The short answer
Most people start with outpatient care: scheduled visits with a therapist or a psychiatric prescriber while you live at home. An intensive outpatient program (IOP) adds several hours of treatment a week (Medicare’s rules set the minimum at 9), and partial hospitalization (PHP) is a day program of at least 20 hours a week for people who would otherwise need a hospital stay. Inpatient care means 24-hour care in a hospital. If you might harm yourself or someone else, or cannot stay safe, skip the comparison: call or text 988, or call 911. Willow & Stone provides outpatient care only.
- Outpatient care fits when scheduled visits are enough and you can manage daily life and stay safe between them.
- IOP and PHP are structured programs you attend for several hours a day while living at home; PHP is the more intensive of the two.
- Residential and inpatient care mean living at the treatment site, with the most support and supervision.
- Crisis care is separate from all of these: 988 is available by call, text or chat 24/7, and 911 is for immediate danger.
- FindTreatment.gov and your state’s resources page can help you find programs, including low-cost and public options.
The levels of care at a glance
Mental health and substance use care is often described as a ladder: the higher the level, the more hours of treatment and supervision. You can move up or down as your needs change, and many people step down to outpatient care after a program or hospital stay.
| Level | What it is | Time involved | Usually for |
|---|---|---|---|
| Outpatient | Scheduled visits with a therapist, a psychiatric prescriber or both, in an office or by telehealth | An hour or so per visit, weekly to monthly | People who can manage daily life and stay safe between visits |
| Intensive outpatient (IOP) | A structured program of therapy, groups and other services; you live at home | Medicare’s rules: at least 9 hours a week | People who need more than separate weekly sessions but not 24-hour care |
| Partial hospitalization (PHP) | A day program with a fuller schedule; you live at home | Medicare’s rules: at least 20 hours a week | People who would otherwise need inpatient psychiatric care |
| Residential | Live-in treatment outside a hospital | SAMHSA describes residential addiction treatment as lasting one month to a year | People who need a stable, supervised setting for longer-term treatment |
| Inpatient (hospital) | 24-hour care in a hospital unit | SAMHSA describes hospital inpatient care as lasting days or weeks | People who cannot stay safe or need round-the-clock care for serious mental or medical concerns |
| Crisis services | 988 (call, text or chat), mobile crisis teams, crisis stabilization centers | Right away, any hour | Anyone in a mental health or substance use crisis, or worried about someone who is |
The hour minimums come from Medicare’s rules (42 CFR 410.43 and 410.44), which are the clearest public definitions available. Private insurers, state programs and individual programs set their own criteria and schedules, so ask each one.
Outpatient care: what it covers and when it is enough
Outpatient care is the most common level. It includes psychotherapy, a psychiatric evaluation, medication management, and testing when it is useful, all on a schedule that fits around work, school and family. Telehealth outpatient care works the same way, by secure video from home.
Outpatient care tends to fit when you can keep appointments, take medication as planned, and get through the days between visits safely. SAMHSA’s FindTreatment.gov notes, in its description of outpatient addiction treatment, that because there is no overnight care, it helps to have a stable living situation and supportive family or friends. The same practical test applies to mental health care: the time between visits is where most of life happens.
Outpatient care can still be intense when you need it to be: more frequent visits, a therapist and a prescriber working together, or a short-term focused format such as a trauma intensive. Those are still outpatient care, not an IOP or PHP program.
Signs outpatient care may not be enough right now
None of these is a diagnosis or a rule. They are signs to raise with a clinician the same day, and some are emergencies:
- Thoughts of suicide, especially with a plan. NIMH’s warning signs include talking about wanting to die or being a burden, feeling hopeless or trapped, making a plan or researching ways to die, and giving away important items. Get help right away, particularly if the signs are new or getting worse: call or text 988, or call 911 if someone is in immediate danger.
- You cannot stay safe between visits, or the people around you are worried for your safety or theirs.
- You cannot carry out daily activities. SAMHSA lists “inability to carry out daily activities or handle daily problems and stress” among the common signs of mental health disorders: not eating, not getting out of bed, unable to work or care for children.
- You are losing touch with reality: seeing or hearing things others do not, or holding beliefs others around you do not share (delusions or hallucinations).
- Extreme mood changes, including uncontrollable “highs” or feelings of euphoria.
- Substance use that needs medical help to stop. Alcohol withdrawal can become life-threatening, and stopping a benzodiazepine abruptly can cause seizures; do not stop suddenly on your own. Supervised withdrawal (detox) is a first step, not treatment by itself.
- Repeated emergency visits or a recent hospital stay, where a step-down program would give more support than weekly visits.
