Levels of Care in Mental HealthCare
Written by: Dr. Kat Harris, PhD, LCP
Many people think of two things when they think of therapy: traditional outpatient therapy, where you meet one-on-one with a therapist, or inpatient therapy where you are admitted to a hospital for safety reasons. However, there are actually several in-between options that may be a good match for your needs depending on the “dose” of treatment you need. The more severe the symptoms and the more impairment the symptoms cause, the more likely a higher level of care will be indicated to best help you get better.
A “Needs Assessment” usually refers to the kind of assessment done by a mental health provider, specifically in higher levels of care, to ascertain the “needs” of an individual seeking services. This assessment will include a recommendation for the level of care indicated for that client depending on a variety of factors including severity, duration, and intensity of symptoms, and level of distress and impairment caused by those symptoms.
An outpatient mental health care provider may recommend a higher level of care for their clients if they are concerned that they need a greater “dose” of therapy, if they are concerned about their client’s safety, if treatment progress is limited or stalled, if there is evidence of a significant deterioration of functioning or increase in symptoms, etc. Higher levels of care may afford greater support, especially outside of normal business hours, access to a diverse interdisciplinary team of professionals, access to community resources, etc. The goal would be to “step down” care back to outpatient services once the client is feeling better.
Levels of Care
Outpatient Treatment: This is the most traditional level of care and will fit most people’s needs. Usually in this setting you see a mental health therapist once or twice a week for between 40-53 minutes or a medication manager (e.g., psychiatrist, primary care physician, nurse practitioner) every few weeks to few months. Examples of outpatient facilities include private practices (groups of providers or providers who work independently), community mental health centers, outpatient behavioral health services through hospitals or healthcare centers, etc. There are also varying degrees of support offered through outpatient centers/resources.
Some facilities are able to offer something sometimes referred to as "wrap-around services." This means that the outpatient facility offers various forms of outpatient services to help support the individual such as traditional therapy, medication management, therapy groups, on-call crisis services, etc.
Intensive Outpatient Programs (IOP): At this level of care, client’s would attend a therapy program anywhere between 3-4 hours a day, sometimes only a few days a week. The therapy program might include group therapy, psychoeducation presentations, meetings with an individual therapist, meetings with a psychiatrist, and an experiential component (e.g., music therapy, art therapy). At this level of care you go home at the end of the day and your participation is voluntary.
Partial Hospital Programs (PHP): This level of care is very similar to an IOP settings (and most of the time client’s start in a PHP and then “step down” to an IOP setting within the same location and program). With this level of care a client might attend anywhere between 5 and 6 hours a day, 5 days a week. At this level of care you go home at the end of the day and your participation is voluntary.
Residential Treatment: This level of care is similar to PHP programming; however, the client’s sleep on a unit in the program and programming might last a little longer throughout the day. At this level of care you don’t go home at the end of the day and your participation is voluntary.
Inpatient/Acute Care: This level of care is reserved for situations where a client’s symptoms are severe enough that the person’s safety or ability to function are at risk, and therefore the person needs to be closely monitored. This might also include situations where a client needs to make drastic changes to their medications and therefore need to be monitored closely. This is a short-term treatment, and the person is usually “stepped down” to a PHP/IOP program as soon as possible. At this level of care you don’t go home at the end of the day and a person's ability to end treatment is sometimes partially determined by the attending physicians.
It's also important to note, that specialized services (e.g., addiction services) might have an even more diverse range of levels of care services.