When you or someone you love receives a diagnosis for a mental health disorder, it can come as a shock. That’s true even if you’ve experienced – or they’ve experienced – mental health challenges or shown symptoms associated with a mental health disorder for months or years. When the diagnosis arrives, you may experience a range of emotions, from sadness, to anger, to fear, to everything in between. Those are all common reactions to a clinical diagnosis. Once you get a handle on your emotions, you wonder what to do next. Do you – or they – need inpatient psychiatric treatment, outpatient psychiatric treatment, or something else?
Those are questions about what we call levels of care.
In mental health/psychiatric treatment, the most common levels of care are:
- Outpatient psychiatric treatment
- Intensive outpatient treatment (IOP)
- Partial hospitalization programs (PHP)
- Inpatient psychiatric treatment
- Residential treatment centers (RTC)
Briefly, those levels of care reflect the relative intensity and immersion of the treatment program. We’ll discuss this in detail below, but here’s the thumbnail version: outpatient treatment is the least intense and immersive level of care, while residential treatment is the most intense and immersive level of care. There is a level of care beyond residential treatment called inpatient psychiatric hospitalization which is an emergency level of care for people in crisis who are a threat to themselves or others. We’ll address that level of care in a separate article.
This article focuses on the five levels of care we list above. We’ll start by discussing how treatment professionals arrive at a diagnosis and determine the best course of treatment for the disorder they diagnose.
Choosing a Level of Care: How Do I Know if Inpatient Psychiatric Treatment Will Help?
If you need to find psychiatric treatment for yourself or someone you love, it’s important to understand that determining the appropriate level of care depends on at least three things:
1. The Disorder Itself
Some disorders respond to intensive and immersive treatment, such as inpatient treatment or residential treatment, while others respond to less immersive options, such as outpatient treatment or intensive outpatient treatment (IOIP).
2. The Severity of the Disorder
Treatment professionals assign most mental health diagnoses one of three levels of severity: mild, moderate, and severe. As a general rule, a person with a disorder accompanied by symptoms that are dangerous or extremely disruptive will receive a referral for and intensive and immersive level of care. In contrast, a person whose symptoms are mildly disruptive and/or not dangerous will receive a referral for a less intensive and immersive level of care.
3. Previous Psychiatric Treatment
If you or your loved one has engaged in treatment – without success, remission, or symptom improvement – at the outpatient, intensive outpatient, or partial hospitalization level of care, then they may receive a referral for a more immersive treatment option, such as inpatient treatment or residential treatment.
At this point, we need to offer this disclaimer: this article cannot diagnose you or your loved one, assess the level of severity of a mental health disorder, or make a referral for a level of care. This goal of this article is to give you the information you need to evaluate the options presented to you by a mental health professional.
A mental health professional arrives at a diagnosis and can make a referral for care after a complete biopsychosocial evaluation. Also known as a biopsychosocial assessment, this process allows a clinician to diagnose a patient, determine whether their condition is mild, moderate, or severe, and refer a patient to the level of care the offers the best chance of full recovery.
The Importance of a Quality Assessment and an Accurate Diagnosis
In some cases, patients spend months or years seeking care before they receive an accurate diagnosis. This is not something you want for yourself or a loved one: it can be frustrating, time consuming, and requires financial resources that for most people are not unlimited. In other words, without an accurate diagnosis – which requires a comprehensive evaluation/assessment – you can waste time, money, and gradually lose faith in the treatment system.
That’s why finding a highly regarded treatment center that guarantees a full biopsychosocial assessment is essential. During this type of evaluation, a licensed, qualified clinician collects the following information:
- Biological history, including:
- Full individual medical history
- Family medical history
- Current medical condition
- Psychological history, including:
- Current or previous mental health symptoms
- Current or previous psychiatric medication
- Family mental health history
- Presence/history of trauma
- Current life situation/current stressors
- Social history, including:
- Risk factors: any factors that increase risk of exacerbating mental health symptoms
- Protective factors: any factors that decrease risk of exacerbating mental health symptoms
- School/academic history
- Gender and sexual identity information
- Present level of
Once a professional clinician completes a comprehensive assessment and arrives at an accurate diagnosis, they can recommend a course of treatment that most often includes psychiatric treatment at one of the levels of care we introduced above.
