial hospitalization program is often recommended, which typically meets several days a week for 6-8 hours. For patients discharged from residential care, a PHP program is less intensive than an inpatient or residential program but does not require an overnight stay in the hospital. Treatment interventions typically include individual and group therapy along with medication management.  

Intensive Outpatient Therapy (IOP) 

Intensive outpatient programs incorporate group and individual therapy 3 hours per day and meet three to five days a week. IOP is a good option for those who would still benefit from a structured treatment program while having the flexibility to work or attend school part-time and maintain daily routines. On average, the duration of an intensive outpatient program ranges from eight to 12 weeks but is variable and determined based on individual needs. 

Outpatient Therapy 

Outpatient therapy is considered the lowest level of care. It typically involves meeting with a therapist and psychiatrist for individual therapy and/or medication management weekly for 45-50 minutes in an office, clinic, or hospital. It is essential to understand that while traditional outpatient therapy is the level of care most people are familiar with, a higher level of care is sometimes needed based on the individual’s needs and level of functionality. Outpatient therapy can be intensified in frequency or duration of sessions but is still a fundamentally lower level of care than IOP. 

Provider and Patient Collaboration 

Determining the appropriate level of care at the beginning of treatment may save individuals in need precious time and valuable resources. In my clinical experience, I have worked with many patients who carry shame about their lack of treatment success, which they consider their failure when, when in fact, they were not receiving the level of care needed. Sometimes, clinicians confuse inpatient hospitalization with residential treatment and partial hospitalization programs with intensive outpatient programs. While there are similarities, it is essential to remember that what separates them is the intensity, duration, treatment goals, and environment. 

In addition to determining the appropriate level of care for a patient, it is also essential to continue to assess throughout treatment to determine whether a patient would benefit from a higher level of care or may benefit from additional outpatient services such as group therapy or a twelve-step program. Communication is vital in helping patients feel confident and cared for on their road to recovery. 

Questions: 

1. If a patient is currently in a residential program and becomes actively suicidal, what level of care would be the most appropriate for this patient? 
2. What are the main differences between a PHP and an IOP? 
3. Why is it important to educate patients and families about all levels of care?