Tag: Inpatient

Introduction

If an individual is struggling with their mental health there are various ways to help, however, if the individual is facing serious issues then it may be time to consider accessing professional treatment options.

Previously, ‘treatment’ may have elicited memories of facilities where locked doors, restricted movement, and visiting hours being restricted was the norm. While this type of treatment still exists (usually for the most seriously ill individuals and can be helpful in certain circumstances) there are also less restrictive therapeutic environments that can be helpful as well.

Outpatient mental health programmes, also known as structured outpatient, offer the same quality of treatment as inpatient mental health programmes, but generally with more freedom and flexibility – but what is the difference?

Inpatient versus Outpatient

Mental health treatment programmes generally fall into one of the below categories and, while equally focused on treatment, each type has unique attributes and benefits to offer.

Programme	Outline
Inpatient	1. Also known as residential treatment programmes (and other names). 2. These are intensive, residential treatment programmes designed to treat serious mental health issues. 3. They require individuals to check themselves into a controlled environment to treat their mental health issues. 4. Individuals stay at a clinic/facility with 24-hour medical and emotional support. 5. May last days, weeks, or even months (in extreme cases years).
Day Care	1. Also known as Intensive Day Care. 2. Can be used as a step-down from inpatient treatment or step-up from outpatient treatment. 3. Characterised by an individual attending a clinic/facility for a set number of full or half-days each week. 4. Particularly useful for individuals who do not need intensive 24-hour care for their mental health concerns, but still require some level of structured, ongoing support.
Outpatient	1. Also known as non-residential treatment programmes (and other names). 2. These are part-time programmes designed to enable the individual to keep going to work or school during the day. 3. Less restrictive than inpatient programmes. 4. Usually require several hours per week visiting the clinic/facility. 5. Sessions can include mental health education (for the individual and family/friends) and individual/group counselling. 6. Can be a useful standalone option for individual’s with mild mental health issues, or part of a longer-term treatment programme. 7. May last several months or longer (e.g. more than one year).
Mixed	1. Some clinics/facilities offer mixed treatment. 2. For example, a stay as an inpatient when a mental health crisis occurs, followed by outpatient treatment when this passes.

What is Outpatient Treatment for Mental Health?

Outpatient treatment refers to non-residential treatment, in which the individual spends structured time in treatment during the day or evening and returns home each night. Individuals who choose to participate in outpatient mental health treatment do so for a variety of reasons, including:

• They may have small children at home or businesses to run and cannot take weeks or months out of their lives to live in a residential facility.
• They may be transitioning out of an inpatient programme but still require the support and structure that outpatient treatment provides.

Outpatient treatment programmes are most beneficial for those with mild to moderate symptoms who have a strong support system at home.

Is It The Same As Outpatient Therapy?

Outpatient therapy is defined as “any psychotherapy service offered when the client is not admitted to a hospital, residential program, or other inpatient settings.”

• Outpatient treatment usually provides:
  • A more comprehensive treatment experience.
  • More treatment hours.
• Outpatient therapy can be part of outpatient treatment.

Who is Outpatient Treatment For?

Outpatient care is the most common treatment for many mental health problems due to:

• Its lower cost;
• Better flexibility to the individual’s needs and schedules; and
• A larger selection of providers.

Outpatient care should only be applied when constant (professional) support is unnecessary and it is healthier for the individual to remain in their environment to experience stressors and learn to cope with professional guidance. This approach is often the best course of action for individuals with problems like eating disorders, depression, and anxiety.

For individual dealing with substance abuse, both inpatient and outpatient treatment plans are an option. The best choice depends on factors like mental health history, relapse history, and commitment to change. For any cases where the health or safety of the individual or those close to them is in question, inpatient care is likely necessary.

For many who undergo inpatient treatment, a long-term outpatient treatment plan is an important part of maintaining healthy habits and learning how to cope with daily life.

If an individual is at immediate risk of harming themselves or others, outpatient treatment is not the right level of care. Generally, individuals are a good fit for outpatient treatment if they are:

• Motivated to participate in programming;
• Able to learn and apply recovery skills;
• Comfortable in a group setting;
• Driven to improve their condition and work towards recovery; and
• Willing to verbally express their thoughts and feelings.

Which Mental Health Conditions?

Outpatient treatment can be used to treat a wide variety of mental health concerns including:

• Addictions (some providers state their addiction service is for adults only).
• Attention deficit hyperactivity disorder (ADHD).
• Alcohol use disorders.
• Anxiety disorders.
• Anorexia nervosa.
• Autistic spectrum disorders (ASDs).
• Bulimia nervosa.
• Depressive disorders.
• Dietetics.
• Early identification of medically unexplained symptoms (MUS).
• Obsessive compulsive disorder (OCD).
• Post-traumatic stress disorder (PTSD).

