Mental Health Care System · Continuum
Moving between levels
Care steps up when you need more and steps down as you steady. That movement is normal, and it’s how the system is meant to work.
In short
- The aim is the least intensive level that keeps you safe and moving forward.
- Tools like LOCUS are built for reassessment, so the recommended level changes as you do.
- A common path after a hospital stay is inpatient → PHP → IOP → outpatient.
- Stepping up isn’t failure. Stepping down isn’t being pushed out.
The ladder
Pick a story and watch how it moves.
Step up, step down
Pick a story, then tap Next or Play. Tap any level to see when people move to it or away from it.
Illustrative paths, not rules. People skip levels, repeat them, or never need more than outpatient care. Moves are decided with your care team, and the goal is the least intensive level that keeps you safe and moving forward.
Signs to move
Signs it may be time to step up
Safety is harder to manage, symptoms are crowding out the day, substance use is rising, or you’re not improving at the current level.
Signs you may be ready to step down
Goals are met or close, skills hold between sessions, supports are in place, and a next provider is lined up.
Hours a week
Each step is mostly a change in hours and setting.
Hours a week → level of care
Drag the slider, or tap a preset, to see which level matches that much treatment time.
Hour bands follow The ASAM Criteria, 4th edition (Level 1.5 under 9 h, 2.1 at 9–19 h, 2.5 at 20+ h) and Medicare’s minimums for IOP (9 h) and PHP (20 h). Hours describe intensity only. Real decisions weigh safety and need, not the clock.
Reassessment is built in
How LOCUS handles change
LOCUS scores six dimensions and is meant to be repeated. In a worked example presented to state insurance regulators in 2024, a person’s recommended level dropped from 6 (inpatient) to 4 (partial hospital level) within four days as things stabilized (Flaum, 2024).
What it can feel like
“I had to go back up.”
Recovery rarely moves in a straight line. Going back up is using the system the way it’s designed.
“I’m scared to step down.”
Less support can feel risky. Ask for an overlap or a warm handoff, and know you can step back up.
Making handoffs smooth
Ask for these
- A scheduled first appointment at the next level, before you leave the current one
- A written safety plan and medication list
- Records sent to your next provider
- Who to call if things slip before that appointment
Sources
All sources, linked6 references⌄
- Flaum, M. (2024). LOCUS presentation to the NAIC Mental Health Parity Workgroup. content.naic.org/sites/default/files/national_meeting/LOCUS Presentation.pdf
- ASAM. The ASAM Criteria, 4th edition. www.asam.org/asam-criteria/asam-criteria-4th-edition
- Washington State Health Care Authority (2026). ASAM Fourth Edition Transition Guidebook. www.hca.wa.gov/assets/billers-and-providers/asam-fourth-edition-transition-guidebook.pdf
- Madakasira, S. (2022). Psychiatric partial hospitalization programs: What you need to know. Current Psychiatry, 21(2), 28–32. doi.org/10.12788/cp.0216
- 42 CFR § 410.43. Partial hospitalization services (Medicare). www.ecfr.gov/current/title-42/chapter-IV/subchapter-B/part-410/subpart-B/section-410.43
- 42 CFR § 410.44. Intensive outpatient services (Medicare). www.ecfr.gov/current/title-42/chapter-IV/subchapter-B/part-410/subpart-B/section-410.44