- Outpatient care has not helped after a fair try, and symptoms keep getting in the way of your life.
If one of these applies to someone you love, you can call or text 988 on their behalf. The counselors support family members and friends who are worried about someone.
IOP and PHP: what the programs involve
Medicare’s regulations define both as “a distinct and organized intensive ambulatory treatment program that offers less than 24-hour daily care other than in an individual’s home or in an inpatient or residential setting” (42 CFR 410.2). In plain terms: you go to a program for part of the day, then go home. Services can include individual and group therapy, family counseling, medication, occupational therapy, patient education and diagnostic services.
Under those rules, both kinds of program are meant for people who:
- need a coordinated program and “more than isolated sessions of outpatient treatment”;
- do not need 24-hour care;
- have adequate support while not at the program;
- have a mental health or substance use disorder diagnosis;
- are not judged to be dangerous to themselves or others; and
- can take part in active treatment and tolerate its intensity.
| IOP | PHP | |
|---|---|---|
| Minimum hours (Medicare’s rules) | 9 hours a week | 20 hours a week |
| Instead of a hospital stay? | Not required to be: the rules say IOP services “are not required to be provided in lieu of inpatient hospitalization” | Yes: a physician certifies the person “would require inpatient psychiatric care” without it |
| Typical use | More structure than weekly visits; a step down from PHP or a hospital | A step down from a hospital stay, or a way to avoid one |
The PHP certification and plan-of-care rules are in 42 CFR 424.24. Program schedules vary: ask each program how many days a week and hours a day it runs, whether it offers evening hours, and how long people usually stay.
Residential and inpatient care
Inpatient care is 24-hour care in a hospital unit. SAMHSA’s treatment guide describes hospital inpatient care as 24/7 care lasting days or weeks, and notes that people with serious mental or medical concerns are the most likely to use it. It is the level for someone who cannot stay safe or needs round-the-clock medical care.
Residential treatment is live-in care outside a hospital, for longer-term treatment in a stable, supervised setting. SAMHSA describes residential addiction treatment as lasting one month to a year and as best for people without stable living or work situations or family support, or who have not been able to stay sober in other treatment.
When someone is in danger and will not accept help, each state has its own rules for emergency evaluation. Plain-language guides: emergency detention in Texas, the Baker Act in Florida and involuntary commitment in Alaska.
Crisis care: its own level, any hour
Crisis care is not a step on the ladder you have to earn. According to SAMHSA, you can call or text 988 or chat online at 988lifeline.org to reach a trained crisis counselor, for mental health, suicide or substance use concerns, for yourself or someone else. Most people who reach out are helped during the call, text or chat without involving 911; a small percentage need emergency services, when there is an imminent risk to someone’s life.
- 911 is for medical emergencies and immediate physical danger. SAMHSA’s examples include a suicide attempt in progress and a suspected overdose.
- 988 connects you to a trained crisis counselor who asks about your safety, listens, and shares resources and local connections. It is free.
- Mobile crisis teams and crisis stabilization centers exist in some areas; SAMHSA notes that these services do not exist in all areas of the country yet. Your state’s resources page lists local crisis lines.
- Text HOME to 741741 to reach the Crisis Text Line at any hour.
How to find a program in your state
FindTreatment.gov, run by SAMHSA, is a confidential and anonymous search for mental health and substance use treatment facilities in the U.S. SAMHSA’s National Helpline, 1-800-662-4357, gives free treatment referral and information 24/7.
For crisis lines, public mental health services and local guides where you live, use your state’s resources page:
- Texas mental health resources
- New Mexico mental health resources
- Florida mental health resources
- Alaska mental health resources
- Arizona mental health resources
- Colorado mental health resources
- Washington mental health resources
Paying for a program: SAMHSA’s payment guide suggests calling the number on your insurance card to ask about coverage, deductibles and preferred facilities, and asking whether your insurer has a case manager who can help. Federal parity law requires health plans to provide the same level of benefits for mental health and substance use treatment as for medical and surgical care. Without insurance, some facilities offer free or sliding-scale care, and every state has funding to help people without insurance get treatment; your state agency can explain how.
Stepping down: from a program back to outpatient care
Leaving a hospital or a day program is a vulnerable time. Before discharge, ask the team for a written plan: who your outpatient prescriber and therapist will be, when the first appointments are, what medications you are on and why, and who to call if symptoms return. Try to have the first outpatient visit booked before you leave.
