Seeking the proper level of care for suicidal or self-harm thoughts

Making the decision to go to therapy can be a challenging one. Understanding one’s options once making that decision is another challenge, with a lot of factors to consider: What am I looking for in a therapist? Do I want to use insurance? Should I do in person or virtual appointments? What level of care do I need?

Level of care refers to the intensity of treatment needed. In therapy there are 4 different levels, and it is helpful to think about each in terms of safety. As you increase in level of care, safety is of greater concern and therefore, more support is required.

Outpatient: Outpatient treatment is generally conducted in regular therapeutic sessions with a counselor in a private practice setting. The frequency of these sessions can vary from once a week, every other week, or once a month. This level of care is for people who are working through a wide array of presenting problems, which can include self-harm thoughts and/or suicidal thoughts but are able to maintain safety. The suicidal thoughts would be passive thoughts; thoughts about killing oneself, but no plan or intent to act upon those thoughts.

Partial Hospitalization Program (PHP) and Intensive Outpatient Program (IOP): PHP and IOP programs are called day programs as patients do not stay overnight at the facility. These intensive programs include 3-4 hours of therapy a day, 4-5 days a week, for 4-8 weeks. Therapy can take place during normal school/work hours or in the evening, depending on the facility. PHP/IOP programs are intended to help individuals establish stability in their everyday life. The patient benefits from increased support compared to Outpatient treatment, while getting the opportunity to implement coping skills at home. Individuals who are struggling with self-harm urges, both active and passive suicidal thoughts, and are working on stability with their safety are recommended for PHP/IOP programs. PHP/IOP programs are usually in group therapy format, but some programs offer additional individual counseling, family sessions, and medication management as part of the treatment plan.

Inpatient: “Inpatient stay” refers to when an individual attends a program at a hospital or treatment facility for 24-hours a day for an average of 3–10-days. Individuals tend to be referred to inpatient facilities when they are struggling with active suicidal thoughts (patient has a plan and/or intent to carry out the plan) or thoughts of engaging in self-harm and do not feel like they can keep themselves safe. The goal for an inpatient stay is to establish safety. Inpatient programs are usually in group therapy format, have psychiatrists on staff for medication management, and some programs offer additional individual counseling and family sessions as part of the treatment plan.

Residential Treatment: Residential treatment is distinct in its length of treatment and environment. Individuals live full-time at a residential treatment facility for an average of 3-4 months. The patient benefits from relocation from their current environment in the pursuit of making lasting changes in their life. Patients who attend residential treatment programs have usually tried Outpatient, PHP/IOP programs, and inpatient facilities (often multiple times) and still feel like they are struggling to succeed in their average daily living. Once completing these other programs they feel like they easily revert back to old unhealthy habits and struggle to maintain safety. Residential treatment programs are usually in group therapy format, have psychiatrists on staff for medication management, often require the patient partake in individual counseling and family sessions as part of the treatment plan. In addition, Residential Treatment Programs also often offer extracurricular activities such as equine therapy, meditation, art-based activities, etc. to promote new coping skills.

In summary
Outpatient is for maintaining safety and progress
PHP/IOP is for stabilizing safety
Inpatient is for establishing safety
Residential is for removing environmental barriers for safety

*Disclaimer: This blog post is intended for informational purposes only and should not be interpreted as a substitute for professional medical advice. Duration of treatment for each level are professional estimates but may vary by facility.