Are Intensive Outpatient Treatment Programs the Future of Mental Health?

Are Intensive Outpatient Treatment Programs the Future of Mental Health?

Are Intensive Outpatient Treatment Programs the Future of Mental Health?

Millions of Americans are affected by mental health conditions every year. It is challenging to turn on the TV or scroll through your favorite news website without seeing a report focused on mental health disparities like the opioid overdoses in the Midwest, the rise in anxiety and depression among young adults, or increase in suicidal ideation and attempts among teens. Approximately 1 in 5 adults in the U.S. (46.6 million) experiences mental illness in a given year. Every day, more than 130 people in the United States die after overdosing on opioids, and suicide is the 10th leading cause of death in the U.S.,and the 2nd leading cause of death for people aged 10–34.

At times, the pervasiveness of mental health issues feels overwhelming and the solutions insurmountable. Yet, as mental health problems evolve, so have the treatment possibilities. One of these evolving treatment structures that has shown success is intensive outpatient treatment programs. An intensive outpatient program (IOP) is a kind of treatment service and support program used predominantly to treat eating disorders, bipolar disorder (including mania; and for types I and II), unipolar depression, self-harm, and chemical dependency. IOP’s often operate on a small scale and do not require the rigorous residential or partial day services typically offered by the larger, more comprehensive treatment facilities. 

Unfortunately, only about 41% of adults in the U.S. with a mental health condition received mental health services in 2017. Among adults with a serious mental illness, 62.9% received mental health services in the past year. Furthermore, serious mental illness costs America $193.2 billion in lost earnings per year. So many individuals do not get the care that they need. IOPs could help close this gap.

IOP’s are a type of clinical service that was established in the early 1990s as a response to managed care organizations costs. The goal was to offer a cost-effective alternative to hospitalization and day treatment by emphasizing the transition from more serious levels of care. They also served as an alternative to hospitalization and day treatment for outpatients in crisis.

IOP’s work to improve a patient’s functioning in the community by offering a more rigorous level of structure and support than was previously available for outpatients in their home communities. The programs offer psychotherapy and integrated group treatment. The time commitment expected of clients can vary. At their finest, IOP’s offer a therapeutic milieu where patients feel heard and understood with minimal intervention by practitioners. Some IOP programs today provide services beyond mental health integrating with community resources to provide support with medication management, jobs, insurance, and housing.

So how is outpatient support different from inpatient care? Even more importantly, how do IOP’s compare with in-patient care facilities in effectively treating mental health issues. Inpatient care is the most intensive level of treatment for individuals suffering from mental health and addictive disorders. It offers 24-hour care in a safe and secure facility, making it best for patients with severe mental health or substance abuse issues who require constant monitoring. The inpatient environment is highly structured and emphasizes understanding the signs of psychiatric illness, rapid stabilization through medication management, developing strategies to avoid re-hospitalization, and discharge planning. Patients in inpatient care programs can work on rebuilding life skills without exposure to negative influences that fuel the urge to continue destructive behaviors.

For many clients who suffer from severe mental illness and/or substance use issues both levels of care may be needed. The challenges with inpatient care are that many clients have difficulty uprooting their lives, leaving their jobs and families for, often up to 90 days of intensive care in a secure facility. Stepping down from hospitalization or partial-hospitalization to an IOP has a number of advantages for clients. An IOP gives clients the flexibility to maintain their responsibilities at home while receiving regular therapy and support. Many clients have children that require continued supervision and care. Other clients may have a partner that works and are not able to schedule or pay for a full-time childcare. Outpatient programs can offer the freedom and flexibility needed to support the busy lives of clients. Inpatient care can also feel isolating, separating a client from family, friends, and community. The difficulty is that often the family, friends, and community are contributing to the mental health issue. IOP’s focus on assisting clients in developing healthy supports and behaviors at home in their communities. IOP’s enable clients to develop relationships with others in program further expanding their community relationships. Maybe the most important benefit for clients and their families is that IOP’s are generally much more cost effective than inpatient care. The cost of inpatient vs outpatient care varies by state and hospital, however hospitalization in California averages roughly 2,000-3,000 a day and could be much higher depending on services. 30-90 day treatment often runs in the tens of thousands of dollars without insurance. Generally, outpatient care runs under 10,000 for a full program

So, if intensive outpatient care is the cheaper option how does it compare to inpatient treatment when it comes to results. Historically there has been an attitude that if one can afford inpatient care, it is the better option because of its “controlled” environment and extensive stabilization services. However, research suggests that when compared to inpatient care, IOP treatment had comparable outcomes. McCarty et al, (2014) examined 12 studies between 1995 and 2012. Multiple randomized trials and naturalistic analyses compared IOPs with inpatient or residential care. The evidence for IOP efficacy was strong. Although the research showed some differences in results depending on disorder severity, all studies reported significant decreases in alcohol and drug use between baseline and follow-up visits.

With the prevalence of mental health issues in the US, intensive outpatient programs are increasingly becoming more relevant because of their cost effectiveness, ability to support clients in their communities, and effectiveness in reducing mental health symptoms. The current research shows the benefits of IOP level of care. Despite changing research methods and study populations, results are consistent—patient outcomes from inpatient, residential, and intensive outpatient services are positive and more similar than different. The challenges of mental health in the U.S. will continue to change, and mental health institutions need to change with it. The flexibility and sustainability of IOP’s will be a fundamental part of this change moving forward.

Resources

Any Mental Illness (AMI) Among Adults. (n.d.). Retrieved May 1, 2019, from https://www.nimh.nih.gov/health/statistics/mental-illness.shtml#part_154785

Insel, T.R. (2008). Assessing the Economic Costs of Serious Mental Illness. The American Journal of Psychiatry. 165(6), 663-665

McCarty, D., Braude, L., Lyman, D. R., Dougherty, R. H., Daniels, A. S., Ghose, S. S., & Delphin-Rittmon, M. E. (2014). Substance abuse intensive outpatient programs: assessing the evidence. Psychiatric services (Washington, D.C.)65(6), 718–726. doi:10.1176/appi.ps.201300249

National Institutes of Mental Health (2018). “Suicide.” Retrieved December 6, 2018, from https://www.nimh.nih.gov/health/statistics/suicide.shtml

Smith, George; Ruiz-Sancho, Ana; Gunderson, John (Apr 2001). “An intensive outpatient program for patients with borderline personality disorder”. Am Psychiatric Assocdoi:10.1176/appi.ps.52.4.532

Substance Abuse and Mental Health Services Administration, Results from the 2014 National Survey on Drug Use and Health: Mental Health Findings, NSDUH Series H-50, HHS Publication No. (SMA) 15-4927. Rockville, MD: Substance Abuse and Mental Health Services Administration. (2015). Retrieved October 27, 2015 from https://www.samhsa.gov/data/sites/default/files/NSDUH-FRR1-2014/NSDUH-FRR1-2014.pdf