An Overview of Outpatient Treatment for Mental Health?


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.

Inpatient1. 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 Care1. 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.
Outpatient1. 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).
Mixed1. 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.

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.


  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.


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.

On This Day … 06 August

  • 2001 – Erwadi fire incident, 28 mentally ill persons tied to a chain were burnt to death at a faith based institution at Erwadi, Tamil Nadu.

What is the Erwadi Fire Incident?

Erwadi fire incident is an accident that occurred on 06 August 2001, when 28 inmates of a faith-based mental asylum died in the fire. All these inmates were bound by chains at Moideen Badusha Mental Home in Erwadi Village in Tamil Nadu.

Large number of mental homes existed in Erwadi which was famous for the dargah of Quthbus Sultan Syed Ibrahim Shaheed Valiyullah, from Medina, Saudi Arabia who came to India to propagate Islam. Various people believe that holy water from the dargah and oil from the lamp burning there have the power to cure all illnesses, especially mental problems.

The treatment also included frequent caning, beatings supposedly to “drive away the evil”. During the day, patients were tied to trees with thick ropes. At night, they were tied to their beds with iron chains. The patients awaited a divine command in their dreams to go back home. For the command to come, it was expected to take anything from two months to several years.

As the number of people seeking cure at dargah increased, homes were set up by individuals to reportedly take care of the patients. Most of these homes were set up by people who themselves had come to Erwadi seeking cure for their relatives.

The origins of the fire are unknown, but once it spread, there was little hope of saving most of the 45 inmates, who were chained to their beds in the ramshackle shelter in which they slept, though such shackling was against Indian law. Some inmates whose shackles were not as tight escaped, and five people were hospitalised for severe burns. The bodies of the dead were not identifiable.


All mental homes of this type were closed on 13 August 2001, and more than 500 inmates were placed under the government’s care.

As per Supreme Court directions, a commission headed by N. Ramdas was set up to enquire into these deaths. The commission recommended that care of mentally ill people is to be improved, that anybody wishing to set up a mental home to acquire a license, and that all inmates be unchained.

In 2007, the owner of the Badsha Home for the Mentally Challenged, his wife and two relatives were sentenced to seven years imprisonment by a magistrate Court.

What Does the Czech Republic Spend on Mental Health Care, and Where?

Research Paper Title

Expenditures on Mental Health Care in the Czech Republic in 2015.


Expenditures on mental health care in the Czech Republic are not being published regularly, yet they are indispensable for evaluation of the ongoing reform of Czech mental health care.

The main objective of this study is to estimate the size of these expenditures in 2015 and make a comparison with the last available figures from the year 2006.


The estimation is based on an OECD methodology of health accounts, which structures health care expenditures according to health care functions, provider industries, and payers.

The expenditures are further decomposed according to diagnoses, and inputs used in service production.


The amount spent on mental health care in 2015 reached more than 13.7 billion Czech korunas (EUR 501.6 million), which represented 4.08% of the total health care expenditures.

This ratio is almost identical with the 2006 share (4.14%).

There are no significant changes in the relative expenditures on mental health care and in the structure of service provision.


The Czech mental health care system remains largely hospital based with most of all mental health care expenditures being spent on inpatient care.

Future developments in the expenditures will indicate the success of the current effort to deinstitutionalise mental health care.


Broulikova, H.M., Dlouhy, M. & Winkler, P. (2020) Expenditures on Mental Health Care in the Czech Republic in 2015. The Psychiatric Quarterly. 91(1), pp.113-125. doi: 10.1007/s11126-019-09688-3.

The Challenges of a Pandemic in Secure Psychiatric Settings

“Before COV-19, the phrase “parity of esteem” was ubiquitous.

Policy makers and politicians emphasised the importance of high quality mental healthcare, insisting it was on an equal footing with physical healthcare.

Most mental health professionals viewed this with some cynicism, especially those working in secure inpatient settings.

