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.
 

Scrupulosity: When religion and morality become impairing

Scrupulosity: When religion and morality become impairing

Although most people are familiar with Obsessive Compulsive Disorder (OCD)—or at least have a general idea and may even feel that they personally have some OCD tendencies—a lesser known form of OCD exists called scrupulosity. Scrupulosity involves obsessions related to religious or moral ideals which cause an individual to be overly concerned that their actions are sinful or are violating religious or moral doctrine (International OCD Foundation, 2010). This concern is so great that it often leads to excessive praying or trips to confession, repeating rituals involving cleansing and purifying, and avoiding situations where some religious or moral error may occur (IOCDF, 2010). One effective and recommended treatment for scrupulosity is Exposure and Response Prevention (ERP); however, another form of treatment, Acceptance and Commitment Therapy (ACT) was shown to be another effective form of treatment in a recent study by Dehlin, Morrison, and Twohig (2013). Acceptance and Commitment Therapy traditionally involves accepting undesirable thoughts and feelings, reducing the meaning of and attachment to these thoughts and feelings, and working toward acting in a way that fulfills one’s values in life and has been used in the treatment of OCD.

Dehlin and colleagues (2013) evaluated the effects of ACT on scrupulosity with five adults (three females and two males) across eight treatment sessions. In order to measure the effects of treatment, researchers tracked the participants’ compulsive behaviors as well as engagement with valued activities. In addition, researchers had participants complete assessment questionnaires. Treatment sessions were 1-1.5 hours each week and consisted of activities that helped the participants incorporate the core processes of ACT. Participants also completed weekly homework assignments. Throughout treatment, participants learned to accept unwanted thoughts, separate themselves from obsessive thoughts, view the self as a context in which thoughts occur, contact the present moment, and commit to actions in alignment with values. Results of the study showed a 74% reduction in compulsions and a 79% reduction in avoided valued behaviors, and these reductions were maintained during a 3-month follow up. In addition, participants reported high levels of treatment acceptability which, combined with the positive results of treatment, makes this a promising treatment for individuals with scrupulosity.

Dehlin, J. P., Morrison, K. L., & Twohig, M. P. (2013). Acceptance and commitment therapy as a treatment for scrupulosity in obsessive compulsive disorder. Behavior Modification. DOI: 10.1177/0145445512475134

International Obsessive-Compulsive Disorder Foundation (2010). Retrieved from https://iocdf.org/wp-content/uploads/2014/10/IOCDF-Scrupulosity-Fact-Sheet.pdf