When to Consider a Higher Level of Psychiatric Care
Last updated May 2025 by Dr. Ashli Kurian
Mental health intervention can occur at several levels of intervention. Many people are familiar with the most basic level of care which is outpatient services. At the outpatient level, a client is seen in an office or virtually. For therapy, outpatient services are typically weekly, but can be as often as twice weekly or as infrequent as monthly or quarterly “check ins.” For psychiatry, outpatient services are typically monthly or quarterly but may vary depending on if medication changes are needed. Outpatient services are appropriate for most people but require a certain level of mental health stability to maintain safety between sessions.
At times, symptoms are more severe or there is a particular time of crisis for which traditional outpatient services are not enough. In other cases, outpatient services have occurred but not brought about the needed change. Sometimes imminent risk of suicide or homicide or psychosis warrant a higher level of care. Other times developmental concerns (IDD, ASD, etc.) warrant more intensive services.
What options are there when traditional outpatient care is not enough?
The answer to that question depends on many factors but essentially boils down to questions of safety and symptom severity. If there is immediate risk or imminent risk of death acute hospitalization/acute psychiatric hospitalization is most appropriate. At times, risk may be so severe that psychiatric transport, police transport, and or a forced 72-hour psychiatric hold (1) may be necessary. Help navigating NC and national crisis resources can be found at https://www.insightcarolinas.com/blog/crisis
Are there other options besides the Emergency Department or acute psychiatric hospitalization?
Yes. Many people are only aware of the two extremes: outpatient or acute inpatient for mental health care, but there are many other options for services. In some cases, symptoms are not so severe or danger so immediate as to warrant acute hospitalization but are more chronic and needing more than outpatient. In other cases, a person has already had one or more psychiatric hospitalizations and needs to “step-down” to something more supportive than traditional outpatient services.
The exact number of levels of care vary by source as different sources word levels somewhat differently. Generally, though, a minimum of 5 levels are recognized. Going from least to most intensive, they are as follows: 1) Outpatient, 2) Intensive Outpatient (IOP), 3) Partial Hospitalization (PHP), 4) Residential Treatment (RTC), and 5) Acute Inpatient Hospitalization.
The Menninger Clinic has a helpful graphic for levels of care and also explains 6 levels of care ranging from the least restrictive which is traditional outpatient therapy (occurs at an office typically and can be weekly, biweekly, or monthly) to the most intensive which is acute or specialized inpatient hospital care. The website also notes additional mid-levels available in some areas.
The Anxiety and Depression Association of America (ADAA) also has a helpful explanation of the 5 main levels.
Are those the only options?
No. In addition to the 5 primary levels of care, there are other programs that fall somewhere between. A few examples are:
Boarding Schools with behavioral or mental health focus
This includes programs like Teen Challenge, River View Christian Academy, etc. They have structured programs, provide academic support, and can connect with other mental health programs but don’t have in-house mental health. However, the adolescent does live there for 9+ months generally.
Therapeutic Boarding Schools
These programs emphasize and actively incorporate mental health treatment along with education. This is sort of between RTC care and a PHP but the youth reside at the program. In some instances, insurance may pay for a portion of the program cost (they tend to be quite expensive). Some examples of such schools are Newport Academy, Wolf Creek Academy, and Asheville Academy.
If you are considering boarding schools or therapeutic boarding schools, it may be helpful to use a free consultant service to find the best fit. Best Choice Admissions is a reliable service: https://bestresidentialtreatment.com/
Depending on your area and insurance, you may have additional options!
For example, Multisystemic Therapy (MST) is available to Medicaid families in northern South Carolina through New Hope and available to families in Mecklenburg County through Alexander Youth Network. MST therapists come to the home, school, etc. and are generally also on call 24-7 for emergencies and consult.
(1) https://medcircle.com/articles/what-is-a-72-hour-psychiatric-hold/
External links: Insight Carolinas does not receive compensation from nor makes endorsement of any organizations listed above. The list is not exhaustive but is provided for convenience. For additional information regarding disclaimers, please visit insightcarolinas.com/disclaim