Is it reasonable to expect parity when it comes to covid-19? Arguably it would not be reasonable to expect the same focus on, for example, PPE and testing as that directed towards the acute emergency services and intensive care.

However, inpatient units struggled with the lack of central guidance on managing patients who had been diagnosed with or were suspected of having covid-19.

Patients with serious mental disorders are at high risk of physical health problems. While they are acutely unwell, they:

  • May not have the capacity to understand the need to self-isolate;
  • May be unable or unwilling to be tested; and
  • If agitated, will be unlikely to be able to practice social distancing.

Mental health trusts have been struggling:

  • With protocols and the availability of testing;
  • With managing the direct contacts of patients; and
  • Like other settings, with sourcing appropriate PPE.

There is intense debate about the apparent lack of appropriate legal frameworks. In the case of a voluntary or inform patient, can the Mental Health Act be used? The Mental Capacity Act is not appropriate as it applies top decisions in the patient’s best interests, not for the protection of others.

The Coronavirus Act 2020 give public health officers the power to impose isolation on someone suspected of being infected, but this seems unlikely to extend to inpatient units.

If parity of esteem is ever going to be meaningful, the challenges of safely and securely managing coivd-19 in the most seriously unwell patients with mental disorders needs to be given a higher priority.”


O’Brien, A. (2020) The Challenges of a Pandemic in Secure Psychiatric Settings. BMJ 2020;369:No.8247, pp.318-319.

What Psychiatric Inpatients Needs when Approaching Discharge?

Research Paper Title

Identifying profiles of need among psychiatric inpatients approaching discharge in New York City: a latent class analysis.


Understanding the needs of individuals transitioning to the community following a psychiatric hospitalisation can inform community service planning.

This study is among the first to examine the needs of a sample of psychiatric inpatients approaching discharge in a large urban area in the USA.


Representative data were drawn from 1129 acutely hospitalised psychiatric inpatients from eight New York City hospitals.

Descriptive statistics were used to estimate patient needs at discharge across nine domains: housing, employment, income, transportation, education, time use, social support, and help accessing medical and mental health care.

Latent class analysis (LCA) was applied to identify subgroups of patients based on needs profiles.

Multinomial logistic regression was used to investigate socio-demographic associations with class membership.


Respondents were most likely to have needs related to income (50.7%), housing (49.2%), and employment (48.7%).

Results from the LCA suggested a five class solution of patient needs:

  • Three domain-specific classes whose members endorsed needs for ‘housing and employment’ (22.5%), ‘social support and time use’ (15.0%) and ‘access to care’ (6.4%); and
  • Two classes where overall member needs were high (‘high needs,’18.4%) or low (‘low needs,’ 37.7%) across all needs.

Compared to the ‘low needs’ class, members of the ‘high needs’ class had significantly greater odds of being black or Latino, male, uninsured, and parents of a child under 18 years.


Patients have unique profiles of need that are significantly associated with the socio-demographic characteristics.

These findings may help practitioners and policymakers improve mental health services.


McDonald, K.L., Hoenig, J.M. & Norman, C.C. (2020) Identifying profiles of need among psychiatric inpatients approaching discharge in New York City: a latent class analysis. Social Psychiatry and Psychiatric Epidemiology. doi: 10.1007/s00127-019-01817-4. [Epub ahead of print].

Are Anti-neuronal Antibodies of Clinical Significance in Psychiatric Patients?

Research Paper Title

A prospective three-year follow-up study on the clinical significance of anti-neuronal antibodies in acute psychiatric disorders.


The clinical significance of anti-neuronal antibodies for psychiatric disorders is controversial.

The researchers investigated if a positive anti-neuronal antibody status at admission to acute psychiatric inpatient care was associated with a more severe neuropsychiatric phenotype and more frequent abnormalities during clinical work-up three years later.


