What is the Mental Health Continuum Of Care?

One of the hardest parts of struggling with mental health is knowing where to turn for help and how to do so. While it is not uncommon for people to experience fluctuations in their mood and emotional well-being, there is often a point in everyone’s life when they know that they cannot go on without professional support. Asking friends and family for advice, doing your best to make changes to your day-to-day routine, or simply just hoping that the feelings will pass, may not be enough to get you back to a place where you feel comfortable. Additionally, due to the stigma surrounding mental health, many people forgo seeking the professional help they need for fear of being judged. 

While the societal stigma surrounding mental health treatment has improved over the past several years, there is no doubt that it still presents a substantial barrier for many people when they consider whether or not to seek treatment. One consideration is that there may be a level of misunderstanding or misconception surrounding what mental health treatment looks like. The reality is that there are many different options when it comes to addressing your mental and emotional well-being. These different options constitute the mental health continuum of care. Asking for professional help does not mean that you are ‘less than’, or ‘crazy’, but simply means that you have become willing to take certain steps to improve your relationship with your mental health.

What is the mental health continuum of care?

According to the Centers for Disease Control and Prevention, more than 50% of people in the United States will be diagnosed with a mental health disorder at some point in their lifetime. Where will these people go to find the help that they need? The complete range of programs and services that are meant to help individuals struggling with their mental health is referred to as the continuum of care. If you or someone you love is worried about their mental and emotional well-being, the first step is to obtain an evaluation from a qualified mental health professional. After an initial assessment, the healthcare professional will recommend a particular type of service on the continuum of care. This article will give an overview of the different types of services that exist on the mental healthcare continuum, and explore some of the treatments that are included in these services.

Levels of care on the continuum:

Psychotherapy or traditional outpatient therapy 

Psychotherapy, also known as ‘talk therapy’, is a term used to refer to a wide range of treatment techniques that attempt to address a person’s emotional, mental, and behavioral difficulties. Commonly, a person will meet with a licensed therapist or counselor on a weekly, biweekly, or monthly basis, and during their time together, will discuss active or ongoing issues surrounding mental health and work on tools to address whatever problems the individual is facing. This type of engagement is considered the lowest level on the continuum of care and is often used for less severe mental, behavioral, and social problems. According to research, approximately 75% of people who enter psychotherapy show some benefit from it.

Elements of talk therapy:

• Raising awareness surrounding self-concept and attitudes
• Teaching tools to change negative thinking and behavior 
• Coping skills and problem-solving strategies  
• Social and communication skills 
• Mindfulness and relaxation techniques 
• Cognitive behavioral therapy 

Intensive outpatient therapy 

Unlike traditional talk therapy, which occurs weekly, biweekly, or monthly and includes sessions that are usually 30 minutes to an hour long, intensive outpatient therapy occurs with higher frequency and typically includes longer therapy sessions. While traditional talk therapy can be effective at improving the symptoms and overall well-being for individuals with mental health diagnoses such as anxiety, depression, behavioral disorders, dissociative disorders, mood disorders, trauma disorders, and others, intensive outpatient therapy offers the individual seeking support on the mental health care continuum the opportunity to engage with professional help with more regularity and vigor. 

It is important to note that whether you find your symptoms to be manageable on a day-to-day basis, or conversely if you are having increased difficulty engaging in life the way you would like to because of your mental health, intensive outpatient therapy might still be right for you. In other words, the lack of severity in your symptoms does not necessarily exclude you from considering intensive outpatient programming on the mental health continuum of care. This decision is a personal one that should be made with the input of a licensed mental health professional and in collaboration with your family and loved ones. Intensive outpatient therapy can be an option for individuals that have found traditional talk therapy ineffective, or for those who would like to attempt a more rapid and focused approach to addressing their mental health needs. 

