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Harvard Commentaries
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Harvard Commentaries
Reviewed by the Faculty of Harvard Medical School


Treatment Settings


February 14, 2014

Depression
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Treatment Settings
Treatment Settings
htmDepressionTreatmentSettings
People who are depressed can be treated in a variety of settings. The most common is outpatient treatment.
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2012-03-05

Reviewed by the Faculty of Harvard Medical School

Treatment Settings
People who are depressed can be treated in a variety of settings. The most common is outpatient treatment, such as going for psychotherapy visits or receiving medication. However, if your depression becomes so severe that you stop functioning and rarely leave home, you may need more assistance than outpatient treatment can provide. And if your depression is complicated by drug or alcohol abuse, you may need additional help, such as a program that supports you while you safely stop using a substance. Fortunately, there are many options available if you require help beyond what is offered in outpatient treatment.
A chief reason for turning to more intensive treatment is a crisis, particularly if thoughts of death or suicide put your safety at risk. In a hospital or other structured environment, the staff can thoroughly evaluate your depression, frequently monitor your response to treatment, and work with other professionals to make sure you are getting the best care possible.

 

Outpatient Treatment
Most people who are depressed are treated in an outpatient setting, which usually involves a combination of psychotherapy (talk therapy) and drug treatment. They visit a psychiatrist, psychologist, social worker or other mental-health professional in a private office, a clinic or a hospital-based office.
The frequency of therapy varies greatly. You and your health-care provider can decide together about the intensity of your treatment, but you have the ultimate say about how treatment should fit into your life.

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Inpatient Hospitalization
In a few situations, 24-hour hospital care is needed. The leading reason for hospitalization is when the severity of your depression puts you in some danger. The hospital is the safest and most secure place for treatment. And, to help with your care, various mental-health professionals are available, including:
  • Psychiatrists
  • Psychologists
  • Social workers
  • Psychiatric nurses
  • Occupational therapists
  • Mental-health workers
This team of professionals carries out the evaluation and treatment of your depression. Ongoing monitoring is possible.
Although hospital programs vary, all provide drug treatment and some form of psychotherapy. Most also invite the family to participate. This allows the mental-health team to gather information about the patient's history, address critical issues that may be a source of stress, and plan long-term care. Inpatient hospitalization usually offers a beneficial environment incorporating group therapy, community meetings and activities. There may be educational groups, meetings that focus on learning social skills, and opportunities for rest and exercise. Staff members provide support throughout the day.

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Partial Hospitalization
Partial hospitalization (sometimes described as a day program) is a "step down" from inpatient hospitalization. Many of the same treatments and activities are offered, but you go home at the end of the day. Most programs run Monday through Friday, and you can attend from one to five sessions per week. Such programs provide structure and support, and they continue to help you plan and monitor your treatment while you make the transition back to life at home.

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Residential Treatment
Residential treatment (or a halfway house) provides a supportive place to live but does not offer any treatment-related activities during the day. It is a good option if you are in school or have a job but have an unstable living situation or are trying to make the transition to independent living. A counseling staff usually provides support and may run evening meetings to review the day's events. However, there is not usually a full range of mental-health professionals on staff. Residents most often visit a therapist and/or psychiatrist elsewhere.

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Emergency Treatment
Sometimes a crisis can be managed with some well-timed extra help, for example, extra appointments with your therapist for support or with a psychiatrist for adjustment of your drug treatment. If the situation is urgent and you are preoccupied with suicidal or self-destructive thoughts, you can find immediate help through your local hospital emergency room, or your local mental-health center may have an emergency service.

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