Bring your discharge papers and medication list to that first visit. If you are starting with a new outpatient practice, tell them about the hospital stay or program when you book, so you can decide together whether outpatient care is the right level for now. Do not stop or change a medication started in the hospital without talking to your prescriber.
Where Willow & Stone fits
Willow & Stone is an outpatient practice. Dr. Stacey Forbes, DNP, APRN, PMHNP-BC, a board-certified psychiatric-mental health nurse practitioner (not a physician), sees people ages 10 and older by secure video in Texas, New Mexico, Florida, Alaska, Arizona, Colorado and Washington. Care includes a 90-minute integrative psychiatric evaluation, medication management follow-ups, psychotherapy and intensive trauma therapy. A first appointment is typically available within 1 to 2 days.
The practice does not provide crisis or emergency care, and it does not run intensive outpatient, partial hospitalization, residential or inpatient programs. If you need one of those, we are the wrong first call, and the resources above are the right ones. If outpatient care fits, or you are stepping down from a program, see who we see and when we refer.
Common Questions
What is the difference between IOP and PHP?
Both are part-day programs you attend while living at home. PHP is more intensive: Medicare’s rules require at least 20 hours a week and a certification that the person would otherwise need inpatient psychiatric care. IOP requires at least 9 hours a week and does not have to be a substitute for a hospital stay. Other insurers and programs set their own criteria.
Can I keep working while in an IOP?
Often, depending on the schedule. An IOP needs at least 9 hours a week under Medicare’s rules, and some programs run part of the day or offer evening hours. Ask each program about its schedule and how long people usually stay.
Will my insurance pay for IOP or PHP?
It depends on your plan. Call the number on your card and ask about coverage, prior authorization, deductibles and preferred facilities. Federal parity law requires plans to provide the same level of benefits for mental health and substance use treatment as for medical and surgical care. Without insurance, FindTreatment.gov lists facilities with free or sliding-scale fees.
Is telehealth enough after a hospital stay?
Sometimes. It depends on how stable you are, how much support you have at home, and what the hospital team recommends. Many people step down through a PHP or IOP first. Tell any outpatient practice about the hospital stay when you book, so you can decide together whether outpatient care fits right now.
What if someone I love needs more help but refuses it?
You can call or text 988 to talk through what to do; counselors support family and friends. If someone is in immediate danger, call 911. Each state has its own rules for emergency evaluation; your state’s resources page has local crisis lines and guides.
Next step
Is Willow & Stone right for you? Who we see and when we refer: the ages, states, conditions and situations the practice sees, and where to go instead when outpatient care is not the right level.
If outpatient care fits
Booking starts with a short form, then you choose a time with Dr. Forbes by secure video; first appointments are typically available within 1 to 2 days. If outpatient care is not enough right now, call or text 988, or use the crisis lines on your state’s resources page.
Book a consultationQuestions first? Call (469) 726-3768 or see fees and insurance by state.
Related reading
Sources
- 42 CFR 410.2: Definitions (partial hospitalization services, intensive outpatient services)
- 42 CFR 410.43: Partial hospitalization services: conditions and exclusions
- 42 CFR 410.44: Intensive outpatient services: conditions and exclusions
- 42 CFR 424.24: Requirements for medical and other health services furnished by providers (paragraph (e), partial hospitalization)
- SAMHSA FindTreatment.gov
- SAMHSA FindTreatment.gov: Treatment Options (types of treatment)
- SAMHSA FindTreatment.gov: Understanding Mental Health
- SAMHSA FindTreatment.gov: Paying for Treatment
- SAMHSA: 988 Suicide & Crisis Lifeline FAQs
- MedlinePlus: Alcohol withdrawal
- FDA Drug Safety Communication: boxed warning for benzodiazepines (2020)
- NIMH: Warning Signs of Suicide (revised 2025)
This article is general education, not a diagnosis or advice for your situation. Only a clinician who has evaluated you can diagnose a condition or recommend treatment. Do not start, stop, or change a medication without talking to the clinician who prescribes it.
If you need help right now
Willow & Stone is an outpatient practice and is not an emergency service. If you or someone you care about is in immediate danger, call 911. For urgent mental health support at any hour, call or text 988 to reach the Suicide & Crisis Lifeline, or text HOME to 741741 for the Crisis Text Line. Both are free, confidential, and available 24/7 nationwide.
About Willow & Stone
Willow & Stone Integrative Mental Health is the practice of Dr. Stacey Forbes, DNP, APRN, PMHNP-BC, a board-certified psychiatric-mental health nurse practitioner (not a physician). The practice sees people ages 10 and older by telehealth in Texas, New Mexico, Florida, Alaska, Arizona, Colorado and Washington.