Mental Health Care System · Continuum
Residential care
Live-in treatment with daily structure, less medically intense than a hospital, for when home itself makes getting better hard.
In short
- You live at the program, with staff there around the clock and therapy most days.
- For substance use, ASAM Levels 3.1, 3.5 and 3.7 describe residential care; LOCUS Level 5 covers mental health residential.
- Usually reached from IOP, PHP or a hospital stay, and followed by a step down to IOP or outpatient.
- Lengths vary widely by program and need; ask each program.
What it typically looks like
What it looks like
A home-like or campus setting with groups, individual therapy, skills practice, meals and routines. Medical and psychiatric care is available, at a lower intensity than a hospital.
Who it’s for
People who are medically stable but keep getting pulled back under at home, or who need a substance-free, structured place to rebuild.
The residential levels
ASAM Criteria, 4th edition.
- 3.1Clinically managed low-intensity residential
- 3.5Clinically managed high-intensity residential
- 3.7Medically monitored residential (with a biomedically enhanced 3.7 BIO option)
In the 4th edition, Levels 3.2 and 3.3 were folded into other levels (WA HCA). For mental health, LOCUS Level 5 is medically monitored residential care (Flaum, 2024).
A typical path in and out
One common route, among many.
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.
What it can feel like
Leaving home for a while
It can feel like a big, scary step, and also like relief. Ask about visiting, phones, and how family can be involved.
Coming home
The transition home is where people need the most support. A good program plans it with you from the start.
Questions to ask a program
Before you go
- Is the program licensed or accredited, and which ASAM levels does it offer?
- How long do people usually stay, and how is that decided?
- Which therapies do you use? Do you treat co-occurring mental health and substance use?
- Do you support medications for opioid or alcohol use disorder?
- What happens at discharge? Who is my next provider?
Access notes
Residential care can be expensive, and coverage rules vary. Get the program’s level of care and your benefits in writing before admission.
To look for programs, try FindTreatment.gov or call the SAMHSA helpline at 800-662-4357. Coverage varies; this site can’t predict what an insurer will approve.
Sources
All sources, linked4 references⌄
- 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
- Flaum, M. (2024). LOCUS presentation to the NAIC Mental Health Parity Workgroup. content.naic.org/sites/default/files/national_meeting/LOCUS Presentation.pdf
- SAMHSA. FindTreatment.gov. findtreatment.gov/