Article | March 2018

Levels of Mental Health Care

The decision to enter treatment for mental health issues can be difficult. Sometimes people seek out treatment on their own. Other times, treatment may be forced upon someone who can't make the choice for themselves.

Treatment begins with a full assessment of mental health and safety concerns. Next, a mental health professional will recommend a type of treatment. The goal is to help the person return to their normal level of functioning.

Outpatient care

Outpatient care can include 12-step programs, therapy, support groups, and partial hospitalization. Learn more:

12-step programs:

  • Are usually community-based and free.
  • Include programs such as Depressed Anonymous, Emotions Anonymous, and the National Alliance on Mental Illness (NAMI).
  • Can help as you work to achieve good, stable mental health.
  • Allow you to connect with other people in recovery.
  • Offer support and strategies for a successful recovery.

Routine outpatient care (ROC):

There are three types of routine outpatient care:

  • Individual counseling. This includes one-on-one sessions with a therapist.
  • Medication evaluation and management. This includes visits with a psychiatrist or nurse practitioner. They can help decide whether medication would be helpful.
  • Group therapy. This includes weekly group sessions with other people with mental health issues. Group therapy allows people to learn from one another’s experiences.

Intensive outpatient program (IOP):*

  • Is a structured treatment that teaches how to manage stress and cope with emotional and behavioral issues.
  • Can include group, individual, and family therapy.
  • Involves frequent visits (usually three to five days per week). Takes about three to four hours of treatment per day. Often lasts four to six weeks.
  • Is structured so patients can continue with their normal daily routines.
  • Provides support from the program and social support from other people in the program.

Partial hospitalization:*

  • Is an intense, structured program.
  • Involves treatment five to seven days per week for six hours each day.
  • Can include group, individual, and family therapy.
  • Often includes an evaluation by a psychiatrist. They may prescribe or adjust medications.
  • Is often recommended for patients who are still struggling after completing lower levels of care.
  • Is helpful for patients who are at risk of hospitalization. Can also work as a step-down for patients who have been hospitalized.

Inpatient care

Inpatient acute care:*

  • Takes place in a hospital setting.
  • Is meant for people who need 24-hour care. Includes daily doctor visits in a hospital setting.
  • Is often recommended for people who aren’t able to care for themselves. Inpatient care is also needed for people who may harm themselves or others.
  • Can last for a few days.
  • Is intended to stabilize a mental health crisis.
  • Includes group therapy. Also includes meetings with a team of professionals, including a psychiatrist.
  • May require a family session to discuss aftercare plans.

Inpatient residential:*

  • Should only be tried when all available outpatient approaches have failed.
  • Is meant to be a short-term placement to stabilize the person.
  • Should take place as close to the person’s home as possible.
  • Is meant for people who don't need medical attention.
  • Is not right for people who are not motivated to change and recover.
  • Offers group, individual, and family therapy. Therapy takes place in a supportive environment.
  • Should include weekly family therapy.

Treatment expectations

Treatment expectations are different for each program and person. Treatment works best when the patient is actively involved. People tend to get better results when they're motivated and committed to working on their mental health issues.

Family dynamics

Having a loved one with mental illness is tough on family members. They may have to take on a caretaking role and advocate for their loved one. They may not fully understand the causes or symptoms of mental illness. It’s common for loved ones to feel depressed or hopeless. They may also try to cope with their feelings in unhealthy ways.

Treatment programs and individual therapy often includes the family. It's important for family members to be educated about mental illness. They can learn new ways of operating within the family. They can discuss the changes within the family, and learn ways to cope better with their loved one's illness.

When to consider a higher level of care

A higher level of care should be considered when the patient:

  • Isn't having his or her needs met by the current level of care.
  • Shows a decreased level of functioning.

If you have questions or concerns about mental health treatment, talk to your doctor or therapist.

Counselor comforts patient during support group meeting

*Authorization of this LOC requires a face-to-face assessment by facility staff who will contact their plan with clinical information and a request for authorization. The plan will then make a determination regarding the appropriate level of care to authorize based on medical necessity guidelines.

This material is provided by Cigna for informational/educational purposes only. It is not medical/clinical advice. Only a health care provider can make a diagnosis or recommend a treatment plan. For more information about your behavioral health benefits, you can call the member services or behavioral health telephone number listed on your health care ID card.