Patients admitted to acute psychiatric inpatient care who tested positive for N-methyl-D-aspartate receptor (NMDAR), contactin-associated protein 2 (CASPR2) and/or glutamic acid decarboxylase 65 (GAD65) antibodies (n = 24) were age – and sex matched with antibody-negative patients (1:2) from the same cohort (n = 48).

All patients were invited to follow-up including psychometric testing (e.g. Symptom Checklist-90-Revised), serum and cerebrospinal fluid (CSF) sampling, EEG and 3 T brain MRI.

Twelve antibody-positive (ab+) and 26 antibody-negative (ab-) patients consented to follow-up.


Ab+ patients had more severe symptoms of depression (p = 0.03), psychoticism (p = 0.04) and agitation (p = 0.001) compared to ab- patients.

There were no differences in CSF analysis (n = 6 ab+/12 ab-), EEG (n = 7 ab+/19 ab-) or brain MRI (n = 7 ab+/17 ab-) between the groups.


In conclusion, anti-neuronal ab+ status during index admission was associated with more severe symptoms of depression, psychoticism and agitation at three-year follow-up.

This supports the hypothesis that anti-neuronal antibodies may be of clinical significance in a subgroup of psychiatric patients.


Schou, M.B., Sæther, S.G., Drange, O.K., Brenner, E., Crespi, J., Eikenes, L., Mykland, M.S., Pintzka, C., Håberg, A.K., Sand, T., Vaaler, A. & Kondziella, D. (2019) A prospective three-year follow-up study on the clinical significance of anti-neuronal antibodies in acute psychiatric disorders. Scientific Reports. 10(1):35. doi: 10.1038/s41598-019-56934-6.

Development and Implementation of a Hospital-Based Clinical Practice Guideline to Address Paediatric Somatic Symptom and Related Disorders

Research Paper Title

Taking the Pain out of Somatisation: Development and Implementation of a Hospital-Based Clinical Practice Guideline to Address Paediatric Somatic Symptom and Related Disorders.


The diagnostic category of somatic symptom and related disorders (SSRDs), although common, is often poorly recognized and suboptimally managed in inpatient pediatric care.

Little literature exists to address SSRDs in the inpatient paediatric setting.

The purpose of the study was to characterise current SSRD practice, identify problem areas in workflow, and develop a standardised approach to inpatient evaluation and management at a tertiary care academic children’s hospital.


A multidisciplinary group identified patients with SSRD admitted between May 2012 and October 2014.

A retrospective chart review on a convenience sample was performed to identify population characteristics and current practice.

Lean methodology was used to define current state practice and future state intervention.

These methods were used to guide identification of problem areas, which informed protocol, a clinical practice guideline, and resource development.


Thirty-six patients aged 8 to 17 years met inclusion criteria for chart review.

Most patients presented with either neurological or pain-related complaints.

The mean length of stay was 5.44 days (SD = 6.3), with few patients receiving a mental health consultation within 24 hours of hospitalisation.

Patients averaged 5.8 medical and/or psychiatric diagnoses on discharge (SD = 5.2), and two-thirds did not have an SSRD diagnosis.

Half of patients had co-morbid psychiatric diagnoses, whereas one-quarter were discharged with no mental health follow-up.


In this study, the researchers describe the process and content development of a single-site institutional protocol, clinical practice guideline, and resources for the evaluation and management of paediatric SSRDs.

This study may serve as a model for similar standardisation of SSRD care in other inpatient paediatric medical settings.


Kullgren, K.A., Shefler, A., Malas, N., Monroe, K., Leber, S.M., Sroufe, N., El Sakr, A., Pomeranz, E., O’Brien, E. & Mychaliska, K.P. (2020) Taking the Pain out of Somatization: Development and Implementation of a Hospital-Based Clinical Practice Guideline to Address Pediatric Somatic Symptom and Related Disorders. Hospital Paediatrics. 10(2), pp.105-113. doi: 10.1542/hpeds.2019-0141. Epub 2020 Jan 2.