The mental health industry can be confusing for those who are not a part of it. Healthcare providers are not sure how we fit into their world of vital signs, physical exams, and procedures. Administrators are not sure how to schedule our patients and why it may take 20 minutes for one type of visit and more than 90 minutes for another. Quality experts are still struggling with how to measure the quality of care we provide; initial attempts have used either grossly misrepresentative metrics such as suicide attempts and hospitalizations, or purely subjective reports by patients. And finally, there are workforce wear and tear factors to consider – provider burnout, vicarious trauma, and compassion fatigue.
Figuring out how to structure clinic workflow and provide staff with sufficient time to provide and document high-quality care without increasing workforce wear and tear can be challenging. The first step in demystifying this complex industry is understanding some basic terminology. The 10 definitions below constitute Part I of this article series. Future articles will review the different types of mental health providers, factors unique to mental health patients, and things to consider when planning the delivery of mental health services.
1. Mental Health – The state of being mentally healthy, or the part of one’s overall health that consists of mental processes, i.e. cognition, attention, memory, mood, emotions, fantasy, hallucinations, delusions, obsessions, etc.
2. Behavioral Health – A more encompassing term that is often used synonymously with Mental Health, but that technically also includes the behaviors associated with one’s mental state, such as what one is eating, drinking, inhaling, watching, buying, doing with their time, etc.
3. Patients – A general term that includes all Behavioral Health consumers, but that has its roots in the fields of psychiatry and inpatient behavioral health. Some patients (unlike clients, described below) may be receiving treatment involuntarily, typically by physicians and nurses.
4. Clients – Essentially the same thing as patients, but this term is used more frequently in outpatient settings, and most commonly by psychotherapists; clients typically receive their care on a voluntary basis.
5. Inpatient – Settings to which patients are admitted by a privileged provider and stay overnight, such as a hospital ward or an inpatient unit in a specialized behavioral health treatment facility. Inpatient units are typically locked, although some residential treatment facilities may allow patients to depart and return on their own accord if they have demonstrated a certain degree of responsibility. Of note, behavioral health patients may sometimes be given the opportunity to stay overnight in a non-medical setting such as a shelter, crisis facility, or halfway house, but they are not admitted by a medical provider and are voluntary, so these would not be considered inpatient facilities.
6. Outpatient – All services provided to behavioral health patients in non-inpatient settings. The most common setting is a clinic or office that offers individual, couples, or group appointments, which typically range from 30 to 90 minutes each. Day treatment programs in the behavioral health field are also defined as outpatient care. They are known as Intensive Outpatient Programs (IOPs) if the patient attends for less than 20 hours/week and Partial Hospitalization Programs (PHPs) if the patient attends for more than 20 hours/week. Although some of these programs, especially PHPs, may resemble inpatient treatment, they are still considered outpatient settings for insurance and accreditation purposes.
7. Programming – The therapeutic activities in which patients participate at day treatment programs or inpatient units. They may include things such as coping skills training, relaxation groups, processing groups, therapeutic horseback riding, yoga, medication management appointments, individual psychotherapy sessions, etc.
8. Intake – This is the term most often used to describe the first in-depth history-gathering meeting that a behavioral health professional has with a patient. It goes beyond crisis evaluation and risk assessment, and typically includes the patient’s current complaint(s), psychological symptoms, behavioral health history, medical history, family history, social history, current living situation, employment, legal challenges, habits, etc. All behavioral health staff should be able to perform an intake that is appropriately detailed for their level of training.
9. Assessment – This term may have several different meanings. For psychologists, assessment typically refers to the administration of a battery of validated clinical instruments, otherwise known as psychological testing. This is a formal process that can take from 2 to 10 hours, sometimes spread over the several sessions, yielding a formal report. Assessment may also refer to the less-structured administration of validated screening instruments, which are self-reported measures of symptoms that do not result in a diagnosis and can be administered by almost any level of mental health provider or even completed by patients online. Assessment can also refer more broadly to the overall evaluation of a patient or client using all of the skills and tools available to a provider or a treatment team, including screening instruments, clinical interviews, a mental status exam, collection of collateral data, etc.
10. Crisis Management – All behavioral health professionals, from the most junior intern to the most seasoned psychiatrist, should be trained in this basic skill, which involves calming (a.k.a. de-escalating) an individual in crisis, gathering necessary information, conducting a risk assessment, and developing a basic plan of action based on that risk assessment. Recently, crisis management has become synonymous with suicide assessment, but crisis management involves much more than just evaluating suicide risk. It includes being able to calm the patient down, take a focused history, assess the risk of harm (harming themselves, harming others, or being harmed by others), and accomplish the appropriate next step for one’s level of training and licensure.
Dr. Wendi Waits (she/her) is an adult and child psychiatrist, certified lifestyle medicine physician, and consultant at MH Insight, LLC. She has written numerous articles, book chapters, and scientific publications on medical leadership and various mental health topics, and she is an experienced public speaker. To see more of Wendi’s work, please visit MHInsight.com.