LEVELS OF CARE IN MARYLAND

12/1/21

There are several different types of mental health treatment available in Maryland. The guide below is intended to help individuals determine which level of care might be most appropriate.

QUICK REFERENCE

DETAILED EXPLANATIONS

1. Outpatient Treatment

Meeting with a psychiatrist and therapist in an office setting. This can be as often as twice a week for acute illness if this frequency is available, and can space out to monthly (or less frequent) meetings if things are going well.

Finding a psychiatrist and therapist who takes your insurance or who is accepting new patients is surprisingly challenging. The wait can be months. It is best looked at as a process. If the match is poor, I recommend that people continue treatment while looking for a better match.

Group Therapy can also be part of Outpatient Treatment and is especially helpful in making people feel less alone in coping with particular stressors.

2. Targeted Case Management

For people with mental illness also at risk of homelessness, most counties offer case managers who can work with clients to find housing and social services. This can happen alongside outpatient treatment.

3. ACT / PACT Assertive Community Treatment

This is an option for adults with persistent severe illness that need a mobile team who can come to where they are to provide care and coordinate with other providers including primary care and case management.

4. Crisis Intervention

Most Maryland counties have a mobile crisis team that can come to evaluate patients in the community where they are. This can be accessed by dialing 211 (available 24/7) in your county. https://211md.org/

In Baltimore City, Baltimore Crisis Response Inc (https://bcresponse.org/) 410-433-5175, can be called 24/7 to come meet with individuals in crisis and if appropriate can provide a psychiatric residential placement for acute treatment.

In the Baltimore area, Sheppard Pratt has a Psychiatric Urgent Care walk in clinic at 6501 N. Charles Street, 21204, 410-938-5302 (open Monday -Friday from 10am-9pm and Saturdays 1pm-5pm), that can evaluate patients and refer them to the most appropriate level of care including partial hospitalization or inpatient treatment (below). They also offer appointments for virtual evaluations, but the quickest access is still in person.

Harford county:

Klein Crisis Center - On campus crisis beds with average 5 day stay and telephone hotline. 410-874-0711

National Suicide Hotline: 1-800-273-8255

5. Partial Hospitalization Programs (PHP) / Day Hospital / Intensive Outpatient Programs (IOP)

Daily meetings for several hours a day in person or virtually with a team offering a psychiatrist, social worker, group therapy and education, usually based in a hospital. A more intensive approach than outpatient treatment, this can prevent hospitalization and rapidly titrate medications, or be used as a step down option after hospitalization. Patients may be able to refer themselves or may need a referral from a psychiatric provider (one way to access this is via the Sheppard Pratt Psychiatric Urgent Care walk in clinic).

6. Hospitalization

Inpatient hospitalization is sometimes necessary to keep people safe and initiate treatment when they are suicidal, manic, or having psychotic symptoms that are dangerous. The truth is that our community still does not invest enough in psychiatric care and there are not enough inpatient beds available.

There are 2 ways to access it:

1.Via an Emergency Room. This process involves going to an ER and being evaluated by a psychiatric provider and then recommended for a voluntary or involuntary admission (see below). Once the evaluation is completed and admission is recommended, if the hospital has a psychiatric inpatient bed available, you could be admitted there or you could be sent by ambulance to another facility in the state that has an available bed. The wait to be evaluated and then to be admitted to an open bed can be lengthy, depending on whether beds are available.

2.Via a Direct Admission. This process avoids the ER, but it is hard to access, is not available at all hospitals or to all providers and there is often a wait of days to weeks. The Sheppard Pratt Psychiatric Urgent Care walk in clinic may be able to offer direct admission to Sheppard Pratt in certain cases depending on availability.

7. Emergency Petition (EP)

In Maryland, a psychiatric provider, the police or family who perceive someone to be an immediate danger to themselves or others because of a mental illness can file an Emergency Petition (if filled out by family, needs to be signed by a district court judge) which sends the police to take the person into custody and transport them to an ER to be evaluated. Once a person is EP’d to an ER, a psychiatric provider still has to recommend admission. Family should make every effort to make sure that information they have about the person’s safety risk is shared with the psychiatric provider and providers should make every effort to obtain collateral information prior to making any determination, but this does not always happen.

If admission is recommended, but the person refuses to agree to a voluntary admission, 2 providers in agreement that they meet the criteria can commit them involuntarily to inpatient treatment. Once admitted involuntarily to an inpatient unit, they must be seen by an administrative law judge within 10 days who will review evidence and decide whether they can continue to be held. They can decide at any time to become a voluntary patient in order to work with the treatment team to get better and be discharged.

Here is one guideline on the EP process from NAMI.

This guide does not address levels of substance abuse treatment available.