What level of care/support is right for me?
Weekly talk therapy is what most people think of when they hear the word “therapy.” It’s a well-known and popular type of mental health treatment for good reason. It’s versatile and can effectively address a wide range of issues. Whether you’re having relationship problems, trying to manage a mental health condition, or seeking personal growth, talk therapy can help.
Even so, weekly talk therapy isn’t always the right tool for the job. Sometimes, it isn’t enough. Sometimes, it’s too much. Fortunately, it’s not the only option. If you need help with your mental health, there is an entire spectrum of choices to consider. By choosing the right level of care, you’ll avoid frustration and make more progress in your healing journey. Read on to learn more about the different levels of mental health care and which one might be right for you.
What Exactly Is a “Level of Care”?
A level of care is a treatment method that meets your specific needs. It isn’t too much or too little to address the problem you have. It’s just right. Think of it this way: you wouldn’t use a pressure washer to clean a delicate piece of porcelain. You wouldn’t try to saw through a log with a nail file. You wouldn’t go to a surgeon to treat a cold or a primary care doctor to treat a bullet wound. And once-weekly therapy isn’t the right choice for treating a life-threatening mental health crisis.
Both the medical and mental health fields are built on the concept of a continuum of care made up of different “levels,” or intensities, of care. Since there is no single correct level of care for all circumstances, the system has to be flexible and offer multiple options. Medical and mental health care professionals need to be able to move you “up” and “down” a level in the system as your condition worsens or improves.
The right level of care corresponds to the severity of your condition. The highest level of care is what you need when your life is in danger, your health is rapidly deteriorating, or you’re at risk of suffering serious losses—in other words when you’re in crisis. The lowest level of care is what you need when you want to make an improvement in your life but don’t face any immediate risk of harm if you don’t. All of the other levels of care fall somewhere in between.
What Are the Levels of Care for Mental Health?
There is not a hard and fast definition of how many levels of mental health care there are. Not all levels of care are available in all places or to all people. However, it helps to know your options so you can make a more informed choice based on what is available where you live (or online). Different levels of mental health care include:
- Support groups
- “Not-quite-therapy” apps or services
- Individual talk therapy and/or psychiatry
- “À la carte” combinations of care
- Intensive outpatient treatment
- Partial hospitalization or day treatment
- Intensive community-based support services
- Crisis stabilization and other community-based crisis services
- Acute inpatient treatment or psychiatric hospitalization
- Long-term residential or subacute inpatient treatment
- Nursing home treatment or round-the-clock care
In the following sections, we’ll describe each level of care and when it works best. But even after you read our article, we recommend reaching out to a mental health professional or organization to help you determine which level of care is right for you. Your state probably has a mental health information or crisis line you can call. Organizations like the National Alliance on Mental Illness (NAMI) also offer mental health helplines. Still, it will help to know about the options that the people you call will discuss with you. Let’s get started with the lowest levels of care.
When Are Lower Levels of Mental Health Care Enough?
Lower levels of care are appropriate when your symptoms are mild or your concerns are minor. They can be the right choice when you’ve just started experiencing an issue and aren’t sure how bad it is or how long it will last. Lower levels of care are somewhat self-directed and can help you explore and learn more on your own. They can also work when you’ve already received treatment and started to recover, but still need a little bit of help to maintain the improvements you made.
Self-help encompasses anything you can do to improve your mental health without working with a peer or professional. Self-help can take many forms. For example, you might:
- Take a self-paced online course
- Complete a do-it-yourself workbook, or
- Read a book or manual that includes exercises or action steps.
“Self-help” can also include techniques you learn at a workshop that you continue to apply on your own. This level of care is best when your issues don’t interfere too much with your daily life, but you want to feel better or improve your overall quality of life. Self-help can also be a great place to start when an issue is new and you haven’t done anything to address it yet. If the issue responds to self-help alone, that may be all you need. If not, you may need a higher level of care.
Support groups are group meetings led by peers who come together to discuss issues they have in common. These groups are not designed to provide therapy. Instead, they help people share advice, resources, and emotional and social support. Everyone has time to talk about their own experiences and to get feedback from others, usually in a structured way. Support groups you might be able to find in your community include:
- Alcoholics Anonymous (AA) meetings
- Narcotics Anonymous (NA) meetings
- Other “Anonymous” support groups and meetings
- Grief support groups run by local hospices, hospitals, or churchesMental health support groups offered by community counseling agencies or local NAMI chapters
Some people have made significant progress in recovery with the help of support groups alone. However, this is often because they took advantage of additional tools beyond group meetings. For example, people tend to do better in AA and NA when they get a sponsor. People who benefit from NAMI or community mental health support groups often also utilize other peer-run support services or activities. Overall, going to support groups is a good choice when you want more help but aren’t sure if you need formal treatment.
What Level of Care Is Weekly Talk Therapy?
Think of individual talk therapy as the Swiss Army knife of mental health care. It’s a relatively simple tool that offers different methods to address a range of mental health needs. It’s not enough when you’re in a crisis that puts you at immediate risk of harm, but it can be an effective treatment choice for just about anything other than that level of crisis. You can alter the intensity of talk therapy, too, by adjusting how often you go or what kind of therapy method you use.
