When Outpatient Isn’t Enough: Signs You May Need a Higher Level of Care
Sometimes, even when you’re doing “all the right things,” it still feels like you’re barely keeping your head above water. You’re going to therapy, taking your meds, and trying to hold it together — but you’re still struggling.
Outpatient mental health treatment works well for many people. But when symptoms become severe and unpredictable, inpatient care can offer the extra structure and safety necessary to recover.
Recognizing when outpatient therapy isn’t working and your care needs to be stepped up prevents bigger crises and gets you on the path to real recovery faster.
On this page, we’ll walk through the signs that indicate outpatient care is no longer enough and what a higher level of care — a partial hospitalization program — looks like.
What Is Outpatient Care?
Now, how does this compare to inpatient care or a partial hospitalization program (PHP)?
In inpatient mental health treatment, you’re admitted to a facility because the symptoms are too severe or risky to handle at home. You stay at a hospital day and night, with 24/7 monitoring and support.
A PHP is a step down from inpatient care. In PHP, you spend most of your day, usually around five to six hours, in group and individual therapy, but return home in the evenings.1 It’s ideal when you need structure and daily support but feel stable enough to sleep at home.
Who Can Benefit From Outpatient Care?
When you’re struggling with your mental health day in and day out, you may wonder whether getting therapy once or twice a week is enough. You’re not alone in this thought. Fortunately, as long as the right support systems are in place, you will benefit from outpatient care. This is particularly true in the following circumstances:
- You’re emotionally drained or feeling stuck but still able to manage daily responsibilities.
- You’re transitioning from a hospital stay or intensive program and need continued support.
- Your home is relatively stable, and you’re not at immediate risk of self-harm or harming others.
- You’re managing long-term conditions like depression, anxiety, or post-traumatic stress disorder (PTSD) and need regular therapy or medication management.
- You’re motivated to heal and willing to apply what you learn between sessions.
Signs Outpatient Mental Health Care Isn’t Enough
Outpatient care is the starting point for many people seeking mental health support. But there are times and circumstances when you may need more structured support than outpatient care can give.
If your symptoms are too severe or unstable to manage without 24/7 care, more intensive care is highly recommended.
Mental Health Symptoms That Require Higher-Level Care
Here are four signs that require more than outpatient care:
1. Self-Harming Behavior
The same goes for self-harm. Cutting, burning, or other forms of self-inflicted injuries signal deep emotional pain that requires daily monitoring and structured intervention.
2. Loss of Basic Functioning
Some people who are struggling with severe mental health difficulties stop eating regularly, avoid leaving the house, withdraw completely from others, or struggle to manage their hygiene or do daily tasks. These are all signs of worrying mental health decline where inpatient therapy may be beneficial.
3. Unstable Mood or Behavior That Disrupts Daily Life
It’s not uncommon for people to cycle in and out of emotional emergencies while technically remaining “in treatment.” In such cases, a more intensive setting can stop the cycle.
4. Lack of Progress or Worsening Symptoms Despite Treatment
Outpatient care is typically built around slow, steady progress. But if someone has been consistent with therapy and medication and still feels worse or stuck in the same patterns, it is not the person’s effort that’s the problem.
Instead, it may be that the treatment setting isn’t intensive enough. This is often when a step-up to a higher level of care brings the momentum needed for real change.
Crisis Situations That Require Inpatient Care
Inpatient care also becomes necessary when there is a clear and immediate risk to safety. The following mental health warning signs require inpatient care:
- Active suicidal intent with a plan and means (for example, access to pills and weapons or prior attempts).
- Recent self-harming behaviors that pose a medical risk or cannot be safely managed at home.
- Aggression or threats toward others, especially if driven by delusions, paranoia, or loss of impulse control.
- Abuse, neglect, violence, or constant conflict at home. Inpatient care is also needed if someone is isolated and has no reliable adult to monitor their condition or intervene during a crisis.
- Psychotic symptoms like hallucinations or delusions that make it difficult to distinguish what’s real from what’s not. An example is a belief that someone is trying to harm you when they’re not.
- Struggling to maintain everyday functions, such as not eating for days, refusing all medications, or not sleeping at all.
