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Summary: The difference between intensive outpatient and partial hospitalization treatment in mental health care is the level of immersion required for the patient participating in the treatment program.

Key Points:

  • Intensive outpatient programs (IOP) and partial hospitalization programs (PHP) are designed to meet different patient needs.
  • Both types of programs support people with a wide range of mental or behavioral disorders.
  • Neither IOP nor PHP programs require patients to live at the treatment facility.
  • Both types of programs are more immersive than typical outpatient programs, and less immersive than residential treatment programs.

How Do Patients Decide Between Intensive Outpatient and Partial Hospitalization Programs?

When a person receives a diagnosis for a mental health disorder, they also, in most cases, receive a referral for treatment at a specific level of care. This is true for virtually all types of mental health disorders, including, but not limited to:

However, sometimes a patient doesn’t receive a referral for a specific level of care, but rather, receives a referral for a more complete evaluation or assessment, called a full psychiatric evaluation of a comprehensive biopsychosocial assessment.

  • Biological: information about past and present medical conditions, including family medical history
  • Psychological: information about past and present mental health conditions and treatment, including family mental health history
  • Social Info: information about present and past family and peer relationships, work history, personal details, and current risk/protective factors
  • Spiritual/Religious: information on any practices or points of view that may impact treatment
  • Cultural Background: information on traditions or norms that may impact treatment

After a comprehensive evaluation of this type – administered by an experienced, qualified, mental health professional – a patient with a clinical mental health disorder will likely receive a referral for a specific level of care, which may include:

We’ll discuss how providers determine which level of care may be appropriate below. We’ll also focus on the primary topic of this post: the difference between intensive outpatient and partial hospitalization treatment.

Levels of Care: Understanding the Difference Between Intensive Outpatient and Partial Hospitalization Treatment

At this point in the process, a patient will understand they need some form of professional support, and need to decide what’s best for them, their family, and their overall goals for treatment and recovery. Part of this decision process involves learning that providers assign or recommend the appropriate level of care for each patient based on three factors:

1. Acuity:
    • The level of acuity of the symptoms: how severe are they right now?
2. Severity:
    • The level of severity of the disorder: how disruptive the symptoms are on a day-to-day basis, and now much they impair daily life.
3. History:
    • Treatment history: a patient with an unsuccessful treatment attempt at a specific level of care may receive a referral for a different level of care, depending on provider assessment of acuity and severity.

We list the levels of care, above, in order of their relative levels of intensity and immersion. Think of the levels of care as points on a continuum of intensity and immersion, with outpatient treatment at one end of the continuum, considered least immersive, residential treatment on the other, considered the most immersive, and intensive outpatient treatment and partial hospitalization in between.

We should also mention one more level of care before we continue: inpatient psychiatric hospitalization. This level of care is reserved for patients in severe crisis, who need around-the-clock medical observation by doctors or psychiatric nurses for safety purposes. The focus(es) of this level of care is/are safety and stabilization. While some treatment and therapy may occur at this level of care, the primary goal of psychiatric hospitalization is helping a patient through a severe mental health crisis in order to prepare them for treatment at a less immersive level of care.

Now let’s take a close look at the topic we’re most interested in: the difference between intensive outpatient and partial hospitalization treatment for mental health. We’ll start by describing intensive outpatient treatment, often called IOP.

Intensive Outpatient Programs (IOP)

On the continuum of intensity and immersion, intensive outpatient programs are one step up from outpatient treatment and one step down from partial hospitalization programs. IOP programs are appropriate for patients with symptoms that are disruptive and difficult to manage, but don’t prevent them from going to school, work, or living at home.

Note: some treatment centers may require IOP patients to live in treatment/recovery-friendly supportive housing, while others may not.

In general, patients in IOP programs receive three hours of evidence-based treatment per day, five days a week. Depending on the treatment center and life circumstances of the patient, IOP treatment may happen in the morning, early afternoon, or late afternoon. The goals of IOP treatment are the same as the goals for more immersive levels of care. Patients learn practical skills to help regulate emotions, manage the symptoms of mental health and/or behavioral disorders, and prepare patients for life after their official treatment program. This brings up one thing that IOP and PHP treatment have in common: in many cases, patients get to go home in the evening and practice applying the skills they learn during the treatment day.

Summary of IOP Treatment

  • Half day of care, typically 3-5 hours
  • Five days a week
  • Includes similar goals as more immersive levels of care
  • Includes similar components as other levels of care:
    • May involve treatment homework or assignments to complete in the evening
    • Attending evening peer support groups is often encouraged but not required
  • Most IOP patients live at home during IOP, but some may live in supportive housing
  • Best for patients with symptoms that are disruptive, but don’t prevent them from going to school or work

Now let’s take a look at the details about partial hospitalization treatment, often called PHP.

Partial Hospitalization Programs (PHP)

On the continuum of intensity and immersion, partial hospitalization programs are one step up from intensive outpatient programs and one step down from residential programs. PHP programs are appropriate for patients with symptoms that are very disruptive and very difficult to manage. For patients with symptoms that prevent/impair them from going to work or school, but not so disruptive they prevent them from living at home may

Note: some treatment centers may require PHP patients to live in treatment/recovery-friendly supportive housing, while others may not.

