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Levels of Care

Reviewed by: HU Medical Review Board | Last reviewed: September 2023

Bipolar disorder (BPD) is a common mental health condition that causes dramatic mood swings. These mood swings are not the same as the highs and lows that everybody feels. Bipolar mood cycles usually require lifelong outpatient care. At times, inpatient care may be needed, too.1

Outpatient care refers to appointments with doctors and therapists that are held in clinics. It also includes telehealth appointments, which occur online. People live at home or in a supportive residence while receiving outpatient care. Inpatient care requires a person to live in a hospital or other facility where around-the-clock care is provided. A person with BPD may need one or both of these levels of care during their lifetime.2

Whether a person can be treated most effectively with outpatient or inpatient care depends on the severity of their symptoms and their safety. For example, someone who is extremely depressed and planning suicide needs inpatient care. Someone who is less severely depressed and still able to work or go to school may do well in outpatient care.1

Outpatient care

Clinic-based health services fall in the category of outpatient care. Most people with BPD receive outpatient care because it is more widely available. It is also what insurance will most often pay for. Outpatient treatment can be highly effective in managing most people’s care most of the time.1,2

Outpatient care includes a wide variety of services, including:1,2

  • Doctor’s appointments to monitor overall health and how well medicines are working
  • Individual therapy and education sessions to help manage stress
  • Family and group counseling
  • Detox support for those with substance use issues
  • Telehealth appointments
  • Intensive outpatient programs
  • Case management
  • Peer support groups

Telehealth

Telehealth is a service that lets patients connect with a healthcare professional on the internet. People can interact with doctors from a different building or even a different city.3

Telehealth can be helpful for people who have trouble finding transportation to appointments. It also might be necessary for those who live in a part of the country with few professionals experienced in bipolar treatment. Sometimes, telehealth appointments can replace office visits.3

Interim outpatient programs

Interim outpatient programs provide a level of care that falls between outpatient care and inpatient care. The person is able to live at home, but they may attend treatment sessions at a clinic or other facility for several hours per day. These sessions may include:2

  • Prescription drug management
  • Mood monitoring
  • Talk therapy
  • Support groups

Studies have shown that intensive outpatient care can be highly effective in treating BPD and substance use disorder. It is also used when there is a long wait list for more intensive inpatient care.2,4

Crisis home support

With crisis home support the person in crisis lives in a home with a trained “professional family.” This “family” provides practical and emotional support and mental health workers visit the home daily to continue treatment.5

Inpatient care

Bipolar mood swings may be so severe that they affect the person’s safety and ability to function. If bipolar mania or depression is this intense, the person may need full-time care to support them until their moods stabilize. These around-the-clock services may be called inpatient hospital care, crisis stabilization units, or extended observation units.2,5

A person with BPD may need inpatient care if they meet certain standards. These standards take into account whether the person:1

  • Is a danger to themselves or others
  • Has delusions or hallucinations which would lead to unsafe behaviors
  • Is catatonic (totally unresponsive) or mute (unable to speak)
  • Has a total inability to meet their or a dependent’s needs
  • Has a total loss of control, such as undertaking a dangerous trip or spending all of their money
  • Has serious exhaustion due to long-term lack of sleep or food
  • Needs close monitoring of their medicines

There are a couple of types of inpatient care: detox and short-term. Crisis home support is considered outpatient care.2

Detox

Inpatient and outpatient detox treatment may be needed for some people with alcohol or drug use disorder. Stopping some substances suddenly can be painful or even dangerous. Detox treatment programs can help guide people through the process and treat them medically to remain safe. These programs last from a few days to a few weeks.2

Short-term treatment

Short-term inpatient treatment may last from a few days to a few weeks. This type of stay helps stabilize a person’s moods through drug treatment and daily therapy sessions.2,5

People who have been living in an inpatient treatment program may need a transition program to help them succeed in independent living.2

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