Psychiatric Treatment: Defining the Levels of Care
We’ll now discuss the levels of care, beginning with outpatient treatment. We describe these levels from the least immersive to the most immersive, but will address inpatient psychiatric treatment before residential treatment for reasons we explain below.
Outpatient Psychiatric Treatment
Outpatient psychiatric treatment is the most common point of entry for an individual who needs support for psychiatric, emotional, or behavioral issues. This level of care may be appropriate for individuals with symptoms that do not significantly disrupt their ability to meet the basic responsibilities of daily life/school/work, or create significant disruption in peer, family, or social relationships. Outpatient treatment typically occurs in an office setting, once or twice a week.
Intensive Outpatient Psychiatric Treatment
Treatment programs at this level of care are called intensive outpatient programs, or IOP. At the IOP level of care, patients engage in treatment three to five days a week, for three to five hours each treatment day. IOP programs may be appropriate for individuals with mental health symptoms that disrupt day-to-day life, but are not so severe that they prevent an individual from working, going to school, or living independently or at home with family.
Partial Hospitalization Psychiatric Treatment
Treatment programs at this level of care are called partial hospitalization programs, or PHP. At the PHP level of care, individuals participate in a full day of treatment, five days a week. This level of care may be appropriate for individuals with mental health symptoms that prevent day-to-day participation in work or school, but not do not prevent them from living independently or at home with family. Individuals in PHP programs are intense and immersive, but patients have evenings and weekends free to consolidate treatment gains and spend time with family, friends, or loved ones.
Inpatient Psychiatric Treatment
Treatment programs at this level of care are about safety and stability. In fact, some of these programs are referred to as psychiatric stabilization.
Inpatient psychiatric treatment – psychiatric stabilization – may be appropriate for an individual in crisis and is at imminent risk of harming themselves or others. Individuals at this level of care may have attempted suicide, engaged in suicidal ideation, engaged in or vocalized homicidal ideation, or have a history of drug overdose or non-suicidal self-injury/self-harming behavior. This level of care may be appropriate for individuals who need removal from their immediate surroundings in order to achieve emotional and psychological stability. Intake at this level of care can be voluntary or involuntary, depending on the specific circumstances.
In most cases, this level of care involves the closest and most intense monitoring of all the various levels of care. Individuals live at the treatment facility 24/7 and receive full-time, around the clock supervision. Activity and movement throughout the treatment facility may be completely controlled. Doors between living areas, common areas, eating areas, and treatment areas may be locked for the safety of patients and clinicians.
Inpatient psychiatric treatment typically occurs upon referral from a mental health professional either during or immediately after a mental health crisis. Most stays last between five and ten days, depending on the reason for admission and the severity of the disorder and/or symptoms. The goal of this level of care is safety and stability, rather than treatment and recovery. Therapy, in the traditional sense, happens when a patient is safe and stable and the crisis has passed. When medical staff determines a patient is safe, stable, and ready to engage in additional treatment and recovery activities, the patient is discharged. The most common level of care upon discharge from inpatient psychiatric treatment is residential treatment.
Residential Treatment (RTC)
These programs are less immersive and intensive than inpatient psychiatric treatment. The nature of the intake process tells us why. Patients in crisis most often spend a short period of time in intensive inpatient care before they begin residential treatment.
However, residential treatment – RTC for short, because these programs derive their name from residential treatment centers – is completely intensive and immersive. The focus is on treatment and recovery, as opposed to safety and stability.
The residential level of treatment may be appropriate for individuals with mental health or substance use issues that are disruptive enough to require 24/7 monitoring and care. Patients in residential treatment programs focus on healing. They have therapy, time to learn coping skills, stress management techniques, and other strategies to manage the symptoms of their mental health disorder. Patients in residential treatment live at the treatment facility and engage in therapeutic activities seven days a week. Evenings and weekends may involve recovery homework, organized/supervised outings, guest speakers, or special, recovery-oriented events or activities.
Those are the levels of care you’ll find when researching treatment for mental health disorders. And if you or someone you love receives a diagnosis for a mental health disorder, reading articles like this one is a good first step to take. After you arrange a full clinical evaluation from a qualified treatment professional, of course.
