Levels of Care

The main parts of schizophrenia treatment are antipsychotic prescription drugs and psychotherapy. However, each person’s treatment experience is different. There are many types of drug and therapy options for people with schizophrenia. The same options may have different results in different people.^1,2

In addition to these treatment options, there are also different levels of care. The level of care refers to how intensive a treatment plan is. Creating a safe, effective treatment plan depends on many factors working together. The right level of care for one person may not be right for another person. Some people may thrive in one setting, while others might not. This is why working with your doctor will help you develop a plan that works for you.^3-5

What are common levels of care?

Care can occur in different locations and involve different levels of professional attention. Some of the most common care settings are described below, in order from least to most intensive.^3-5

Outpatient care

This is the level of care someone might use for a long-term medical issue, like diabetes or high blood pressure. The exact schedule can vary, but most treatment is managed at home.^3-5

This means that a person with schizophrenia is able to take their drugs as prescribed and attend regular therapy sessions. They might visit their therapist once a week. They might also check in with their psychiatrist once a month for any drug changes.^3-5

Intensive outpatient care (IOP)

Intensive outpatient care is similar to outpatient care but more intensive. Someone in IOP still lives at home and functions mostly independently. The exact treatment schedule can vary, but it is typically 3 to 4 days a week of therapy, medical check-ins, and learning skills to manage your illness.^3-5

Partial hospitalization program (PHP)

Like someone in IOP, a person in a partial hospitalization program still lives at home. But they receive care more often, about 5 days per week. Each day may be 6 to 8 hours long. PHP care may include individual therapy, group therapy, and medical care. People in PHP may be able to focus more fully on their treatment because it is where they spend the majority of their day.^3-5

Residential care

In terms of intensity, residential programs fall in between PHP and hospitalization. People in residential care live wherever they are being treated. There are staff available to them all the time to provide support.^3-5

But the treatment center is not a true hospital setting. It is meant for people who might be unable to live at home or need to learn skills to live independently. Residential care can also be helpful for people transitioning back home after a hospital stay.^3-5

Hospitalization

During episodes of crisis or severe symptoms, hospitalization might be necessary. This is around-the-clock treatment in a hospital. It can be in a mental health hospital or a general hospital that has the ability to care for someone in crisis. This level of care is reserved for cases where it is needed to ensure safety.^3-5

The hospital is used to stabilize someone as quickly as possible and create a plan for continued support and safety at home, using community support or at a residential treatment center. Planning for return to the community should begin as soon as someone is admitted to the hospital.^3-5

Choosing the right level of care

The level of care needed for each person, and at different times in their life, will differ. It should be based on personal preferences and needs. The best treatment location and intensity will be a shared decision. You, your doctor, and your loved ones will ideally work together to find a solution that is safe and leads to the best quality of life with the least restrictions possible.^2-5

For example, a person might be on the same treatment plan for years without issues. This person will probably do well in outpatient care. Someone else might have problems completing daily activities and have no natural supports. They might need more support, like partial hospitalization or residential treatment.³

When is hospitalization necessary?

A common myth about people with schizophrenia is that they need to be hospitalized all the time. This is not the case. Many people with schizophrenia live full lives outside the hospital or more intensive care settings. Some people will never need to be hospitalized.⁶

Hospitalization is never ideal. But there are some reasons why it might be needed, including:^2,4,5,7

• Being at risk of killing yourself
• Being at risk of harming or killing someone else
• Having an active psychotic episode with dangerous behavior
• Needing nutritional support or rehydration if you have not been eating or drinking well
• Needing special tests or treatments that cannot be done at home
• Having severe drug side effects, like toxicity
• Needing attention for drug or alcohol use due to dangers of withdrawal

Understanding the decision to hospitalize

It is important to remember that going to the hospital does not mean you have failed at treating your (or a loved one’s) schizophrenia. Schizophrenia is a complicated condition that is hard to predict. Sometimes hospitalization is needed for faster, more direct attention. This care leads to better outcomes in the long run.^2,4,7

In some cases, whether or not to hospitalize is up to the person with schizophrenia and their caregivers. In other cases, especially those involving safety concerns, there may be laws that require hospitalization. These vary based on location, severity, and available support outside of the hospital.⁸

Ask your doctor about what factors are at play in your (or your loved one’s) situation. They can help you create a treatment plan that will keep you out of the hospital as much as possible. You should also discuss with your doctor about developing a psychiatric advance directive and safety plan to best prepare in the case of hospitalization.