Currently trends in
mental health care dictate a step down or step up range of programs based on the needs of the
patient. The idea is to use the “
least restrictive” means of treatment necessary. This is radically different from how things worked in the past. Typically if you needed treatment you went to a state hospital and society forgot about you (think
One Flew Over The Cuckoo’s Nest).
Going from most restrictive to least here are the typical treatment options:
- Inpatient – Inpatient is the typical setting the public thinks of when they think of mental health institutions. It is an inpatient hospital for those with a psychiatric emergency. This is where people go when they are feeling suicidal, homicidal or are showing signs of persistent psychosis. You always have doctors on-call and in the building at all times in order to keep a close eye on patients as new drugs and other treatment options are started. Typically a stay in inpatient is 28 days or less, because that is the maximum that almost all insurers will cover. If someone needs intensive care for longer they will go to the local state mental hospital.
- Residential Treatment Facility – A residential treatment facility is a place where people coming from inpatient go if they need constant quick access to treatment, but have progressed to the point where they no longer need inpatient level of care. This type of facility has a staff psychiatrist who meets weekly to discuss patient progress but does not actually work there full time. It is staffed by therapists, sometimes a nurse, and direct care staff that work with the patients most directly. While patients have a bit more freedom than inpatient, at an RTF there is usually staff within eyesight at all times. The length of stay varies widely from facility to facility, but to use my place of work as an example, the stay is roughly 6-8 months.
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Partial Hospitalization – Partial is the next step down, and is the first step in which a patient is allowed to return home. At partial a patient comes in during work hours and gets intensive group and individual therapy. Typically partial is staffed by a psychiatric resident physican, psychiatric nurses, social workers and a variety of therapists. A typical run through partial is 2 weeks to a month.
- Outpatient – Outpatient, the least restrictive means, is where a patient returns home and usually sees a therapist on a weekly basis and sees their psychiatrist monthly to bimonthly. In order to get to this point the patient must be able to accomplish their ADLs or Activities of Daily Living, which means that they can meet their basic needs of hygiene, meals, etc, and if possible go to work.
I should note that patients could hop up or down this list without going through all of these options. If a doctor feels that a particular patient can go from inpatient to outpatient or residential to outpatient directly than that's what is done. Here again the preference is for the least restrictive means necessary. Also this is not an exhaustive list as new program types are frequently studied and sometimes implamented.