Levels of Mental Health Care
By Mark Reeves, Ph.D.
In the mental health field you will often hear professionals refer to the “recovery process.” The term implies that people experiencing either a temporary mental health crisis or chronic mental illness have as a goal to recover as much of their ability to function in life, and to increase that functioning, but that reaching this goal takes time and includes multiple steps. The term also evokes a compassionate mentality of seeing every human being as capable of some amount of recovery, constantly striving towards improvement and happiness, peace and fulfillment. This contrasts with other views of people with mental illness as either moral failures or as less-than-human individuals to be hidden away from society.
This recovery process is reflected in the different levels of care in the network of mental health treatment. Movement between each level can be seen as a step, ideally a step towards recovery, though of course everyone experiences setbacks and crises at times.
Most people in society live at the least restrictive level of care, meaning adults and children live in the community independently, are able to go about their lives generally unrestricted, and are able to function as students, employees, caregivers, and in other roles in society. People who are functioning at average or above-average levels do not require any mental health intervention as they cope well with stress and meet their obligations and needs. They may live their entire lives without any contact with a mental health professional.
However, we know that about 19% of adults (ages 18 and older) and 13% of children (age 8 to 15) will experience some type of mental illness in any year1. When they seek treatment, a person with a mild mental health issue may seek the least restrictive type of mental health care, such as seeing a counselor to talk about some issue in their life. An example might be someone experiencing some mild stress at work or in their marriage. Such a person may not experience much distress or interference in their life, but may wish to enhance their functioning and peace in their life.
People experiencing mental health problems that are more upsetting or that interfere with their everyday lives may seek more serious psychotherapeutic help and also may consider taking psychiatric medication. Consider a depressed husband who cannot bring himself to get out of bed to go to work. He experiences significant distress in his mood and he is at risk for being fired as a result. He would benefit at the least from effective psychotherapy for depression (e.g., Cognitive Behavioral Therapy) and/or psychiatric medication (e.g., antidepressant medication). In addition to a therapist and medication prescriber, such clients may receive case management services to connect them to helpful agencies and other resources in the community.
Sometimes people experience a serious psychiatric crisis and are temporarily hospitalized. This may be for a few days or weeks. A typical client may have experienced multiple losses (e.g., death of a loved one, job loss, financial problems, car accident), feel overwhelmed, and may be considering suicide. Others are experiencing a severe disconnect from reality and hold unusual beliefs (e.g., that they are someone famous when they are not) or bizarre perceptions (e.g., hearing a voice that no one else can hear). People hospitalized in a crisis hospital are locked in temporarily for their safety and receive medication to help stabilize them as well as supportive counseling and other therapeutic activities. Some will weather a temporary crisis, but others may be experiencing chronic mental illness that requires ongoing support in the community.
When people are frequently hospitalized due to severe and persistent mental illness, they may be ordered by a judge to a state hospital facility, such as nearby Florida State Hospital. This is generally the most restrictive level of care. People in such a hospital are again locked in but as they improve in their recovery may be granted grounds access. They receive ongoing adjustment of their medication and continued supportive counseling and therapeutic activities. However, as with all levels of care, the goals of mental health professionals working even at a state hospital level of care is to assist human beings in moving back towards recovery. A goal of every hospital is to discharge a client as soon as possible.
Often people leaving a state hospital may not be ready to step all the way back to independent community living, so they may step down first to living in an assisted living facility or group home. These facilities are typically not locked. Residents are able to come and go freely within the structure of the program for their well-being and recovery. Some people remain in such a facility for much of their life. If they experience a crisis, they may step back up levels of care to a crisis hospital or even state hospital. Others progress in recovery out of a residential program back into the community. Again, at all levels of care, it is the goal of all mental health professionals to “put themselves out of business,” to help all human beings to function completely independently.
At Apalachee Center, Inc., we provide services at almost all levels of care. At our Capital Therapy program, we serve mostly working professionals facing relatively mild to moderate mental health problems. At our outpatient programs in eight counties, we provide medication services, therapy, case management, and day classes that teach independent living skills to people with typically more moderate to severe mental health challenges. We have a free-standing psychiatric hospital and crisis stabilization unit for individuals of all age ranges experiencing any kind of mental health emergency. We also have residential programs for people stepping down from the state hospital with or without court involvement. We constantly work to match all of our clients to the level of care appropriate for them at any given moment in their life, while always striving to help them move through the recovery process to full independence.
If you or a loved one are experiencing any kind of mental health issue, we encourage you to get help through our agency or any qualified mental health provider. We believe that all human beings have the potential for recovery and the right to helpful and effective treatment.
1 National Institute of Mental Health. (2012). What is Prevalence? Retrieved June 2, 2015, from http://www.nimh.nih.gov/health/statistics/prevalence/index.shtml