Therapy Options for Everything from a Crisis to a Small Worry
Talk therapy is popular for a 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.
But weekly talk therapy isn’t always the right level of care. 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 are many levels of care to consider. By choosing the right one, you’ll be much more likely to meet your treatment goals. 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"?
The medical and mental health fields each have 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 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 Mental Health Care?
Like with medical care, the two main levels of mental health care are inpatient and outpatient care. Inpatient care is what you need when you’re in crisis and can’t be safely treated at home. Outpatient care is what you need when your symptoms aren’t severe enough to warrant inpatient care.
When you get inpatient care, you stay in a facility during the day and overnight until your treatment is complete. When you get outpatient care, you go somewhere to get care during the day, then go back home later.
Ultimately, it’s a little more complicated than that, but the first thing clinicans always try to figure out is whether you can get the care you need at an outpatient facility or need to be admitted to the hospital.
Levels of Outpatient and Inpatient Mental Health Care
Most mental health professionals divide the two main levels of care, inpatient and outpatient care, into additional levels and categories.
Common categories of outpatient mental health care include:
- Self-help
- Support groups
- “Not-quite-therapy” apps or services
- Individual talk therapy and/or psychiatry
- “À la carte” combinations of mental health care
- Intensive outpatient treatment programs
- Partial hospitalization or day treatment
- Intensive community-based support services
- Community-based crisis intervention services
Common categories of inpatient mental health care include:
- Crisis stabilization units and other short-term inpatient crisis care
- Acute inpatient treatment (intensive psychiatric hospitalization)
- Subacute inpatient treatment (long-term residential care)
- Nursing home treatment or round-the-clock care
In general, the lowest levels of care are the ones you can get on your own without meeting or working with a professional.
Next are the levels of care where you meet with a professional for a brief appointment (usually an hour) anywhere from once a month to once a week.
Next are intermediate levels of care where you receive services multiple times a week. This often includes multiple group or individual therapy sessions plus other services.
Finally, there are the various levels of inpatient care, where you stay in a facility overnight for anywhere from one night to several months.
In the following sections of this article, we’ll describe each level of mental health care and when it generally works best. However, to truly know which level of care is right for you requires personal evaluation by a mental health professional.
After you read this 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 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 helps to know about the options that the people you call or meet with 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 you’re looking for help with everyday issues that don’t threaten your immediate health or well-being.
Lower levels of care can also 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.
The lowest levels of care are self-directed and can help you explore and learn more on your own. They can also be a good option when you’ve already received treatment and started to recover, but still need a little bit of help to maintain the improvements you’ve made.
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What Is Self-Help?
Self-help is 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.
Self-help can be the right level of care 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, you may not need professional help or peer support. If it doesn’t resolve the issue, you may need a higher level of care.
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What Is a Support Group?
Support groups are group meetings led by peers who come together to discuss issues they have in common.
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 churches
- Mental health support groups offered by community counseling agencies or local NAMI chapters
These groups are not designed to provide therapy. Instead, they help people share advice, resources, and emotional and social support about a particular topic or issue.
Everyone has time to talk about their own experiences and to get feedback from others, usually in a structured way. There may be a leader or group format, but the purpose is always to support members of the group in sharing and learning from one another.
It’s possible to make significant progress in recovery with the help of support groups alone.
However, you usually get better results if you also take 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 groups often make more progress in their recovery when they also utilize other peer-run support services or activities.
Overall, going to support groups is a good choice when you want more help than you can get from self-help alone but aren’t sure if you need formal treatment.
What Level of Care Is Therapy?
Therapy is somewhere in the middle of all the levels of mental health care. Individual talk therapy can address a range of issues and is used in many different mental health settings. It’s often included in higher levels of care like intensive outpatient and inpatient programs. However, it’s best known as a popular form of standalone mental health care.
Therapy alone is all many people need. Weekly individual talk therapy is 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.
Think of individual talk therapy as the Swiss Army knife of mental health care. It’s a relatively simple tool that includes a set of different methods therapists can use to address a range of mental health needs.
Weekly talk therapy can be the right level of care for treating moderate to severe depression or anxiety symptoms. It can be the right fit when you don’t have any symptoms but just want to work on personal growth. It can also help you with relationship problems, work stress, or existential questions—basically anything that’s affecting your mental health.
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.
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What Is Group Therapy?
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.
For more information, you can read our article, “What Is Group Therapy?”
Individual and group therapy are generally considered to be the same level of care. Which one is best for you depends on what you want to address.