Most patients in PHP programs receive a full day of treatment – typically 5-6 hours – five days a week. The goals of PHP treatment resemble the goals for patients at more immersive and less immersive levels of care. Patients learn practical skills to help regulate emotions, manage the symptoms of mental health and/or behavioral disorders, and prepare for life after their official treatment program. This brings up one thing that IOP and PHP treatment have in common: in many cases, patients get to go home in the evening and practice applying the skills they learn during the treatment day.

However, because of the extended hours involved in PHP treatment, patients may dive deeper into their recovery, participate in a wider variety of group education and group processing workshops/classes, and engage more frequently in adjunct/complementary treatment modalities.

That’s an important difference between intensive outpatient and partial hospitalization treatment. Patients in PHP programs have more time to work on their challenges, process difficult emotions, and learn practical coping skills.

Summary of PHP Treatment

  • Full day of care, typically 6 hours
  • Five days a week
  • Includes same basic goals as more and less immersive levels of care
    • PHP patients have more treatment time
    • PHP patients may have group sessions in the evening
    • PHP patients often have evening treatment homework/journaling assignments
  • Many PHP patients live at home during PHP, but some may live in supportive housing either provided by or affiliated with their treatment center
  • PHP treatment is often best for patients with symptoms that are very disruptive and very distressing, prevent them from the ability to function well at school or work, but do not prevent them from living at home, or semi-independently in supportive housing

With the main difference between intensive outpatient and partial hospitalization clarified – time in treatment – we understand how PHP can help patients with symptoms that create significant disruption in their lives and prevent them from going to school or work, while IOP programs help patients with symptoms that are disruptive and difficult, but don’t prevent them from the ability to attend school or go to work.

Now let’s look at the similarities between these two levels of care, and identify the components most IOP and PHP treatment programs have in common.

Intensive Outpatient and Partial Hospitalization Programs: Core Features

High quality treatment centers create treatment plans in collaboration with patients and their families. That’s why the assessment, evaluation, diagnosis, and referral process is thorough. It helps providers learn everything they can about a patient, and patients learn everything they can about the clinicians and approach at their treatment center.

While plans start with clear goals and a path to reach them, the best plans change over time as patients make progress. They’re designed to be responsive, adaptable, and meet individual needs as they arise.

At the IOP level of care, treatment plan will include a combination of the following therapeutic approaches:

  • Psychotherapy:
    • Individual therapy
    • Group therapy
    • Family therapy

Therapeutic modalities include, but are not limited to cognitive-behavioral therapy (CBT), dialectic behavioral therapy (DBT), acceptance and commitment therapy (ACT), solution-focused therapies, EMDR (eye movement and desensitization reprocessing), trauma-informed therapy

  • Medication and medication management:
    • May include ketamine or Spravato® for patients with treatment-resistant depression
    • May include antidepressants, anxiolytics, and/or antipsychotic medication for patients with depression, anxiety, borderline personality disorder, or schizohrenia
  • Experiential therapy:
    • Yoga
    • Exercise
    • Mindfulness
    • Meditation
  • Education and workshops:
    • Healthy eating
    • Relationship coaching, e.g. help with family and peers
    • Healthy communication, e.g. setting boundaries and self-advocacy
  • Case Management
    • Basic life skills: including but not limited to things like cooking, shopping, daily hygiene
    • Vocational support: including but not limited to help searching for jobs, interviewing for jobs, and getting started in a new job, when appropriate

Patients work with their treatment team to fine-tune the plan. But in the end, each patient becomes the best expert on their own care. They decide what works, what doesn’t, and which elements of their plan gives them the best chance at achieving their long-term treatment goals.

About Case Management: Why It’s Important

Navigating the mental health treatment and recovery process can be overwhelming. At a high-quality treatment center, case managers take a proactive role from the start. They help everyone involved – from patients to family to providers – stay on track and working together toward mutually agreed upon goals.

Case managers learn about:

  • Individual treatment preferences
  • Recovery goals
  • Unique cultural, religious, or social needs
  • Personal motivations for recovery

With that information, they advocate for patients and ensure they get the appropriate care at the appropriate level at the appropriate time. They work to eliminate gaps in treatment and mitigate barriers to care. They use information from intake and assessment to guide treatment planning, monitor treatment progress, and plan for any support services patients need, based on individual circumstances.

Finding Help: Resources

If you or someone you know needs professional treatment and support for a mental health disorder or need to talk to someone to further clarify the difference between intensive outpatient and partial hospitalization treatment, please contact us here at Crownview Psychiatric Institute.

We can help.

In addition, you can find support through the following online resources:

About Angus Whyte

Angus Whyte has an extensive background in neuroscience, behavioral health, adolescent development, and mindfulness, including lab work in behavioral neurobiology and a decade of writing articles on mental health and mental health treatment. In addition, Angus brings twenty years of experience as a yoga teacher and experiential educator to his work for Crownview. He’s an expert at synthesizing complex concepts into accessible content that helps patients, providers, and families understand the nuances of mental health treatment, with the ultimate goal of improving outcomes and quality of life for all stakeholders.