By Cassandra Roos
There are many ways that lack of information about the realities of mental health interventions disturb me. One issue I would like to focus on is a form of therapy and rehabilitation called Intensive Outpatient Therapy (IOT), Intensive Outpatient Program (IOP), or Partial Hospitalization. For this blog article I will refer to this treatment as IOP. I feel the need to shed light on what IOP entails because it can often be incredibly overwhelming and patients may not understand what they are participating in for maybe a couple of months or even after a couple of different times attending one.
My goal is to try to raise awareness in the general public about forms of therapy beyond one-on-one talk therapy and medication. I want to spread awareness about the various types of group therapy models other than Alcoholics Anonymous and Narcotics Anonymous. I find that most mental health professionals are so immersed in research and treatment that they are unable to address the persistent myths surrounding successful interventions for mental illness. Legislators and activists can also get trapped in a bubble. There must be some other way to let more people know about the realities of intensive treatment post-hospitalization. Even the Wikipedia pages for these types of treatment are sparse. I was disturbed to find that the search bar on mentalhealth.gov brings up no results for any terms related to “intensive outpatient treatment” “intensive outpatient therapy” or “partial hospitalization.”
What is an Intensive Outpatient Program? Intensive Outpatient Therapy is used as treatment after a hospital stay or as a more serious means to prevent psychiatric hospitalization. IOPs treat patients with mood disorders, anxiety, chronic suicidal ideation, situational conflicts, and personality disorders. Patients with co-occurring disorders, when a mental illness and substance abuse disorder occur simultaneously, also attend IOPs. Sometimes those with co-occurring disorders are placed in a separate IOP. IOPs are used for patients with a high suicide risk because the program has built-in concrete and extensive monitoring and assessment methods to evaluate a patient’s condition. Even if someone misses a day the provider will usually try to contact the patient or their emergency contacts to assess suicide risk and check in.
What are some of the different types of treatments used in IOP? IOP is based around group therapy and the benefits of learning from others. There are common treatment methods used within IOPs including Dialectical Behavioral Therapy (DBT), Cognitive Behavioral Therapy (CBT), distress tolerance, interpersonal relationship skills, mindfulness, emotional regulation, and free form talk therapy. There are activities and skill building techniques unique to IOPs that are difficult to achieve in a one-on-one setting. The nature of the treatment urges you to go home and review skills and try to actively apply them to real life situations.
When are people referred to IOPs? People are commonly referred to IOPs in a discharge plan given to them by an inpatient hospital. When a patient is discharged from a psychiatric inpatient unit, it is helpful for them to attend a “step-down” program, which is often an IOP so that the patient’s progress can be monitored and changes in medication can also be made more easily. The IOP can also help a patient process and cope with their recent hospital stay. Other times individual therapists may recommend an IOP when a patient’s case is too complex for them to handle and current treatment is not enough. This is also a good option because an IOP can help avoid a crisis and prevent a person from an inpatient hospital stay.
What does an IOP entail? Often family members do not know what IOP entails. IOP is a program a patient must remain dedicated to, and in order to work best, should become that person’s sole focus. Of course, this is not financially and logistically feasible for many people, and in that case, often clinics will help with arrangements and provide case workers or other options. For those who are able and/or required to attend an IOP, it is usually around 3-4 hours three or more days a week. Usually attending the IOP for its entirety takes around 12-15 weeks. Initially, this throws many people off because they cannot simply imagine spending almost 12 hours a week for months at a time on healing their brain.
What are the benefits of IOP? IOPs are extremely helpful in monitoring new medication changes over short periods of time. Often people need to be monitored more closely when they are changing medication and need fairly regular adjustments in the beginning stages. Being linked to a clinic and IOP can gain you easier and faster access to your medication provider, who is always separate from the social workers and psychologists who work on therapy. For example, during the first two weeks after my most recent hospital stay I needed my medications changed three times, and if I hadn’t been in the IOP I would have had to go back to the hospital because it was that serious.
In conclusion, everyone’s life circumstances will determine the feasibility, eligibility, and necessity of attending a more intensive treatment program. I personally would feel more validated if I could spread awareness about these programs so people with severe mental illness who attend them, often multiple times, do not feel trapped within this invisible system. Everyone has different symptoms and diagnosis that determine what kind of IOP is right for them. Upon an extensive intake, a clinic will formulate an individual treatment plan with goals and a course of action with each patient for them to review and approve. You have rights as a patient to know your treatment plan and get a paper copy of it if it applies.
Please call a local clinic or speak to your individual therapist, child’s school social worker, or local clinic about your options if you find your traditional outpatient therapy is not doing enough. If you or a family member just got out of the hospital for an inpatient stay and IOP was recommended I strongly consider you look into it. If you are dealing with a situation where a form of IOP is court mandated I hope you can learn to benefit from it or if you are a family member dealing with this I encourage you to do any research you can into what these programs are like and why they are necessary for certain people.
This website provides a list of some options for IOPs in Connecticut https://treatment.psychologytoday.com/rms/prof_results.php?state=CT&spec=223. You can also contact the Yale Psychiatric Hospital Outpatient Services (for adolescents as well) at 203-688-3182 and inquire about the programs there. It can be incredibly difficult to get into a program or figure out if your insurance will be taken unless an outside provider recommends you or you are admitted to a clinic directly from an inpatient hospital stay. It may also take 30-60 days to get an appointment. In case of emergency or if you feel you cannot wait that long for more intensive treatment, you should go to the nearest emergency room. Sometimes you will not even be admitted to the hospital itself, but they have doctors there who can assess you and get you services exponentially faster than you can yourself. It is scary but it is scarier to be alone on the outside and does not make you weak for seeking more serious help. And if you have already crashed and burned and you are starting an IOP or have a family member who is you are not alone and I encourage other people to share their experiences and normalizes this very successful form of treatment.