Individual therapy is used more widely and is usually easier to find. It’s your standard option when you’re looking for help with mild to moderate mental health concerns. However, group therapy is also common and is favored in certain settings.
Group therapy is a popular option for treating substance use disorders and is also usually part of intensive outpatient and inpatient mental health programs. It’s also a great format for structured or manual-based therapy methods like Seeking Safety or dialectical behavioral therapy (DBT). Many use it as a way to combine therapy with education about mental health topics.
Can You Get Therapy from an App?
The only way to get therapy is to have a live session with a licensed therapist.
So, if an app puts you in live video or voice contact with a licensed therapist for regular hour-long sessions (like our sponsor BetterHelp’s app does), you’re getting therapy from that app.
But if an app offers anything less than that, such as guided exercises or access to a discussion group, it isn’t therapy. That isn’t necessarily a bad thing if you don’t need the level of care therapy provides.
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What Kinds of Mental Health Apps Are There?
You can actually get therapy from some mental health apps that link you with therapists for live video or voice sessions. However, most mental health apps on the market don’t actually provide therapy. Instead, they connect you with some type of digital, interactive self-help or peer support.
“Not-quite-therapy” apps or services come in a variety of forms. Some provide articles, videos, and interactive exercises. Some include guided meditations or audio tracks that can help you calm and ground yourself. Others offer chat windows where you can get live mental health support provided by peers and coaches (rather than licensed therapists).
You can think of these apps as the virtual version of a self-help book or support group. They can be a good choice when your issues aren’t severe and you don’t have time to attend an in-person group or class.
Some platforms connect you with a therapist for messaging-based “therapy” that does not include live video or voice sessions.
Even though you’re working with a licensed therapist, this still isn’t quite therapy, because it isn’t face-to-face. That’s okay if it’s the right level of care and a better fit for your needs.
For example, messaging-based services can work really well when you need help with an issue that isn’t too severe, such as work stress or a relationship conflict. They make it possible to message with your therapist when you’re in the situation you need their help with and to get discreet and immediate assistance with that situation.
What Provides the Same Level of Care as Therapy?
Therapy isn’t the only type of care that can address a wide range of mild to moderate mental health issues. Psychiatry or medication management offers the same level of care as weekly talk therapy.
Like group therapy, psychiatry is not “more” or “less” than individual therapy—it’s just a different type of care. Whether you want or need therapy or medication (or both) depends on your personal preferences and what you’re seeking to treat.
Ultimately, the best way to figure out which one is best for you is to talk to a mental health professional. So, we always recommend that you consult with one to help you decide.
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Should You Get Therapy or Medication?
There are some general rules mental health professionals use to determine whether medication or therapy is best.
Some conditions, like bipolar disorder and psychotic disorders, nearly always require medication to successfully treat.
Some conditions, like most personality disorders, can’t be treated with medication at all (though some symptoms of these disorders can be).
Most depressive or anxiety disorders can be treated with or without medication, and often respond best to a combination of medication and therapy.
For more information, you can read our article, “Therapy vs Medication: Your Decision-Making Guide.” We also strongly recommend consulting with a professional.
“À la carte” combinations of outpatient care can be more effective than talk therapy alone. Many people choose to get both medication and therapy. Taking medication can relieve difficult symptoms and help you get more out of individual or group therapy sessions. Another popular combination is to do both individual and group therapy. Support groups, self-help, and mental health apps can be even more effective when combined with therapy and medication.
Some people who start out combining medication and therapy get to a point where they can maintain their mental health just by taking a maintenance dose of medication. Some people can fully treat their mental health symptoms with medication alone. Others never need it or want it and can recover without it. Some don’t like the side effects or simply prefer therapy. Only you can discover what is right for you.
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.
You go multiple times a week and get more than one kind of service. For example, you might go to group therapy twice a week, individual therapy once a week, and have optional support groups or therapeutic activities you can attend as part of the same intermediate care program.
These kinds of programs can be a good choice when you are recovering from a crisis or need more structure and support throughout the week.
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What Is an Intensive Outpatient Program (IOP)?
A popular intermediate care option for both mental health and substance use disorder treatment is intensive outpatient treatment.
Intensive outpatient (IOP) programs often focus on group therapy sessions, which are usually 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 and follow your normal weekly schedule 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 a great option when you are learning how to cope with day-to-day stressors and triggers.
While they’re popular for treating substance use disorders, IOPs can also be used to treat mental health conditions. For example, dialectical behavioral treatment, a popular treatment for borderline personality disorder and other trauma-based conditions, is sometimes offered in an IOP format.