Moving From IOP to PHP: Next Steps in Treatment
IOP requires going to a mental health facility three to four days a week for two to three hours a day. You can keep up with work, school, or life at home while getting support. PHP, on the other hand, is more intensive. It’s five days a week for about five to six hours each day. Transitioning from outpatient to residential mental health support gives you the stability you need in your daily life and social interactions, which you may not be able to manage on your own at this time.4
PHP fills the in-between space — you don’t need hospitalization, but you need more than a few therapy hours per week where:
Emotions are addressed in real time, rather than saved for next week’s session.- Medication changes are closely monitored, so adjustments are safer and more effective.
- Family support can be integrated if home dynamics are affecting recovery.
An average day in PHP includes:
Check-in and goal-setting- Multiple group therapy sessions focused on coping skills, emotional regulation, trauma work, or interpersonal skills
- Breaks for meals and rest
- Individual therapy and medication management sessions woven into the week
- On-site support staff to intervene during emotional crises
Creating a Care Plan for Intensive Treatment
A care plan is a personalized guide that outlines your treatment goals and the support you need throughout the program. Here’s a guide about what to include when creating a care plan for intensive treatment:
- List your main symptoms and triggers, like suicidal thoughts, mood swings, panic attacks, or emotional shutdowns, so your team knows where to focus.
- Set clear, realistic goals, such as “stay the full day” or “speak once in a group”.
- Since PHP is non-residential, identify any home barriers like lack of privacy or emotional support to help the team identify the need to involve your family or offer resources.
- Include emergency contacts and crisis strategies for evenings and weekends, when the program isn’t running.
- Schedule recovery time at home, including quiet routines, simple meals, rest, journaling, or calming routines, to help you recharge.
Inpatient Treatment at Mission Connection
At Mission Connection, inpatient treatment is built on a strong clinical foundation and delivered with compassion, warmth, and a deep respect for each person’s journey.
We have created a structured, supportive space that is never cold or judgmental. At the heart of our program is the Recovery-Oriented Cognitive Behavioral Therapy (CT-R) model. It is a clinically proven, research-backed approach that goes beyond just managing symptoms.
Unlike traditional cognitive behavioral therapy that focuses on symptom relief, CT-R helps individuals rediscover a sense of identity and build real-world skills.
You’ll work with licensed therapists to understand what drives you and how to use your strengths to move forward. You’ll also practice managing emotions, building healthier relationships, solving problems, and most importantly, creating a life that feels worth living.
Reach Out for Mental Health Support Today
If you’ve read this far and see some of your own struggles reflected, know that help is available, and it’s closer than you think.
At Mission Connection, we provide mental health services tailored to meet you where you are. Our team offers evidence-based care built on the CT-R in inpatient, PHP, outpatient, and telehealth settings.
We offer specialized treatment for:
- Trauma, using trauma-informed CT-R to help you process safely and rebuild emotional resilience
- Depression, focusing on rewiring depressive thought patterns and helping you re-engage with life
- Bipolar disorder, combining CT-R and medication to stabilize mood and build structure
- Anxiety, teaching you how to challenge anxious thoughts/triggers and build lasting calm
Call us today at 866-338-4958 or get started online to begin your journey to mental wellness.
References
- American Academy of Child & Adolescent Psychiatry. (2023). Continuum of Mental Health Care. https://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/FFF-Guide/The-Continuum-Of-Care-For-Children-And-Adolescents-042.aspx
- World Health Organization (2015). Hospitalization for persons with self-harm. https://www.who.int/teams/mental-health-and-substance-use/treatment-care/mental-health-gap-action-programme/evidence-centre/self-harm-and-suicide/hospitalization-for-persons-with-self-harm
- Keita Tokumitsu, Norio Yasui-Furukori, Adachi, N., Kubota, Y., Watanabe, Y., Miki, K., Takaharu Azekawa, Koji Edagawa, Eiichi Katsumoto, Hongo, S., Goto, E., Ueda, H., Kato, M., Nakagawa, A., Kikuchi, T., Tsuboi, T., Watanabe, K., Shimoda, K., & Yoshimura, R. (2023). Predictors of psychiatric hospitalization among outpatients with bipolar disorder in the real-world clinical setting. Frontiers in Psychiatry, 14. https://doi.org/10.3389/fpsyt.2023.1078045
- Schene, A. H., & Gersons, B. P. R. (1986). Effectiveness and application of partial hospitalization. Acta Psychiatrica Scandinavica, 74(4), 335–340. https://doi.org/10.1111/j.1600-0447.1986.tb06251.x
