Choosing a Level of Care: From Weekly Therapy to Crisis Help

In crisis or thinking about suicide? Call or text 988 now (in Colorado it reaches the 988 Colorado Mental Health Line). If you are in immediate danger, call 911.

When weekly sessions might not feel like enough

Maybe you have been in therapy for a while and things are getting harder, not easier. Maybe you are about to start and you honestly do not know how much help you need. Either way, it can feel like a big, scary choice to make alone.

It helps to know that care comes in levels, from a weekly appointment up to round-the-clock support. You do not have to pick the right one by yourself. A licensed clinician can look at what is going on and help you sort out where to start, and the level can change as things change.

This guide explains each level in plain words, the signs that more support may be needed now, and how to raise it with a therapist. If you are a parent of a child who is missing school, the site's guide to when weekly therapy is not enough for school refusal covers programs for young people.

The levels of care in plain words

The Substance Abuse and Mental Health Services Administration (SAMHSA) describes where care happens in a few broad settings. Programs differ, so treat these as general descriptions, not rules.

• Standard outpatient. Like a regular doctor's visit: you come to an appointment and leave the same day. SAMHSA describes it as suited to people who can make and keep regular appointments, and how often you go depends on the care you need. It can happen in person or by telehealth.
• Intensive outpatient (IOP) or partial hospitalization (PHP). Still outpatient, so you go home after. These programs can include one-on-one sessions, groups and learning coping skills, and SAMHSA says they usually last at least a few hours.
• Inpatient. You stay overnight at a hospital or program for a few days or weeks. SAMHSA says this is usually for people who need 24-hour care, and most programs are connected to a hospital or clinic.
• Residential. You live at a treatment program. SAMHSA says it usually lasts a few weeks to a few months, and longer for more serious conditions.
• Interim care. If there is a waitlist, SAMHSA notes that interim care can help keep you safe until a spot opens.

Signs that more support may be needed now

If you are thinking about suicide, call or text 988 now. If you or someone else is in immediate danger, call 911. You do not need to wait for your next session.

The National Institute of Mental Health (NIMH) lists warning signs that someone may be thinking about suicide. They include talking about wanting to die or being a burden, feeling trapped or hopeless, making a plan or researching ways to die, giving away important things, and using drugs or alcohol more often. NIMH says to get help as soon as possible, especially if a sign is new or has increased.

Other signs are less urgent but still worth raising soon. None of these is a diagnosis. They are reasons to ask whether your current level of care still fits:

• You are struggling to stay safe between sessions.
• Things keep getting worse even though you attend and practice.
• You can no longer manage work, school or basic self-care.
• You are leaning on alcohol or drugs to get through the day.
• The people around you are worried about your safety.

Crisis help in Colorado

In Colorado, calling or texting 988 reaches the 988 Colorado Mental Health Line, which is free, confidential and open 24/7. You can also go in person. 988 Colorado lists walk-in crisis centers across the state, including Denver, Aurora, Littleton and Wheat Ridge in the metro area.

Colorado's Behavioral Health Administration (BHA) says walk-in centers are open 24/7/365 and have no overnight beds. Staff can meet with you and help you plan next steps. If you need more than 23 hours of help, they will find another place that can help.

The BHA also describes mobile crisis response: when 988 Colorado sends a team, crisis professionals come to where you are, and the teams do not include law enforcement. Crisis stabilization units offer short-term, 24-hour care by referral.

How to talk with your therapist about stepping up or down

Raising this can feel like admitting failure. It is not. Changing the level of care is a normal part of treatment, and therapists usually welcome the question. You might say, "I'm not sure weekly sessions are enough right now. Can we talk about other options?"

Careful therapists usually walk through a few things with you:

• What they are seeing that points to more or less support, and why.
• Which type of program they would suggest and how to find one.
• Whether they can stay in touch with the program, with your written permission.
• What stepping back down could look like when things settle.
• How you will both know the plan is working. The guide on whether therapy is working covers this.

Stepping back down is part of the plan

Moving to more support is not a one-way door. Some people use a program for a while and then return to weekly therapy or a skills group once things are steadier. It is reasonable to ask a program early on what the step after it will look like, so you are not left without care when it ends.

Before you leave a higher level of care, it can help to have a few things in writing: who your outpatient therapist will be, when your first appointment is, what to do if things get worse again, and who to call after hours. If you are unsure how long any of this tends to take, the guide on how long therapy takes explains what changes the timeline.

What Mountainside offers, and when to look elsewhere

Mountainside is an outpatient practice. It offers individual, couple and family therapy, an adult DBT skills group and a teen multi-family DBT skills group, in Greenwood Village and by secure video for clients located in Colorado. It does not list intensive outpatient, partial hospitalization, residential or inpatient care, and it does not prescribe medication.

If you need one of those services, the Denver mental health resources page is a place to start, and SAMHSA's FindTreatment.gov (opens in a new tab) is a confidential search tool for treatment programs. For questions about medication, the guide on therapy, medication or both explains who prescribes.

If weekly outpatient therapy or a skills group sounds like the right level, you can request a free 15-minute consultation. A therapist can help you think through fit, and say so if a different level of care looks safer.

Frequently asked questions