CONTENTS

• • IN TIMES OF CRISIS
  • TYPES OF MENTAL HEALTH TREATMENT
  • TYPES OF ADDICTION TREATMENT

IN TIMES OF CRISIS

Please note: if there is an immediate concern for the safety of yourself or others, please call 911 or go to the nearest emergency room. The information provided below is not instructional nor medical or psychiatric advice. Please read our “Terms of Conditions” and “Medical Disclaimer.”

Mobile Crisis Team

Each county of each state in the US has a mobile crisis team, or is in the process of assembling one, expanding their program and crisis intervention efforts/initiative. The mobile crisis team can come to any location to perform a mental health assessment and wellness check.

If they determine that the person is at imminent risk to themselves or others, they will sign legal documents to have the adult transported to the nearest hospital for further assessment and hospitalization. If the adult is not agreeable to going or is not able to make decisions for themselves due to their mental state, the clinician from the mobile crisis team will have to transport them on an involuntary status to the nearest hospital (specific legal documents must be filled out by them which will then be presented to a judge later).  If it is a child in crisis (under 18 years of age) and the parents are not agreeable to having the child be sent to the hospital despite the child being in immediate danger to harm themselves or others, most states lean towards calling Child Protective Services as refusal by the parents can be considered as child neglect. Please note, you can discuss this with the mobile crisis clinician when they arrive.

Each county of each state has a different protocol when sending out the mobile crisis team so it is best if you ask them about any concerns you may have, including if the police come with the team, when they will arrive and other related concerns. When calling mobile crisis, explain clearly that the person you are calling about has a mental health disorder, or is displaying mental health symptoms and needs a psychiatric evaluation.

You can find more information on calling the crisis mobile line and links to the mobile crisis team for your state on the Crisis Hotlines by State page.

Psychiatric Emergency Room

Upon arrival to the hospital (either via ambulance through the mobile crisis team or via self-reporting), the person will need to be cleared medically in the emergency room. The person will then be assessed by a mental health clinician and/or psychiatrist to determine the plan of action and recommended treatment plan, (including but not limited to discharge with a referral to an agency or recommendation to see a therapist). Some hospitals have a psychiatric emergency room where the person will be transported. You should be informed upon arrival at the emergency room of the protocol. If you feel your rights have been violated at the hospital or that you are not being treated well, ask for the patient advocate to file a complaint.

TYPES OF MENTAL HEALTH TREATMENT

There are different levels of mental health treatment, each categorized by the severity of the mental health disorder and how often treatment is needed. Below is a list of levels of treatment in order of increasing need.

Outpatient

Outpatient mental health treatment is usually once a week counseling/therapy. Generally, therapy sessions run from between 45 to 55 minutes, while medication follow up appointments with your psychiatrist can be a maximum of 15 minutes (please ask your provider the duration). With time, you may decide you want to come in for therapy sessions every two weeks or perhaps once a month. You and your mental health therapist can discuss what may be effective for you based upon your treatment plan, needs and current progress. How often you meet with your psychiatrist may vary and will be determined by you and your psychiatrist.

Intensive Outpatient Program (IOP)

Those enrolled in IOP need more focused care then an outpatient program can provide. Clients at an IOP program meet a few times a week, with each meeting being held for a few hours. This type of treatment setting focuses mostly on group sessions, but can incorporate individual sessions as well. The complete structure will depend upon the program design and goal.

Partial Hospitalization Program (PHP)

Partial hospitalization programs are a step higher than IOPs in that they require clients to attend the program usually at least five days a week, with potentially each visit being eight hours. PHPs include a comprehensive treatment approach including a medical team and behavioral health team which includes therapists and case managers. Treatment duration depends upon what your team of providers decide based upon your progress as discussed with you.

Inpatient Unit

Being hospitalized is the highest level of care. The type of hospitalization falls under three types and might be referred to by different terms in each state:

• • Voluntary hospitalization is when the patient is willing to go for treatment and there is no concern for imminent risk of danger to self or others. They can sign in voluntarily. Therefore, the patient can request a discharge from the unit when they would like to leave (there are certain protocols within each hospital for each state, please check with your state and specific hospital).
    
