Types of Mental Health Treatment Settings and Levels of Care
Treatment and care for mental health-related issues is provided in a variety of settings. The environment, and level or type of care, will depend on multiple factors: the nature and severity of the person’s mental condition, their physical health, and the type of treatment prescribed or indicated. The three primary types of treatment settings for receiving mental health care or services are 1) hospital inpatient, 2) residential and 3) outpatient. In addition, some mental health care services are delivered via online and telecommunications technologies.
Hospital inpatient settings involve an overnight or longer stay in a psychiatric hospital or psychiatric unit of a general hospital. The facility can be privately owned or public (government-operated). Inpatient hospitals provide treatment to more severely ill mental health patients, usually for less than 30 days. A person admitted to an inpatient setting might be in the acute phase of a mental illness and need help around the clock. Typically, a person who requires long-term care would be transferred to another facility or a different setting within a psychiatric hospital after 30 days of inpatient treatment.
Psychiatric hospitals treat mental illnesses exclusively, although physicians are available to address medical conditions. A few psychiatric hospitals provide drug and alcohol detoxification as well as inpatient drug and alcohol rehabilitation services and provide longer stays. A psychiatric hospital might have specialty units for eating disorders, geriatric concerns, child and adolescent services, as well as substance abuse services.
General medical and surgical hospitals may have a psychiatric inpatient unit and/or a substance abuse unit, although these units are not very common. They provide medical services that would not be available in a free-standing psychiatric hospital.
Residential mental health treatment environments generally provide longer-term care for individuals. Most residential treatment settings provide medical care but are designed to be more comfortable and less like a hospital ward than inpatient hospitals. Examples:
Psychiatric residential centers are tailored to people with a chronic psychiatric disorder, such as schizophrenia or bipolar disorder, or who have a dual diagnosis (i.e., a mental disorder and substance abuse problems), which impairs their ability to function independently.
Alcohol and drug rehabilitation facilities are inpatient centers that treat addictions and may provide detoxification services. Patients typically reside in this type of facility for 30 days but stays may be individualized according to each facility’s policy.
Nursing homes have psychiatric consultation available as needed.
Outpatient Settings – While there is wide variety in the types of outpatient settings, they all involve office visits with no overnight stay. Some are based in community mental health centers; others are located in general hospitals where individuals visit an outpatient clinic for an appointment. In addition, many individuals in need of mental health counseling or treatment go to private offices to see a mental health clinician who is in solo or group private practice.
Partial hospitalization programs (PHPs), also called “day programs,” refer to outpatient programs that patients attend for six or more hours a day, every day or most days of the week. These programs, which are less intensive than inpatient hospitalization, may focus on psychiatric illnesses and/or substance abuse. They will commonly offer group therapy, educational sessions and individual counseling. A PHP may be part of a hospital's services or a freestanding facility.
Intensive outpatient programs (IOPs) are similar to PHPs, but are only attended for three to four hours and often meet during evening hours to accommodate persons who are working. Most IOPs focus on either substance abuse or mental health issues. IOPs may be part of a hospital’s services or freestanding.
Outpatient Clinics are settings where patients obtain therapy services from a variety of mental health professionals. Depending on the particular clinic, individual therapy, group therapy and medication management may be available.
Community Mental Health Centers – Often referred to as Mental Health and Mental Retardation Centers (MHMR), these clinics treat persons whose incomes fall below a state-determined level.
Practitioners in private practice – Many individuals see a mental health professional in solo or group private practice at the practitioner’s office for mental health treatment/counseling. Appointments may be for individual, group or family therapy. Many practitioners accept insurance payments, but practitioners vary in which insurance plans they will accept; some practitioners accept only personal payment for services.
Telepsychiatry, Telemental Health Services refer to the remote delivery of psychiatric assessment and care, or psychological support and services, via telephone or the Internet using email, online chat or videoconferencing. Most commonly, these services improve access to care for individuals with mental health issues living in remote locations or underserved areas, or who can’t leave home due to illness, emergencies or mobility problems. They also allow clinicians to support their patients or clients between visits.