This form of treatment can be beneficial for individuals who require ongoing therapeutic input for their mental health difficulties, but their challenges are not severe enough to require more intensive day care or inpatient treatment.

What Types of Outpatient Treatment are Available?

Outpatient treatment is not a one-size-fits-all programme and, therefore, should be tailored to the needs of the individual. However, programmes generally include some combination of:

• Individual, group, and/or family/friend therapy.
• Mental health education.
• Managing symptoms.
• Identifying triggers.
• Overcoming fears.
• Developing communication skills.
• Establishing healthy social norms.
• Coping skills/strategies.
• Helping the individual to learn to thrive, rather than survive, outside the therapeutic environment.
• Medication management.
• Aftercare.
• Counselling.
• Psychoeducation.
• Psychiatric care.
• Personalised treatment/care plan.
• Complementary therapies, for example: art therapy, yoga, and music therapy.

The exact combination will depend on the needs of the individual, and can change as the individual’s circumstances change.

With this in mind, an important element to consider is which type of outpatient treatment programme will be most beneficial to the individual. Broadly speaking, there are three main types of outpatient programmes, each with varying levels of structure, to consider. Further, while one individual may be able to manage their symptoms with an hour or two of mental health treatment per month, another individual may need more support and structure.

Programme	Outline
Standard Outpatient Treatment (SOT)	1. This involves regular visits to the outpatient clinic, treatment centre, or hospital, as outlined by the individual’s personalised care plan. 2. Therapy sessions are scheduled around the individual’s work, school, and other responsibilities. 3. Treatment may be weekly or more frequent, and may continue for a year or more.
Intensive Outpatient Programme (IOP)	1. At least six hours per week for adolescents and nine hour per week for adults, and this typically involves 3 to 4 hours of treatment for up to 5 days per week [1]. 2. IOPs are designed to provide more structure and support than SOT while still allowing individuals the time and flexibility to tend to outside responsibilities. 3. The length of an IOP can be anywhere from a few weeks to a year – 90 days is usually the recommended minimum.
Partial Hospitalisation Programme (PHP)	1. At least 20 hours per week, and this typically involves 6 or more hours of treatment per day, for up to 7 days per week [1]. 2. Highly structured and supervised, PHPs provide the most intensive level of non-residential care, and are often beneficial for individuals reintegrating into their lives after an inpatient stay. 3. PHPs typically last around 30 days before the individual transitions to a more flexible level of care.

Notes

1. The number of hours and days of treatment will vary between providers and clinics/facilities.

While traditional outpatient sessions may take place once a week and last around an hour, structured outpatient lasts anywhere from 6 to 35 hours per week. Individuals will often attend structured outpatient programmes three to five days per week.

Multidisciplinary Teams

Various professionals will make up a multidisciplinary team who will be involved in an individual’s outpatient treatment, and can include:

• General practitioner (GP)/primary care physician.
• District/mental health nurse.
• Psychologist.
• Psychiatrist.
• Social worker.
• Counsellor.

What are the Benefits of Outpatient Treatment?

For individuals with mild to moderate symptoms, (and preferably) strong support systems at home, and the ability to function independently, outpatient treatment is usually a good choice. With this in mind, individuals can benefit because they can:

• Receive an intense level of programming (much like inpatient treatment) without entirely disrupting their current situation in life, such as work, school or family responsibilities;
• Turn to outpatient treatment after completing an inpatient programme as part of their continued recovery journey;
• Return home each night (the home environment can be beneficial for recovery provided that it is a healthy, stable environment);
• Stay connected with family and friends ones while still receiving the treatment they need;
• Maintain commitments and responsibilities, such as work and school;
• Receive extra support from healthcare professionals and fellow participants;
• Spend more time at the treatment centre, which enables them to focus their attention on recovery;
• Apply the skills and strategies they learn in treatment to real life situations;
• Stay connected with their treatment team and remain accountable to their personalised care plan; and
• Transition slowly back into everyday situations, equipped with tools to help optimise their independence and live a meaningful life.

Outpatient treatment can also be conducted via telehealth, so individuals (for example) living in rural areas or with transport issues do not (always) have to travel to receive services (although telehealth provision varies between countries and providers).

Depending on the country the individual resides in, most outpatient treatment programmes also have the added benefit of being less expensive than inpatient programmes. The on-hand medical care and psychotherapy available as an inpatient increases treatment costs, however, the price difference should not encourage or discourage an individual from choosing the most appropriate treatment for them.

Summary

Mental health treatment can be thought of as a continuum, with individuals moving up or down in levels of care as needed. However, it is important that both the individual (with a mental health issue) and their family/friends understand the differences before selecting a treatment programme. Exploring all options prior to making a decision can put you or a loved one on their journey to better long-term mental health.

No matter which treatment option an individual may choose, mental health treatment programmes can help change their life for the better. Mental health issues can be chronic and recovery a lifelong process.