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What Is Partial Hospitalization or Day Treatment?
Partial hospitalization or day treatment is one of the highest levels of care you can get outside of an inpatient unit.
It gives you nearly the same amount of structure as hospitalization but without the same level of security or oversight. Basically, you go every day, you just don’t stay overnight.
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 is often used as step-down care, or care that helps you readjust to life after inpatient treatment.
It’s 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 or if you’re trying to rebuild your life after a long period of serious illness.
What Is the Highest Level of Mental Health Care?
Acute inpatient treatment, also known as psychiatric hospitalization, is the highest level of mental health care. Its purpose is to help you stabilize severe symptoms and get through a 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. It usually includes group and individual therapy, medication management, and therapeutic activities.
When you get admitted for inpatient mental health treatment, it usually lasts for 3-15 days. You can learn more about it by reading our article, “How Inpatient Mental Health Treatment Works.”
There are a few other kinds of inpatient care as well. Crisis stabilization can be an option if you only need a short stay, while residential treatment can help if you need to be in inpatient care longer.
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What Is a Crisis Stabilization Unit?
Crisis stabilization units (CSUs) are alternatives to hospitalization for people who are in crisis.
Most CSUs are unlocked facilities where you’re able to leave when you feel ready and where you usually only stay a day or two. Most offer medication, therapy, support groups, and other therapeutic activities just like standard inpatient facilities do.
You’re a good candidate for a CSU if you want to volunteer for treatment and don’t present a risk of harm to yourself or others that would require you to be treated in a secure facility. Many CSUs can’t admit you for more than 72 hours. Some are even limited to 24 hours.
After you’re admitted, CSU staff will determine if you need to go to a hospital for additional care or can be discharged back home with a referral to outpatient services.
Residential or long-term inpatient treatment is increasingly rare and expensive. It’s where you go if a few weeks of inpatient care aren’t enough. It’s 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.
Going to a residential treatment facility is a little like going to college. You go live on a campus or in a single building where you take different “classes” and activities until you’re well enough to “graduate.” You learn different skills and habits that can help you manage your condition when you go back home.
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?
“Step-down” is a term mental health professionals use to refer to types and levels of care that are designed to help you transition from inpatient treatment to life in the community.
In rare cases, you may continue to need an intensive level of care after you receive inpatient care and leave the hospital. 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.
Sometimes, you just need to spend a few weeks in an intermediate level of care like day treatment or IOP. That’s why these are sometimes called “step-down care.” Or you may need ongoing specialty and intensive care in addition to therapy and medication to keep you stable while living in the community. These kinds of services are usually called “community-based support services.”
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What Are Community-Based Support Services?
Community-based support services help you readjust to life at home after psychiatric hospitalization or manage severe and complex conditions that can make it hard to live independently without help. Community-based support services can include:
- Assertive community treatment
- Mental health support services
- Psychosocial rehabilitation
These intensive community-based services connect you with clinicians who meet and work with you at your home or in the community, where they provide therapy or help you manage activities of daily life. Their goal is to help you build or regain skills that you lost or that were negatively impacted 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.
In rare cases, you might need nursing home treatment. When you get this level of care, you live in a facility where you can receive around-the-clock medical care and other services you’d normally get in a hospital but where you can also participate in community activities.
Nursing home care is sometimes needed when you are unable to function independently even after short- or long-term inpatient treatment. It’s what you might 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 include assisted living and supported housing, where on-site staff are available to provide medical or mental health help when you need it, but you have your own apartment and can come and go as you please.
Conclusion
The different levels of mental health care make it possible to get just the right kind of care for your situation. There are many treatment options that can address different needs, goals, or symptoms you might have.
One simple rule can help you get started. 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 because of a mental health condition, you probably need inpatient care. Most other levels of mental health care fall in between these two options.
When in doubt, call your state or local crisis line. It’s okay to call even if you’re not sure you’re in crisis. They can help get you to the right place.
Finding the right level of care can keep you from getting “stuck” or frustrated in your recovery. When you know about all of your options, you can tailor your treatment so it’s specifically attuned to you. A combination of methods like group therapy, individual therapy, psychiatric care, support groups, and self-help can often be more effective than a single method alone.
If you’re not sure what level of care you need, it can help to talk to a professional. You can call a local counseling agency or a mental health helpline or hotline to learn about your options and which ones might be right for you.
We hope you can use the information in this article to have an informed conversation with a caring professional who can help you get started on your journey. The sooner you find the right level of care, the sooner you can start getting better and building the life you want to have.