On TV and in movies, treatment for mental health problems and substance abuse is typically shown in one of two ways: admission to an inpatient facility or a weekly visit with a therapist.
But there is an option in the middle: intensive outpatient programs, or IOPs.
“IOPs are structured programs that provide support for people who don’t meet the criteria for an inpatient hospitalization but who need more than traditional once-a-week therapy,” says Helga LeMaster, LCSW, ACSW, program director of UNC Health’s Virtual Intensive Outpatient Therapy program, which serves adolescents and young adults with depression and anxiety.
Many IOPs involve about 10 hours a week of treatment, typically in three to four blocks of time; the UNC Health program, for example, requires three-hour group therapy sessions three times a week, plus one hour of individual therapy, for six weeks. While this represents a significant commitment, it can allow someone to maintain their work or school schedule and avoid hospitalization.
“IOPs are really meant to be a springboard to propel you forward to a lower level of care, usually weekly therapy, by providing you with a toolbox of skills that will support your mental health journey,” LeMaster says.
Who is a good candidate for an intensive outpatient program?
A person experiencing a crisis such as psychosis or active suicidal ideation requires a higher level of care than an IOP, typically hospital admission. Most programs will require that you complete detox from substances or get medical help for an eating disorder before starting an IOP (though some facilities have linked programs, so that you can obtain all levels of care through one provider and step down as you need).
Some IOPs may have a specific focus, such as substance addiction or trauma and PTSD, while others may be more generalized for anyone with a mood disorder. The program staff can help you determine if a program will be a good fit for you or your loved one.
“It might be someone who is already in treatment for depression or anxiety, but they’re seeing an uptick of symptoms,” LeMaster says. “Despite treatment, they might be feeling stuck and not hitting their goals and want more intensive focus on skills and supports.”
Unlike an inpatient program, where staff are on site with patients to make sure they attend sessions, an intensive outpatient program requires someone to show up to these sessions on their own, so a participant should have the willingness, motivation and availability to attend. Most of the therapy is administered in a group with other people.
“The focus is to build resilience and other skills that help you manage your mental health in a supportive setting where you feel heard and understood,” LeMaster says. “It’s validating to know that others are struggling with the same issues and that you’re not alone.”
How does a virtual intensive outpatient program work?
Some IOPs are available virtually, meaning that you attend therapy sessions via an online meeting.
“Studies have shown that the benefits of an IOP are the same whether you do it in-person or virtually,” LeMaster says. “It really depends on the individual’s preferences.”
Virtual options can be especially helpful to teens and young adults, who may not have reliable transportation options for in-person meetings. They can also benefit people who live in rural areas with limited mental health offerings.
“From our surveys, we know that some people are skeptical of the virtual form, but they ended up finding it more relaxing to do from the comfort of their home,” LeMaster says. “When someone has difficulty getting out of the house because of their depression or anxiety, being able to do it in a familiar environment can be really helpful.”
How do I start an intensive outpatient program? What questions should I ask?
Some people may enter an IOP right after completing psychiatric hospitalization. You may be referred to an IOP by your therapist, primary care provider or as part of your discharge if you sought emergency care for your mental health. You can also contact an IOP directly if you think a program is right for you or your loved one; program staff can help you figure it out.
IOPs may offer different types of therapy; UNC Health’s program, for example, offers cognitive behavioral therapy (CBT), dialectical behavioral therapy (DBT) and acceptance and commitment therapy (ACT).
It can be especially important to ask about these approaches when looking for treatment, LeMaster says.
“Young people can check out or get tired if it feels like three more hours of school in the afternoon, so ask how they keep people engaged and what activities they use,” she says, noting that the UNC Health Virtual IOP uses games, videos, art, movement and collaboration via online whiteboards to keep teens and young adults engaged. “If someone is neurodivergent, sitting can be hard, and they may be able to listen better if they can crochet or play with Lego or a fidget toy.”
Availability and cost are also factors. Some IOPs have waiting lists or require that an entire group is ready to start the curriculum at once, while others may have rolling admissions. Insurance doesn’t always cover the entire cost of an IOP; LeMaster notes that Medicaid doesn’t cover any part of IOP treatment.
What happens during an intensive outpatient program?
While most sessions in an IOP are group sessions, everyone has an individual treatment plan created with doctors, psychologists, therapists and social workers on staff to address their unique goals.
Specific curriculums vary by program, but as an example, UNC Health’s Virtual IOP offers weeklong units on topics such as stress management, emotional regulation, distress tolerance, self-care and building social supports.
“That strong support system can help to provide accountability after the program,” LeMaster says. “We’re not meant to do this life alone, and an IOP can help you identify those resources and skills you need for long-term success.”
If you’re struggling with your mental health, talk to your doctor or find one near you.