    
  • Consensual hospitalization is when the person is willing to be hospitalized, but there is enough concern for imminent risk of danger of self or others that results in the psychiatrist signing them in to indicate that they cannot request a discharge whenever they want but rather their discharge is contingent upon them being determined as safe by the psychiatric team at the inpatient unit.
    
    
  • Involuntary hospitalization is when the psychiatric team at the hospital believes that the patient is an imminent risk of danger to self and others and is either unable to sign in consensually (due to current mental state), or too great of a concern to be signed in as consensual. The discharge time is determined by the treatment team.

TYPES OF ADDICTION TREATMENT

There are different levels of substance abuse treatment, each categorized by the severity of the mental health disorder and how often treatment is needed. For addiction treatment, there are specific levels of treatments with each one being necessary to complete before being able to attend the other. The list of treatment settings below is in order of the first treatment to last.

Detoxification and Medically Managed Withdrawal

Detoxification and medically managed withdrawal is considered the first step in addiction treatment. In a detox facility, as the client’s body clears itself of drugs, clients are monitored by a medical team to address the impact of stopping drug use. Because of how potentially dangerous detoxification can be, the medical team at the detox center helps the client with the drug withdrawal by giving medications to address withdrawal symptoms. Generally, at a detox center, the client is referred to additional drug and alcohol addiction treatment to address the underlying causes and impact of drug addiction. The recommended next stage is usually long-term residential rehabilitation treatment, or at least short-term residential rehabilitation treatment. 

Long-term Residential Rehabilitation Treatment

Long-term residential treatment provides care 24 hours a day, generally in non-hospital settings. The length of stay can be between 6 to 12 months. The focus on treatment includes medication management, developing necessary social skills and life skills, teaching personal responsibility and assisting clients with mental health related issues. Treatment teams at these facilities include a psychiatrist or APN and addiction counselors. Many such rehab programs focus on using group and individual counseling, as well as including family members to plan for after the client leaves treatment. Drug testing is conducted throughout the time the client is at the facility, with a positive drug test resulting in immediate discharge at most facilities. Suggested treatment after leaving short-term rehab is an Intensive Outpatient Program.

Short-term Residential Rehabilitation Treatment

Most short-term residential programs provide intensive but relatively brief treatment over a period of a few weeks. These programs have treatment teams of addiction counselors and a psychiatrist and/or APN. The treatment model includes individual and group counseling. Drug testing is conducted throughout the time the client is at the facility, with a positive drug test resulting in immediate discharge at most facilities. Suggested treatment after leaving short-term rehab is an Intensive Outpatient Program or at least, individual outpatient.

Intensive Outpatient Program (IOP)

IOPs focus heavily on group counseling and individual counseling. IOPs are designed so that individuals can have a job during the day and then attend the program three to four times a week for a few hours. IOPs may also include random drug testing of participants. The consequence for having a positive drug test is not discharge, although it may vary based on each program.

Medication Assisted Therapy: Medication assisted therapy refers to the use of FDA-approved medications, along with counseling, for substance abuse treatment. Medication assisted therapy programs usually mandate that patients also attend individual and group counseling (number of times varies by each program). The medications used in MAT programs for opioid dependence can include methadone and suboxone. Other MATs include MAT for alcohol and smoking.

Individual Outpatient

Individual counseling is best for maintaining sobriety by continuing to address triggers, mental health issues, relapse prevention skills and other related concerns. Individual counseling for individuals with substance abuse disorders is best done with a dual-licensed clinician: LPC and LCADC, psychologist and LCADC, or LCSW and LCADC.

Group Counseling

Group counseling is a key component of substance abuse treatment as it can help individuals to hear from their peers about similar struggles they share. Group counseling has been found to improve outcomes of treatment when clients are doing group counseling along with individual counseling.