Understanding Levels of Care in Mental Health Treatment

When it comes to seeking mental health treatment, many patients find themselves confused as to what may best fit their needs. There are many factors to consider including acuity of one’s illness/struggles, location, insurance and the specific treatment needs. For example, while mental illness and substance abuse often co-occur, they will likely require different facilities and providers to adequately treat them. Being armed with the correct information can assist in making an informed choice and ensure you are receiving the best quality care. Below are examples of these levels of care, what they entail and how to go about accessing them. 1.Outpatient Counseling

Counseling at the outpatient level is often considered to be the least intensive or restrictive level of care. The patient is likely visiting the practice at a maximum of once weekly for about 50-60 minutes per session.During this time, they will be working on personalized treatment goals, identifying coping strategies and addressing problems they have identified as impacting their quality of life. A variety of mental health diagnoses are addressed at this level and are often done in conjunction with outpatient medication management. Common treatment modalities may include Cognitive Behavioral Therapy (CBT), Mindfulness Based Stress Reduction, Family and Couples Therapy and a variety of others.Exposure Response Prevention (ERP) is an example of a more structured type of outpatient counseling designed to treat OCD. This may include meeting more than once weekly and is specific to each patient. Most insurance plans allow coverage for this level of care under their mental health benefits, though you will likely need to determine if your identified provider is in network. 2.Intensive Outpatient (IOP) While an IOP program is still done at the outpatient level, the intensity of treatment and frequency of meeting are both significantly higher. IOP programs can treat mental health treatment, substance abuse treatment or a combination of both (in a co-occurring specific program). IOP is often done in a group setting, which can range from small (5-10) up to 25+ patients, meeting three or more times weekly. In this setting, patients are identified as being moderately at risk for substance abuse relapse/complications, suicidal thinking and/or significant impact to ability to care for themselves. Working within the group can be especially beneficial in forming peer support, normalizing struggles and understanding that we are never alone in what is ailing us. Depending on the program, the duration of treatment may run up to 8-12 weeks, including individual sessions with the lead therapist and also include family programming. While these are often included in many health coverage plans, it is best to confirm with your coverage provider. While this program may be more costly, the benefits to the patient and their loved ones can be invaluable. These programs tend to be available during both the daytime and evening, which may allow for working patients, parents, etc., to attend to their personal obligations.

3.Partial Hospitalization Program (PHP) This program is very similar to an Intensive Outpatient Program, with the most notable difference being an increase in length and frequency of sessions. PHP often meets 4-5 times per week and lasts a full day. Patients at this level are considered “partially hospitalized”, as they spend their entire day in a treatment center but return home for the evening. At this level, patients are often either transitioning from an inpatient program (“stepping down”) or considered moderately to severely high risk of worsening symptomatology. This program may continue for several weeks, with the patient then transitioning to IOP or OP counseling, depending on their specific needs. 4.Inpatient Hospitalization Hospitalization for behavioral health (BH) is considered necessary when the patient is considered at risk of harm to themselves and/or others. A person can be assessed at any emergency department (ED), not only one with an inpatient mental health unit. If the patient is deemed necessary for admission, the hospital social worker will facilitate the transfer or direct admission, if a BH unit is on site. It is important to know that a patient may be transferred to a hospital somewhat out of the area, depending on bed availability across facilities. In the event of hospitalization for substance abuse, a patient may again present to any ED to access care. If detoxification is required, this may be done on a medical floor, with a potential transfer to a substance abuse inpatient facility once detox is complete. Detox can also be completed at these facilities, depending on their medical history and current condition. The length of stay while inpatient will depend on a variety of factors, most notably the time it takes to be stabilized. Stepping down to one of the levels of care mentioned above is often indicated and beneficial to the patient’s recovery process. 5.Inpatient Substance Abuse Rehabilitation At this level, a patient voluntarily admits themselves for inpatient care lasting around 28 days (this will vary by location, condition and coverage). Patients able to complete detox on site will transition to the inpatient program to begin group and individual therapy. A substance abuse treatment evaluation completed at an outpatient substance abuse treatment site can determine if this level of care is necessary. Patients may also contact the inpatient facility if they suspect detox is needed for a more direct admission. This level of care is often indicated if there is physical and mental dependence on a substance, to the point of one’s life being significantly affected. Area Facilities and Resources: Western Psychiatric Institute and Clinic- (412) 624-1000 Bellefield Clinic- UPMC/WPIC

St. Clair Hospital- (412) 942-4000 Forbes Hospital- (412) 858-2000 UPMC McKeesport- (412) 664-2000

UPMC Center For Eating Disorders- (412) 647-9329 Renfrew Center (Eating Disorders)- (800) 736-3739

Gateway Rehabilitation Center (multiple locations, inpatient site)- 1-800-472-1177 Recovery Centers of America- 844-242-7596

ReSolve Crisis Center- 888-796-8226

Alexis Joy Foundation (perinatal mental health) - (412) 578-5000

By: Maura L. Johnson, LCSW, PMH-C