Mental health treatment is not limited to choosing between a weekly therapy appointment and psychiatric hospitalization.
There are several levels of care between those two points, including Intensive Outpatient Programs (IOP) and Partial Hospitalization Programs (PHP). These programs are designed for people who need more structure and clinical support than traditional outpatient treatment can provide while still receiving care in an outpatient setting.
For patients and families, one of the more difficult questions is knowing when the current treatment plan is no longer enough.
A change in level of care does not necessarily mean that treatment has failed. Mental health needs can change over time. Symptoms may become more severe, everyday functioning may decline, or someone may simply need more frequent support for a period of time.
The goal is to match the intensity of treatment to what the individual needs now.
When outpatient mental health treatment may no longer be enough
Traditional outpatient therapy can be highly effective for many mental health conditions. For someone who is generally able to maintain day-to-day responsibilities and remain stable between appointments, regularly scheduled therapy and psychiatric care may provide an appropriate level of support.
There are times, however, when symptoms begin to exceed what can reasonably be addressed through periodic appointments alone.
The National Institute of Mental Health recommends considering not only the presence of mental health symptoms, but also how significantly those symptoms are affecting everyday life. Difficulty completing normal tasks, persistent changes in sleep or appetite, problems concentrating, loss of interest in usual activities, and increasingly severe or distressing symptoms are all reasons to seek professional help.
Some signs that it may be appropriate to discuss a higher level of care include:
- Depression, anxiety, mood instability, trauma-related symptoms, or other mental health concerns that are becoming more severe or more difficult to manage.
- Increasing difficulty going to work, maintaining relationships, managing household responsibilities, or completing basic daily activities.
- Frequent episodes of emotional distress or repeated crises between outpatient appointments.
- Significant withdrawal from friends, family, work, or normal activities.
- Symptoms that continue to worsen despite participating in outpatient treatment.
- Difficulty using coping strategies independently outside of therapy.
- A recent psychiatric hospitalization or emergency evaluation followed by a need for continued structured treatment.
- A treatment team that believes more frequent therapeutic contact, psychiatric support, or structure is clinically necessary.
These signs do not automatically mean that someone needs PHP, IOP, or hospitalization. They are reasons to have a more detailed conversation with a qualified behavioral health professional.
The appropriate level of care should be determined through clinical assessment rather than by a diagnosis alone.
Daily functioning matters
One of the most important things to consider is how much a person’s mental health symptoms are interfering with everyday life.
Two people may have the same diagnosis but require very different levels of treatment.
For example, one person with depression may continue working, caring for themselves, maintaining relationships, and responding well to weekly outpatient therapy. Another person with the same diagnosis may be missing work repeatedly, sleeping much of the day, isolating from others, struggling with basic responsibilities, and experiencing progressively worsening symptoms.
The diagnosis may be the same. The level of functional impairment is not.
NIMH notes that mental health conditions such as depression can affect sleeping, eating, working, concentration, decision-making, relationships, and the ability to meet normal responsibilities.
This is why determining the right level of care requires looking beyond a diagnosis or symptom checklist.
Clinicians need to understand how the person is actually functioning.
What is a Partial Hospitalization Program?
A Partial Hospitalization Program, commonly called PHP, is an intensive and structured form of outpatient behavioral healthcare.
CMS defines partial hospitalization as an organized intensive treatment program that provides less than 24-hour care. Medicare describes PHP as an alternative to inpatient psychiatric care that is more intensive than the treatment typically received in a physician’s or therapist’s office.
Patients generally participate in treatment during the day and return home afterward.
A mental health PHP may include services such as group psychotherapy, individual clinical support, psychiatric services, medication management, nursing services, psychoeducation, coping-skills development, treatment planning, and discharge planning. The exact structure varies by program and according to the individual’s treatment plan.
PHP may be appropriate for someone who needs significant structure and frequent therapeutic intervention but can safely remain in the community outside program hours.
It can also serve as a transition from inpatient psychiatric hospitalization when someone no longer requires 24-hour care but still needs substantial clinical support before returning to traditional outpatient treatment.
At Falcon Behavioral Services, our adult mental health PHP in Virginia Beach is designed for adults who need more support than weekly outpatient therapy but do not require inpatient hospitalization.
What is an Intensive Outpatient Program?