Weekly talk therapy can be the right fit when you don’t have any symptoms but just want to work on personal growth. It can be the right fit for treating moderate to severe depression or anxiety symptoms. It can help you with relationship problems, work stress, or existential questions. Think of it as the “default” option. You might need a higher or lower level of care, but if you’re not in crisis or at immediate risk of harm, it’s usually a safe place to start your journey.
Group therapy is its own unique modality. It’s not “more” or “less” than individual therapy—it’s just different. While individual talk therapy helps you dive deep into your personal issues, group therapy helps you experience your “self” in dialogue with others. It can help you heal how you feel and see yourself in relationships. The therapist who leads the group helps everyone learn from each other in the moment, through the group process itself.
Group therapy is a preferred format for treating substance use disorders and some other specific conditions. It’s also a great format for providing structured or manual-based therapy methods like Seeking Safety or dialectical behavioral therapy (DBT).
What Are Intermediate Levels of Care?
Intermediate levels of care provide a higher level of care than weekly talk therapy but a lower level of care than hospitalization. They can be a good choice when you are recovering from a crisis or need more structure and support throughout the week.
Intensive outpatient treatment (IOP) programs are a higher level of care than weekly talk therapy, but a less intensive level of care than inpatient treatment or partial hospitalization programs. They focus on group therapy sessions, which are held two to three times each week. Most IOPs also offer individual therapy on a weekly, as-needed, or by-request basis. Other services vary from program to program and may include psychiatry and therapeutic activities. You can usually choose either day or evening groups so you can still work while receiving a higher level of care than you would with individual talk therapy alone.
Because they provide so much structure and support while you’re still dealing with everyday life, IOPs are great at helping you learn how to cope with day-to-day stressors and triggers. While they’re popular for treating substance use disorders, they can also be used to treat mental health conditions. Dialectical behavioral treatment, a popular treatment for borderline personality disorder and other trauma-based conditions, is sometimes offered in an IOP format, for example.
Partial hospitalization or day treatment is one of the highest levels of care you can get outside of a hospital. It gives you nearly the same amount of structure as hospitalization but without the same level of security or oversight. Going to day treatment is like going to school or a job. You spend several hours (often 5-6) at the program each day (usually with weekends off), then go home. The program consists of group and individual therapy along with psychiatric care and a mix of therapeutic activities.
Day treatment programs are often used as step-down care, or care that helps you readjust to life after inpatient treatment. They are the right level of care when you’re ready to be discharged from the hospital but need more than standard outpatient treatment. It can also be a good option if you have a complex condition and need intensive programming to address all aspects of it.
What Are the Highest Levels of Mental Health Care?
Acute inpatient treatment is also known as psychiatric hospitalization and is the highest level of mental health care. It’s designed to help you get through a mental health crisis safely. Inpatient treatment takes you out of stressful life circumstances and places you in a secure environment where you receive psychiatric care around the clock. Inpatient treatment usually consists of a combination of group and individual therapy, medication administration and management, and therapeutic activities. It usually lasts for 3-15 days.
Crisis stabilization units (CSUs) and other community-based crisis services are alternatives to hospitalization for people who are in crisis. You’re a good candidate for a CSU if you want to enter treatment voluntarily and do not pose a medical or behavioral risk that requires you to be treated in a secure facility. Many CSUs cannot admit you for more than 72 hours, and some even have a 24-hour limit for in-facility care. After you are admitted, CSU staff will determine if you need to go to a hospital or can be discharged back home with a referral to outpatient services.
Residential or long-term inpatient treatment is increasingly rare and expensive. It is what inpatient treatment used to be before psychiatric hospitals started specializing in acute care. Residential care is usually only recommended if short-term inpatient treatment doesn’t stabilize you. It consists of the same kinds of activities as acute inpatient treatment, but often on a larger campus that includes outdoor and recreational spaces. This allows the facility to provide more types of therapeutic recreation and rehabilitation. Even though it’s long-term care by definition, most people don’t receive residential treatment for more than 30 to 90 days.
What Are “Step-Down” Levels of Mental Health Care?
In rare cases, you may continue to need an intensive level of care after you no longer meet criteria for acute hospitalization. This can happen when you have a severe psychotic or mood disorder and have not yet been able to fully control your symptoms with medication. It can also happen when you have a combination of severe medical and mental health conditions. In such cases, you may require one of the following types of “step-down” care until your symptoms are more stable.
Intensive community-based support services are the most intensive services you can receive outside of an inpatient facility and are designed for people with severe mental health conditions. Support services like assertive community treatment connect you with clinicians who meet and work with you in the community, where they provide therapy or help you manage activities of daily life. Psychosocial rehabilitation is a support service that helps you regain skills that were negatively impacted or lost during a period of serious mental illness. You typically won’t be offered community-based support services unless you’ve been hospitalized more than once.
Nursing home treatment is sometimes needed when you are unable to function independently even after short- or long-term inpatient treatment. It’s what you need when you have one or more chronic conditions that make it impossible to live safely on your own, even with the help of support services. It’s rare to need this level of care due to a mental health condition alone, even a serious one. It’s more common to need it when you have a combination of chronic, severe psychiatric and medical disorders. Similar, but slightly lower levels of care included assisted living and supported housing, where on-site staff are available to provide medical or mental health help when you need it.
If you’re not in crisis, weekly talk therapy is usually a safe place to start treatment. If you’re in crisis and at risk of harm, you probably need inpatient care. Most other levels of mental health care fall in between these two options.