Inpatient Psychiatric Treatment: What it Helps and the Common Therapeutic Modes
Treatment at the inpatient level of care – meaning both inpatient psychiatric treatment and residential treatment – may be appropriate for individuals diagnosed with a wide variety of mental health disorders. Inpatient treatment can help people who receive a clinical diagnosis for:
- Mood disorders, including:
- Major depressive disorder (MDD)
- Bipolar disorder (BD I & BD II)
- Mood disorder + substance use disorder (co-occurring disorders)
- Anxiety disorders, including:
- Generalized anxiety disorder (GAD)
- Social anxiety disorder (SAD)
- Panic disorder (PD)
- Post-traumatic stress disorder (PTSD)
- Personality disorders, including borderline personality disorder (BPD)
- Psychotic disorders, including schizophrenia
- Addiction disorders:
- Non-suicidal self-injury
- Self-harming behavior
- Suicidal ideation/suicidality
- Homicidal ideation (for a patient in crisis in a stabilization program)
We use inpatient treatment in the general sense here. During both inpatient psychiatric treatment programs and residential treatment programs, patients live in the facility, are removed from their home or living situations, and engage in and intense and immersive level of therapy or stabilization all day, every day. They stay in immersive care until their treatment team determines they’ve made sufficient progress to move to a less immersive level of care.
During an inpatient psychiatric treatment program or a residential treatment program, patients may engage in the following therapeutic modes.
Inpatient/Residential Treatment: Common Modes of Therapy
- Individual therapy:
- Group therapy:
- Group DBT
- Group CBT
- Family therapy
- Medication management
- Stages of Change
- Trauma-Informed Care
- Secondary therapies, including:
- Anger management
- Grief/loss therapy
- Life skills
- Motivational enhancement therapy (MET)
- Motivational interviewing (MI)
- Nutritional counseling/healthy eating
- Spirituality groups & counseling
- Specialized alumni programming
- Holistic therapy:
- Yoga
- Mindfulness
- Stress-reduction
- Experiential/expressive therapy:
- Exercise
- Art Therapy
- Dance/movement
- Writing
- Dance
- Drama
- Additional support, including:
- 12-step meetings
- Case management
- Peer support
It’s important to reiterate that inpatient psychiatric stabilization is for patients in crisis right now who are in imminent danger of harming themselves or others. Residential treatment, on the other hand, is technically inpatient treatment, but it’s for patients who are not in crisis and are stable enough to fully engage in a full range of therapeutic activities.
Now let’s get back to the question we pose in the title of this article:
When is inpatient treatment for psychiatric disorders the right choice?
Inpatient Treatment: Crisis or Severe Disorder?
We’ll repeat our disclaimer above.
This article cannot diagnose you or your loved ones or recommend a course of treatment or appropriate level of care.
However, with that said, we can review the facts about these levels of care. This information can help you make an informed decision about treatment options:
Inpatient Psychiatric Stabilization
These programs may be appropriate for patients in crisis who are an imminent danger to themselves or others. This intensive and immersive level of care is about keeping an individual – and the people around them – safe from any behavior associated with a severe mental health disorder. When medical staff determines a patient is safe and has achieved psychiatric stability, they may discharge them to a less immersive level of care.
Residential Treatment Programs (RTCs)
These programs may be appropriate for patients who need time away from their current home or living environment in order to focus on healing and growth. Time in immersive therapy allows these patients to find balance and develop the skills required to return to independent living and full participation and the typical activities of daily life.
The basic takeaway is this. if a patient is in crisis, they may need inpatient psychiatric treatment in a stabilization program. But if a patient is not in immediate crisis and instead needs time in an immersive treatment environment, they may need a residential treatment program.
Both levels of care support people with severe mental health disorders start the road to recovery. Some patients may require inpatient psychiatric treatment to prepare a patient for residential treatment. Others may initiate treatment at the residential level of care.
In both cases – and for any individual with a severe mental health disorder – it’s critical to understand that treatment works. Evidence shows that the sooner and individual who needs treatment gets the treatment they need, the better the outcome.
How to Find Treatment
If you are not in crisis or emergency, you can use the therapist locator maintained by the American Psychological Association (APA) to find support near you. Finally, both the National Institute of Mental Health (NIMH) and the National Alliance on Mental Illness (NAMI) provide and high-quality online resources – including treatment locators – that are available 24/7/365.
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