Why Isn’t Outpatient Treatment Working?
Written by Elizabeth Castrellón.
As a clinical social worker, I have worked with many patients and families who ask why their outpatient treatment is not working. Is it that the psychiatrist/therapist is incompetent? Is their family member simply “not trying hard enough?” Often, the answer to this question is that the symptoms of the person receiving care are too severe for the level of care that they are engaging with.
The problem is that the people with the most information about the patient, the family, do not always know or understand the different levels of care available to help their loved one. Therefore, their experience is one of helplessness and hopelessness.
We explore the different levels of psychiatric care available in the United States that may help families navigating these difficult situations. Unfortunately, not all the programs described below are available in every part of the country. We hope this post is a mini “guide” to understanding different levels of mental health care.
Outpatient Level of Care
This is the level of care most people are familiar with. A patient may go see their psychiatrist a few times per month for medication management. The patient may also go see a therapist (for some patients this may be their psychiatrist) once a week or more depending on their symptoms and overall goals. If a person going into outpatient care has severe symptoms, the providers involved may choose to increase the frequency of visits. If this is not effective, it may be time to consider a higher level of care.
Intensive Outpatient Program (IOP)
In general, an IOP is three days out of the week for at least three hours per day. The programs can vary, possibly being more days and more hours. These programs will focus on group work to help the patient develop additional skills to manage their symptoms. The IOP can include medication management services, although not always.
Partial Hospitalization Program (PHP) or “Day Treatment”
These types of programs are five days out of the week for six to eight hours per day. The program will focus on group work and forming a patient community, as well as psychiatric care. A PHP is normally more days than an IOP and will include psychiatric assessment and care. At this point in their care, patients, their families, and their providers have identified that treatment needs to be the primary focus rather than work or other family responsibilities.