An Intensive Outpatient Program, or IOP, is another structured outpatient level of behavioral healthcare.
IOP generally provides more treatment than traditional weekly outpatient therapy but less intensity than PHP.
Medicare describes intensive outpatient treatment as a level of care between traditional once-weekly therapy or counseling and partial hospitalization or inpatient psychiatric treatment. Services may include individual and group psychotherapy, mental health education, and medication management.
IOP can be appropriate for individuals who need regular structured treatment but do not require the frequency or intensity of a PHP.
It may also be used as a step-down level of care as someone progresses through treatment and requires less clinical structure.
The distinction between outpatient therapy, IOP, and PHP is not simply the number of hours someone attends treatment. The appropriate program also depends on symptom severity, functioning, safety, treatment goals, and overall clinical needs.
When hospitalization or emergency care may be necessary
PHP and IOP are outpatient services. They are not substitutes for emergency or inpatient psychiatric care when a person cannot safely be managed in an outpatient setting.
If someone is in immediate danger or experiencing a medical emergency, call 911 or go to the nearest emergency department.
If someone is experiencing suicidal thoughts, a mental health crisis, severe emotional distress, or another behavioral health crisis, the 988 Suicide & Crisis Lifeline is available 24 hours a day by calling or texting 988. SAMHSA states that 988 connects people with trained crisis counselors who can provide support and help connect callers with additional resources when needed.
Families should not delay emergency evaluation while waiting for an outpatient PHP or IOP assessment when there is an immediate safety concern.
How a clinical assessment helps determine the right level of care
It can be tempting to try to determine the appropriate level of care based on a list of symptoms found online.
In practice, level-of-care decisions require considerably more information.
A clinical assessment may consider the person’s current symptoms, severity and duration of those symptoms, safety concerns, daily functioning, psychiatric and medical history, current medications, previous treatment, response to treatment, substance use, available support system, living environment, and ability to participate safely and meaningfully in a structured outpatient program.
The assessment also gives the patient and family an opportunity to ask questions.
What is happening now?
Have the symptoms or level of functioning changed?
Which treatments or supports have already been tried?
How much support does the person need between appointments?
Can the individual safely return home after treatment each day?
What treatment environment gives the person the best opportunity to stabilize and make progress?
Those questions matter more than simply asking whether someone has a particular diagnosis.
Moving to a higher level of care is not a failure
Patients sometimes view the recommendation for more intensive treatment as evidence that they have failed.
Families may feel the same way.
That is not a useful way to think about levels of behavioral healthcare.
Treatment needs change.
Someone recovering from surgery may temporarily need physical therapy several times per week before transitioning to a less intensive schedule. Behavioral healthcare can work similarly. A person may need greater structure during one phase of treatment and considerably less support later.
The objective should be to provide enough treatment to address the individual’s current needs without using a more restrictive level of care than is clinically necessary.
For some people, the appropriate next step may be continuing weekly outpatient therapy. Others may benefit from the additional structure of IOP or PHP. When 24-hour treatment or immediate stabilization is necessary, inpatient or emergency care may be the appropriate level of care.
The appropriate level can also change as the individual improves.
Mental health PHP in Virginia Beach
Falcon Behavioral Services provides structured adult mental health Partial Hospitalization Program treatment in Virginia Beach, Virginia.
Our PHP is designed for adults who need more support than traditional outpatient therapy but do not require 24-hour inpatient hospitalization. Treatment is individualized and delivered within a structured, multidisciplinary behavioral health environment.
Patients may come to PHP after a psychiatric hospitalization, following a referral from an outpatient provider, or when worsening symptoms indicate that their current level of treatment may no longer provide enough support.
Every admission begins with an assessment to determine whether Falcon’s program is clinically appropriate for the individual’s needs.
Not Sure What Level of Care May Be Appropriate?
You do not have to determine the right level of care on your own. Falcon Behavioral Services can explain our assessment and admissions process and help determine whether our adult mental health PHP may be appropriate for you, someone you care about, or a patient you are referring.
Contact our admissions team to get started.
Prefer to speak with us? Call (757) 340-9485.
Need immediate help?
Falcon Behavioral Services is not an emergency service. If you or someone you know is in immediate danger or experiencing a medical emergency, call 911 or go to the nearest emergency department. For mental health crisis support, call or text 988.