Treatment Settings

Treatment is not a one size fits all approach. Where you go for mental health treatment depends on your situation and recovery needs. Knowing where to look and what to expect can help reduce confusion and stress. Mental health care professionals that provide services include psychologists, psychiatrists, psychiatric or mental health nurses, social workers and counselors. Psychiatrists prescribe and manage medications. Finding a professional who accepts your health insurance can help cover the cost of services, but some psychiatrists and other doctors do not accept insurance.

Private Practice

Individual, family and group therapy sessions are held in a variety of settings, a common one being private practice. A professional in private practice may work out of a variety of places, from an office to her home. Meeting weekly, bi-weekly or monthly with a care provider, can provide a person better understanding of relationships, feelings, behaviors and how to manage symptoms and reduce the risk of relapse.

Community or County Mental Health Centers

A community or county mental health care center often provides public mental health care services when a referral to a private doctor or therapist is not possible. Centers are operated by local governments to meet the needs of people whose mental health condition seriously impacts their daily functioning. Some of the services a person might receive from a community or county mental health center include outpatient services, medication management, case management services and intensive community treatment services.

Often centers manage contracts with mental health service providers and refer clients for employment, day program services, residential treatment services, therapeutic residential services and supportive residential services.

Psychiatrists, psychologists, social workers, counselors and peer support specialists work at centers to provide the range of services clients need. Some centers use the Assertive Community Treatment (ACT) team-based care model to coordinate a client’s care. Services may include psychiatry, case management services and help with employment and substance use issues.

Most of the people getting services from a community or county mental health care center receive Social Security disability benefits and rely on Medicaid to fund their treatment needs.

Mental health centers often have emergency walk-in services or a mobile crisis unit with clinical staff able make an on-site evaluation of a person’s condition. The purpose of both is to deescalate, stabilize the individual and determine the next steps.

Hospitalization

There may be times when a person is admitted to the hospital for intensive treatment. Private psychiatric hospitals, general hospitals with a psychiatric floor or state psychiatric hospitals are designed to be safe settings for intensive mental health treatment. This can involve observation, diagnosis, changing or adjusting medications, ECT treatments, stabilization, correcting a harmful living situation, etc.

If a person and their doctor agree that inpatient treatment is a good idea, they will be admitted on a voluntary basis, meaning that they choose to go. Some private hospitals will only take voluntary patients.

If a person is very ill and refuses to go to the hospital or accept treatment, involuntary hospitalization is an option. The legal standard for an involuntary hospitalization requires that a person be considered a “danger to self or others.” This type of hospitalization usually results in a short stay of up to 3 days but can occasionally last a week or so longer.

For an involuntary hospitalization to be extended, a court hearing needs to be convened, and a judge and two doctors must agree that there is still a need for hospitalization. The rules for involuntary hospitalization are done at the state level. The initial criteria are typically based on whether or not there is an immediate safety risk to his or herself or others. In other states, other criteria, such as being severely disabled, may be used as criteria for involuntary hospitalization.

Before a person is discharged from the hospital, it is important to develop a discharge plan with a social worker or case manager. Family members should be involved in discharge planning if the person is returning home or if they will need significant support. A good discharge plan ensures continuous, coordinated treatment and a smooth return to the community.

Partial Hospitalization or Day Hospitalization

Partial hospitalization provides care and monitoring for a person who may be having acute psychotic symptoms without being a danger to self or others. It allows a person to return home at night and is much less disruptive. It can also be used as a transition from inpatient hospital care before a complete return home.

Emergency Rooms

When it isn't possible to get treatment from a mental health center or private doctor, or a situation escalates into an emergency and safety is a concern, a visit to an emergency room might be the only option.

Situations that might require a trip to the emergency room include:

  • A suicide attempt
  • Assault or threatening actions against another person
  • Hearing voices, paranoia, confusion, etc
  • Drugs or alcohol escalating a person’s mental health issue

If you are calling 911, be sure to tell the operator that it is a “mental health emergency” and ask for emergency responders with Crisis Intervention Team (CIT) training. Many first responders will approach a mental health situation differently if they know what to expect.

A person can expect to be registered upon arriving at the emergency room. This will involve paperwork and answering questions about insurance, medical history, etc. Medical staff will then quickly make an assessment to determine how urgently care is needed. A psychiatric examination will establish a “working diagnosis” and determine a plan of action. Most people will receive tranquilizing medications, crisis counseling, an explanation of what’s happening and a referral for treatment after discharge.

Having a crisis plan that determines steps to take to prevent a crisis and to handle a crisis once it's developed can help prevent emergencies from escalating.

Substance Abuse Treatment Centers

Some people with mental health conditions also have substance abuse concerns. The most widely used form of treatment is integrated intervention. With this treatment, a person receives care for both a specific mental illness and substance abuse. Types of substances abuse centers include:

  • Detoxification facilities. Withdrawal from alcohol can be life-threating and requires medical supervision. Opiate withdrawal is less risky, but detox can be important to organize community-based efforts to provide sobriety supports.
  • Acute Residential Treatment (ART) programs. ART are short-term, highly focused treatment programs that help individuals solidify their recovery and sobriety.
  • Intensive Outpatient Programs (IOP). IOP allows individuals to work, go to school and carry on their regular activities while also providing services and supports, such as a 12-step program to remain sober.