Levels of Care for Suicidal and Self-Harm Thoughts

Making the decision to start therapy can feel overwhelming. Once that decision is made, many people find themselves facing an additional challenge: understanding their options. Common questions often include: What am I looking for in a therapist? Should I use insurance? Do I want in-person or virtual sessions? And importantly—what level of care do I need?

When someone is experiencing suicidal thoughts or urges to self-harm, determining the appropriate level of care is especially important. Level of care refers to the intensity of treatment and support a person needs. In mental health treatment, there are generally four levels of care, and it can be helpful to think about them through the lens of safety. As the level of care increases, concerns about safety increase as well, and additional structure and support are provided.

1. Outpatient Therapy

Outpatient treatment typically consists of regularly scheduled therapy sessions with a counselor in a private practice or clinic setting. Sessions may occur weekly, biweekly, or monthly, depending on individual needs.

This level of care is appropriate for individuals working through a wide range of concerns, which may include passive suicidal thoughts or self-harm thoughts, as long as the individual is able to maintain safety. Passive suicidal thoughts generally refer to thoughts about wanting to die or not wanting to exist, without a plan or intent to act on those thoughts.

Outpatient therapy focuses on building insight, developing coping skills, and maintaining progress while the individual continues to live their day-to-day life.

2. Partial Hospitalization Programs (PHP) and Intensive Outpatient Programs (IOP)

PHP and IOP are often referred to as day programs, as individuals do not stay overnight at the facility. These programs typically involve 3–4 hours of therapy per day, 4–5 days per week, for approximately 4–8 weeks. Some programs operate during daytime hours, while others offer evening options to accommodate school or work schedules.

PHP and IOP provide a higher level of support than traditional outpatient therapy and are designed to help individuals stabilize while still practicing coping skills at home. These programs are often recommended for individuals experiencing active or passive suicidal thoughts, increased self-harm urges, or difficulty maintaining safety on their own.

Treatment is usually group-based, though many programs also include individual therapy, family sessions, and medication management as part of a comprehensive treatment plan.

3. Inpatient Treatment

An inpatient stay involves receiving care at a hospital or treatment facility 24 hours a day, typically for 3–10 days. Individuals are generally referred to inpatient treatment when they are experiencing active suicidal thoughts, meaning there is a plan and/or intent to act, or when they are engaging in self-harm and do not feel able to keep themselves safe.

The primary goal of inpatient treatment is to establish immediate safety. Inpatient programs are highly structured, often include daily group therapy, access to psychiatric care for medication management, and may also offer individual therapy and family sessions.

4. Residential Treatment

Residential treatment differs from other levels of care in both duration and environment. Individuals live full-time at a treatment facility for an average of 3–4 months. This level of care allows for removal from one’s current environment in order to focus fully on healing and long-term change.

Residential treatment is often recommended for individuals who have previously tried outpatient therapy, PHP/IOP, and/or inpatient treatment—sometimes multiple times—and continue to struggle with safety or daily functioning. Many individuals report that once they return home from lower levels of care, they quickly fall back into unhealthy patterns or find it difficult to maintain progress.

Residential programs typically include group therapy, individual therapy, family sessions, psychiatric care, and medication management. Many also incorporate experiential and holistic approaches—such as equine therapy, meditation, art-based activities, and movement—to help individuals develop new coping skills and routines.

In Summary

• Outpatient therapy focuses on maintaining safety and progress

• PHP/IOP focuses on stabilizing safety

• Inpatient treatment focuses on establishing safety

• Residential treatment focuses on removing environmental barriers to safety

Disclaimer: This blog post is intended for informational purposes only and is not a substitute for professional medical or mental health advice. Duration and structure of treatment may vary by facility and individual needs.