Levels of Care & Types of Providers

Mental health care is provided in a continuum of settings that address the acuity and severity of an individual's symptoms at the time of care.  

Mental health care must be provided in the least restrictive environment in which patient safety can be reasonably assured. 

Outpatient care

Outpatient therapy: regular visits with a therapist or counselor, usually weekly or more frequently if needed.  Outpatient therapy can be individual or may take place in groups.

Medication management: After an assessment visit or visits, the prescriber, patient and caregivers settle on a medication treatment plan.  Follow-up visits are usually monthly while medication adjustments are made, then may be less frequent.  Medication management visits may include therapy as well. 

Intensive outpatient care (IOP)

Intensive outpatient program is often a step-down level of care from PHP (see below).  Intensive outpatient treatment is individual, group and family therapy provided 4-5 days a week for 3-4 hours/day.  IOP is an appropriate level of care for children and adolescents who are able to attend school but who can benefit from a concentrated period of therapy to address impairing mental health symptoms. Examples include recurrent non-suicidal self-injurious behaviors, severe anxiety or depression, obsessive-compulsive disorder, and ongoing stabilization for eating disorders. IOPs are staffed by psychologists, clinical social workers, and milieu therapists.  They do not generally provide medication management.  

Partial Hospitalization (PHP)

Sometimes called "day hospital", PHPs provide intensive individual, group, milieu and family therapy 5 days a week, similar to a school day.  Pediatric PHPs include daily time for school work, and a teacher with mental health training liaises with participants' regular schools to facilitate post-discharge support and plans for transitioning back to school.  The PHP level of care is for individuals whose mental or behavioral health symptoms preclude them from functioning in the school and/or home environments but which do not constitute an imminent risk of harm.  PHP programs are staffed by multidisciplinary teams including psychologists, psychiatrists, clinical social workers, teachers, and milieu therapists. 

Inpatient psychiatry 

Inpatient psychiatry takes place in closed part of a hospital or facility.  Inpatient care provides mental and physical stabilization during an acute episode of psychiatric distress.  Criteria for inpatient care are that the individual poses an imminent danger to themselves or others, or that their mental health has deteriorated such that they are unable to care for themselves or be cared for in an outpatient setting.  Children and adolescents on inpatient pschiatry units spend much of the day in group therapeutic activities and will have a period of time set aside for school work.
Inpatient programs are staffed by multidisciplinary teams including psychologists, psychiatrists, clinical social workers, teachers, and milieu therapists.  Caregivers cannot stay with patients on most pediatric inpatient psychiatry units but can visit and are expected to participate in family therapy sessions and discharge planning.

Other settings:

• School-based mental health clinics
• Residential treatment facilities
• Dual-diagnosis programs for mental health and substance use disorders

Assessment and Therapy

Psychologists

Psychologists conduct mental health assessments through clinical interviews, psychological evaluations and testing.  Psychologists can make diagnoses and provide individual and group therapy.  Pediatric psychologist is a descriptor often used for a child psychologist who works in health care settings as part of pediatric specialty teams.  

Degree requirements: Doctor of Philosophy (Ph.D.) in a field of psychology or Doctor of Psychology (Psy.D.)
Licensure & Certification: Psychologists are licensed by state boards.

Clinical Social Workers

Clinical social workers provide individual, group, and family therapy, as well as conduct psychosocial assessments and evaluations to determine mental health diagnosis and treatment needs. While professionals with MSWs can be found in a range of roles outside the domain of mental health, Clinical Social Work is a specialty practice area of social work which requires additional clinical education, training, and licensure, and focuses on the treatment and prevention of mental illness, as well as other emotional and behavioral disturbances or relationship challenges.

Degree and Training Requirements: Master’s or Doctorate's degree in social work and at least 2 years of supervised post-graduate clinical experience
Licensure & Certification: licensing through examination from the Association of Social Work Boards; certification through state Boards of Social Work.  Certification varies by state and may be LCSW (Licensed Clinical Social Worker) or LICSW (Licensed Independent Social Worker)

Other Counselors & Therapists

The terms counselor and therapist can be used for any licensed clinician who provides psychotherapeutic services.  The types of counselors/therapists listed below differ from clinical social workers in that they have master's level training in a field other than social work. 

Requirements: Master's degree (M.S. or M.A.) in a mental health-related field such as psychology, counseling psychology, or others, and completion of 2-3 years of supervised post-graduate clinical experience
Licensure & Certification: varies by state and specialty.  Examples include:

• LCPC, Licensed Professional Counselor
• LMFT, Licensed Marriage and Family Therapist
• LCADAC, Licensed Clinical Alcohol & Drug Abuse Counselor

Prescribe and Monitor Medication

Psychiatrists

Psychiatrists are medical doctors who diagnose mental health medications, prescribe and monitor medications and provide therapy.

Degree requirements: Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO), plus residency training in psychiatry
Licensure & Certification: state physician licensure; board certification in psychiatry, additional board certification in Child & Adolescent Psychiatry

Psychiatric Nurse Practitioners

A psychiatric nurse practitioner is an advanced practice registered nurse trained to provide mental health care. They are qualified to diagnose patients with mental health disorders and to prescribe treatment.

Degree requirements: Master's of Science in Nursing with a specialization in psychiatric care
Licensure & Certification: State license; Board certification as Psychiatric-Mental Health Nurse Practitioner

Primary and Specialty Care Physicians

Primary care physicians prescribe more psychotropic medications than do any other group.  Many specialists and subspecialists prescribe psychotropic medications, particularly SSRIs, for their patients with chronic illness who see their subspecialist more often than they do their PCP.

Other members of multi-disciplinary teams who may be involved in mental health care

Medical Social Workers

Medical Social Workers play key roles in helping patients navigate health care systems, obtaining resources for patients and families, facilitating communication between patients and care teams, as well as finding and implementing solutions to challenges related to health and healthcare.

Degree requirements: Master's degree in social work (MSW)
Licensure & Certification: licensing through the Association of Social Work Boards; certification through state Boards of Social Work