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Levels of Care

Reviewed by: HU Medical Review Board | Last reviewed: September 2023

Treating major depressive disorder (MDD), also called clinical depression, usually involves a combination of antidepressant drugs and therapy. But each person’s treatment needs will vary. Differences can depend on personal preference and symptom severity. For example, some people with mild depression may undergo therapy for only a few sessions per month. Others may need more intensive support.1

How much support a person needs dictates their level of care. Level of care refers to the location and amount of time spent in treatment. Levels range from less intensive options (outpatient care) to more intensive support (inpatient hospitalization).2,3

Choosing the right level of care

You, your doctor, and your loved ones will determine what level of care you need. It can be a shared decision among all involved. In some cases, there is flexibility in the level of care. But in other cases, like if you are having thoughts of harming yourself or others, hospitalization may be necessary.2-4

Your level of care also may be impacted by your location, health insurance status, and other medical conditions. Common levels of care for people with MDD are described in order of intensity below.2-4

Outpatient care

Outpatient care is the least intensive level of care. It is most commonly used by people with mild to moderate depression. A person using outpatient care lives at home and may take antidepressant drugs and attend therapy occasionally.3-5

The exact schedule of therapy sessions and their type can vary. Some people may have 1 session a month with their therapist. Others may go once per week. Some people attend group therapy, too. The exact schedule and treatment plan are unique to each person.3-5

Intensive outpatient care (IOP)

People who are undergoing intensive outpatient care (IOP) still live at home. But they need more support than they would get in basic outpatient care.4

IOP program schedules can vary. Most are 3 to 5 days per week for around 3 hours per day. People may attend a mix of doctor’s appointments for drug management, individual therapy, group therapy, and more.3-6

People using IOP function mostly independently. They just need a little extra support. How long a person uses IOP depends on how severe their symptoms are and how they are responding to treatment.4

Partial hospitalization program (PHP)

The next level up from IOP is a partial hospitalization program (PHP). This is similar in structure to an IOP. It may include daily 1-on-1 therapy, group therapy, social skills training, recreational activities, doctor’s visits, and more. But people in a PHP spend more time each day in the care setting.3-5,7

People undergoing care at a PHP will often have treatment 5 days a week. Days may be 6 to 8 hours long. Each treatment facility and plan will be different. This is called partial hospitalization because those using these plans still live at home. They may need help from a caregiver outside of the treatment setting if their symptoms make it hard to carry out daily tasks.3-5

PHPs are a good option for people with severe symptoms of depression. Most of them spend several weeks or more undergoing PHP-level care.3-5,7

Residential or community care

Residential and community care options are the last level before full hospitalization. Community care often is needed for only a short time.3,4

One type, community-based crisis stabilization (CCS), is for those in acute crisis. Signs of an acute crisis are having thoughts of wanting to harm yourself or others. CCS locations are open 24 hours a day. They provide support and therapy in emergency situations. Most people stay only a few days at a time. They sleep at the facility until they can go home.3,4

Residential care is a longer-term care option. People in residential care do not live at home. In some residential programs, people live at the same location where they get treatment. Other residential care facilities are just for supervised and supported living. In these situations, treatment takes place off-site.3,4

Residential treatment often lasts several weeks or more. The amount of time people undergo therapy and other forms of treatment varies. Many people leaving residential treatment will “step down” to a middle level of care. For example, a person who is stable enough to leave a residential treatment facility may start a PHP or IOP immediately afterward.2-4

Hospitalization

Inpatient, or hospital-based, care is the highest level of treatment for depression. It is used for people who are at risk of harming themselves or others, or who have tried to do so. In some cases, a person may willingly seek hospitalization. In other cases, especially if medical attention is needed or there is immediate danger, a person may be hospitalized against their will.3,4

Not everyone with thoughts of harming themselves needs to be hospitalized. The decision to hospitalize depends on many factors. A person may not need to go to the hospital if:2,4

  • There is a clear plan in place to keep them safe at home
  • They have stable housing
  • They have good social support
  • They will get immediate follow-up care

Hospitalization can be a sensitive topic for some people with MDD and their families. But hospital stays are usually short and serve as a way to stabilize people in crisis. From there, people often go to whatever lower level of care is safe in their situation.2,4

Role of telemedicine

Telemedicine has been increasing in popularity for depression care and therapy. This change sped up as a result of the COVID-19 pandemic. Some doctor’s appointments, 1-on-1 therapy sessions, and group therapy options can be delivered through telemedicine instead of in person. This means services can be accessed on a computer, phone, or tablet from anywhere.8

Telemedicine has many benefits. It can be ideal for people with a lack of transportation, privacy concerns, anxiety, and more. But experts do not know whether it is as safe and effective as in-person care. While more research is needed, some studies have suggested that telemedicine can be just as effective in many situations. This may be true for the outpatient setting as well as in IOP and PHP programs.8

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