Levels of Mental Health Care: Inpatient, Residential, Partial Hospitalization, Intensive Outpatient, Group Therapy, and Individual Therapy

Levels of Mental Health Care: Inpatient, Residential, Partial Hospitalization, Intensive Outpatient, Group Therapy, and Individual Therapy

Understanding the different levels of mental health care can make all the difference in whether or not you receive proper treatment, or how quickly you recover from an episode of depression, anxiety, eating disorder, or substance abuse. Although mental health disorders are very common in the United States, many people don’t know how to get help until it’s too late. Recognizing the different levels of mental health care can help you figure out what level of care your situation warrants so that you can get the help you need as quickly as possible.

Inpatient hospitalization
If you are reporting that you are a danger to yourself or others or that you are in an immediate psychiatric crisis, you may be admitted to an inpatient hospital program. Inpatient facilities are meant to stabilize people who may be a danger to themselves or others or may need brief medication stabilization to prevent themselves from acting on acute disturbing symptoms (for example brief supervision during an escalating manic episode where someone may know they are about to behave in ways they do not want to behave). People who are admitted to an inpatient program are monitored closely because they might be at higher risk for suicide or harming themselves. Inpatient treatment typically lasts no longer than a few days. Many people confuse inpatient facility admittance as a route to treating severe, long-standing problems. Inpatient facilities are not designed for these purposes and serve more as crisis centers that keep people safe briefly and triage them to an appropriate treatment level following hospitalization.

Residential mental health centers
If you have a mental health condition that’s severe enough to keep you from working or functioning normally in your daily life, residential mental health centers are where you might go. Residential centers tend to provide long-term care for severe symptoms with a greater degree of comfort and more established treatment programs than inpatient centers. They often feel much more like a ‘resort’ or a hotel to clients though they include overnight supervision and assistance to a lesser degree than inpatient centers. Many residential centers are designed to improve daily living skills over time and progressively have residents engage in more self-care at the facility. For example, over time the resident may be asked to take on more responsibilities for caring for their own room (e.g., bringing one’s laundry to be washed). Residential treatment centers are often targeted toward addressing a specific problem (e.g., substance abuse, anxiety disorders, eating disorders, etc.).

Partial Hospitalization
This is a modified form of hospitalization that allows patients to receive treatment while still maintaining their independence. Patients may be required to attend partial hospitalization on a daily basis for several hours (or half-days) or an afternoon each week. To qualify for partial hospitalization, patients must be diagnosed with a mental illness; have problems living independently; maintain an adequate level of medical care; demonstrate motivation to seek treatment; and agree to abide by facility rules. Partial hospitalization programs also vary significantly in their focus on treating specific problems versus focusing on re-integration and coping skills. Many people with specific severe disorders (e.g., anxiety disorders, eating disorders, etc.) do not experience significant benefits from attending general partial hospitalization programs that focus on coping and life skills but benefit from specialized partial hospitalization programs. You will often need a clinician to advocate with your insurance with regard for your need to attend a specialized program as frequently these programs may be reimbursed by insurance but not accept insurance directly.

Intensive Outpatient (IOP)
IOP, like partial hospitalization (PHP; Day Treatment), is often used as a stepping stone between inpatient care and individual therapy. IOP patients attend sessions on a part-time basis (usually three to five days per week). Sessions are typically two-to-three hours long, and they may be held at an outpatient clinic or at a location that’s convenient for patients who live nearby. The frequency of treatment allows people to maintain their work schedule while continuing to receive support from their therapist. It also gives them time for self-care activities such as exercise or housework. It’s important to note that like partial hospitalization programs, if you have a type of severe symptoms (rather than general issues with coping) you may need to seek out a specialized IOP program that addresses those issues. You may also need to advocate for your insurance to reimburse you for these services as many specialized IOP centers do not accept insurance directly.

Group Therapy
This form of therapy is designed to address issues within a group setting. The level of interaction between clients differs from group to group, but overall it’s an opportunity for others to support you through your own personal journey with mental health care.

Individual Therapy
An individual therapy session is one on one with a mental or behavioral health professional. These sessions are appropriate when you are able to continue to complete therapeutic assignments independently between sessions or when you are simply looking for support from a clinician briefly.
Check out our other articles to understand the differences between different types of clinicians and what types of therapies they offer.
 

Contamination OCD in Adolescents: Treatment with Acceptance and Commitment Therapy

Contamination OCD in Adolescents: Treatment with Acceptance and Commitment Therapy

Obsessive-Compulsive Disorder (OCD) describes a condition in which an individual has uncontrollable thoughts and/or behaviors (i.e., compulsions) that are problematic on an ongoing basis (National Institute of Mental Health), and these symptoms can be experienced by adults as well as children and adolescents. Common treatments for OCD involve exposure therapy, which is sometimes combined with a selective-serotonin reuptake inhibitor (SSRI) medication (International OCD Foundation). However, recent advances in treatment for OCD are now including Acceptance and Commitment Therapy (ACT), which is a form of therapy that encourages individuals to accept unwanted thoughts without judgment, separate themselves from their thoughts, engage in activities that move the individual toward life values, and mindfulness (see contextualscience.org/act for more information). Although there is growing evidence for ACT as a component of treatment for OCD, the majority of these studies have been conducted with adults. Therefore, Armstrong and colleagues (2013) evaluated the effects of ACT for three adolescents (ages 12-13 years old) diagnosed with OCD.

Participants in this study reported fears about contamination and dying which were linked to problematic behaviors such as excessive hand washing, frequent reassurance-seeking, and lengthy bedtime routines. Treatment occurred weekly over the course of 8 weeks and involved a variety of components. A few examples of treatment components were 1) identifying differences between obsessions and compulsions; 2) drawing activities; 3) education about and activities surrounding the futility of fighting thoughts; 4) identifying life values; 5) accepting unwanted thoughts; and 6) mindfulness. Each treatment session was 50 min and included related homework assignments. The results of this study showed that self-reported compulsions decreased by 40%, and these effects were maintained at a 3-month follow up, and treatment was rated as highly acceptable by participants as well as their parents.

Armstong, A. B., Morrison, K. L., & Twohig, M. P. (2013). A preliminary investigation of acceptance and commitment therapy for adolescent obsessive-compulsive disorder. Journal of Cognitive Psychotherapy, 27, 175-190.