Elements of intensive outpatient programming:

• Art & music therapy
• Attachment-based family therapy
• Cognitive behavioral therapy (CBT)
• Dance & movement therapy
• Dialectical behavior therapy (DBT) skills
• Drama therapy
• Experiential therapy
• Family support groups
• Motivational interviewing
• Yoga, mindfulness, and meditation

Partial hospitalization program (PHP) or “day treatment”

These programs meet five days out of the week and are in session for six to eight hours a day. The primary focus of a PHP is group work, creating community among the program participants, and providing medication management and administration to those that need it. PHPs meet more often than IOPs, and are for individuals that are at the point where their mental health diagnosis has become their primary focus, and are in need of daily psychiatric assessment and treatment.

Community integration program/extended care

At this level on the care continuum, individuals live in a shared therapeutic space, such as apartment-style housing, and are supervised by trained staff to maintain their safety and provide support. Therapy and other mental health services are provided outside of the residential space. This level of care is meant to help teach residents of the program to achieve a certain amount of independence, and foster their ability to engage with the community.

Psychiatric assertive community treatment (PACT)

Individuals live in their own apartments and maintain a high level of independence. Mental health professionals and social workers collaborate with the individual to provide services and support in order to circumvent the need for hospitalization. At this level on the mental health care continuum, the services are brought to the individual, instead of the individual having to travel to obtain services.

Residential Level of Care

Individuals live in the place where they are provided treatment.  This level of care on the continuum is for those that have not been able to safely maintain their indendence, and require 24-hour-a-day monitoring and support. 

Acute care hospital/ crisis response center 

This level of care on the continuum is reserved for individuals that are actively posing a threat to themselves or others. This may include homicidal behavior, suicide attempts or threats, or manic and psychotic episodes. The primary purpose of these facilities is to stabilize the individual suffering from the acute event and provide a level of containment that can ensure their safety. Typically, people will only find themselves at this level of care for three to five days before they are stabilized and downgraded to a lower level on the continuum.

Movement throughout the continuum 

For people engaged in the mental health continuum of care, it is possible that they may find themselves at different levels throughout their lifetime. Depending on the mental health diagnosis, the severity of symptoms, and the individual’s ability to actively participate in their journey toward recovery, it is possible that a person can move from higher levels on the continuum to lower levels. The primary takeaway from an understanding of the mental health continuum of care is that no matter where you currently stand in relation to your mental health and well-being, there is help available. 

How Charlie Health can help 

One of the most exciting evolutions within the mental health continuum of care over the past several years, especially since the COVID-19 pandemic, has been the use of telehealth technology to help facilitate engagement between providers and those seeking mental health services. Unfortunately, there is a serious incongruity between the need for mental health services in the United States and the availability of mental health services. According to Mental Health America, in the United States, there are an estimated 350 individuals for every mental health provider, and engaging in the mental health continuum of care is more difficult than ever due to a lack of providers. 

When considering the traditional modality of mental health therapy, wherein a person meets their mental healthcare provider at an office or facility, it is easy to conceptualize the many barriers that might exist that would hinder a person in accessing care beyond simply not being able to find an available provider, especially for young people. Some of these barriers include issues with securing transportation, the physical distance to the provider’s office, as well as issues with insurance. 

Dr. Caroline Fenkel DSW, LCSW, Co-Founder and Chief Clinical Officer at Charlie Health, and Dr. Kate Gliske, Director of Research & Clinical Outcomes, in collaboration with the University of Pennsylvania, conducted a study to evaluate the effectiveness of Charlie Health’s Virtual Intensive Outpatient Program. The research concluded that virtual treatment programs have the potential to meet the growing demand for greater access to behavioral health services for young people. By providing care via telehealth, such as with Charlie Health’s virtual intensive outpatient program, teens have an opportunity to receive treatment without many of the traditional limitations of in-person care. 

If you or someone you love are a person that is considering engaging in the mental health continuum of care, or are already engaged and are looking for extra support, Charlie Health is here to help. Charlie Health provides individualized and evidence-based mental health care in a safe, supportive space. Contact Charlie Health to learn more today.