Understanding Levels of Care in Depression Treatment
January 9, 2023
Approximately 53 million people in the United States live with depression. But not every person living with depression gets treatment. According to Dr. Philip Wang, Professor at Harvard Medical School, “Depression is the most common mental health disorder, affecting more than 21 million adults in America. However, only 66% of those with depression receive treatment.”
Depression is a leading cause of disability. It is also a risk factor for suicide, whether diagnosed or not. Health disparities such as poverty, discrimination, negative attitudes about mental health issues, and lack of access to safe housing, healthy food, and affordable medical care can have a negative impact. These disparities increase the likelihood of developing depression while also making diagnoses and treatment difficult. Additionally, the lack of an appropriate screening process leads to late diagnosis and intervention. Late diagnosis means depression has had more opportunity to negatively impact a person’s quality of life, making depression more difficult to treat.
There is no one-size-fits-all depression treatment. Treatment usually begins with therapy, medication, or a combination of the two. However, we do not know which types of therapy or which medications (at what doses) will be effective for each person. This means that an individual will likely need to try out different treatment options to find the approach that works best for treating their depression.
Navigating the mental health system is difficult for everyone. Due to location, finances, waiting lists, or insurance requirements, we often do not have easy access to depression treatment. But the more you know about what different treatment settings offer and what treatments are available, the better you will be at supporting your loved one and advocating for their care. Understanding the levels of care can help you identify treatments and settings that may be right for your loved one. Here is a quick overview.
The outpatient (OP) setting is commonly used for individuals who continue to function well despite their mental health condition. Outpatient care is often what we think of when we talk about depression treatment. It means seeing a provider, usually in their office, for recurring individual or group therapy, medication management appointments, or both.
There is also an “intensive outpatient” (IOP) treatment option for those who may need additional support, but do not require hospitalization. Intensive outpatient programs provide a more comprehensive and structured approach than traditional outpatient care, with more individual or group therapy sessions each week. More frequent daytime meetings can impact a person’s daily life, which means employers and educators may need to be flexible or provide accommodations so an individual can attend for depression treatment.
Partial Hospitalization Program (PHP)
PHPs are more intensive and require a greater commitment of time than IOPs. A PHP usually lasts for two to three weeks, with daily sessions lasting six to eight hours. Partial hospitalization can be an alternative to inpatient hospitalization when your loved one is having a harder time functioning and if there are no safety concerns, such as self-harm or suicidal ideation. It is important to note that, depending on insurance coverage, an individual may not be allowed to participate in his/her outpatient program while participating in a PHP. Find out if your insurance has any such restrictions.
Inpatient (IP) care is the most restrictive setting for depression treatment. People in inpatient care have very little control over their schedules, their movement, and their lives. Inpatient care is used almost exclusively for individuals at risk of harming themselves or others. Because of the restrictive nature, the general shortage of beds, and the cost, inpatient care should be thoughtfully considered and used only when necessary.
Individuals can be voluntarily or involuntarily admitted. There are legal requirements and time limits for involuntary admissions. Generally, treatment is more effective when undertaken voluntarily, but credible concerns about imminent harm to one’s self or others can support a temporary involuntary hospitalization.
Inpatient care provides 24-hour monitoring and treatment. IP care offers a safe environment and focused treatment to stabilize a person from being suicidal or otherwise distressed and to help plan for treatment (and housing and other life issues) after discharge. When your loved one is discharged, make sure that they leave with a care plan and/or referrals for continued care.
Community-Based Crisis Stabilization (CCS) and Residential Services
Community-Based Crisis Stabilization (CCS) facilities are an alternative to hospital emergency departments for people experiencing a mental health crisis (e.g., thoughts of suicide). A CCS facility is open 24 hours and staffed by mental health professionals. People enter a CCS facility voluntarily and receive short-term individual and group treatment for 3-5 days.
A residential program is a voluntary, long-term placement (weeks, months, years) in a home-like environment that helps with socialization for individuals who tend to isolate themselves from others. Residential care works well for individuals with moderate symptoms who do not pose an imminent risk to themselves or others, but who may benefit from more support and monitoring.
Enhanced Acute Treatment Services (EATS)
Enhanced Acute Treatment Services (EATS) offer specialized treatment for people living with a combination of mental health and substance use disorders. People with this ‘dual diagnosis’ often have trouble securing services. Mental health-oriented facilities often require a person to be sober or off the non-sanctioned drugs they are using. Detox facilities often don’t have the capacity for treating mental health conditions. With EATS, people receive 24-hour intensive treatment for both conditions, including medically monitored withdrawal management as well as psychiatric treatment and stabilization.
Caregivers Should Also Know About Emergency Services Programs (ESP)
Emergency Services Programs (ESPs), also known as crisis services, are NOT a level of care. Still, they are helpful, and sometimes necessary (depending on insurance requirements), for accessing services at other levels of care. ESPs provide 24/7 assessment and referral services for people experiencing a mental health crisis. Some ESPs have mobile units for on-site crisis intervention. You can call 211 to connect with an expert who can recommend services in your area.
Caregivers who know about mental health care can provide invaluable support to help their loved ones with depression get care and get well. People living with depression often can’t recognize any improvement in their mood or behaviors, and they don’t have many positive feelings about themselves or their future. Share with them your observations about the positive changes.
Help your loved one remember these key points:
- Depression treatment is hard, but you are there to support them through it
- Be patient. Treatment takes time to take effect, and, unfortunately, things may get worse before they get better
- Do not rush the process
- Getting well is not necessarily a linear process, but setbacks don’t have to be disastrous
- Stick with the treatment. Being consistent is key to seeing how well a particular treatment is working
- Celebrate small victories!
Knowing what type of care your loved one needs is the first step in getting them help. Watch our webinar, What’s my Role? Helping Your Loved One Manage Depression Treatment, to learn more about supporting your loved one on their path to mental wellness.
Michelle Burfoot has been a registered nurse for 25 years. She is currently a travel nurse working on assignment in New York in the Post Anesthesia Care Unit (PACU), caring for patients after surgery. Michelle earned her Bachelor’s degree in Nursing from Virginia Commonwealth University-Medical College of Virginia, and her Master’s degree in Public Health from Liberty University. In her free time, Michelle enjoys traveling with her husband and spending time with her family.