Higher Levels of Care

In therapy-land, the term “level of care” refers to the amount of care provided (frequency of services and actual duration of time services are provided). My practice offers outpatient psychotherapy in private practice setting, and can generally offer services anywhere from 1 – 8 hours per month, depending on a range of factors, including your care needs and my capacity, for each of my clients. While this is plenty for some people, it’s not enough for others. When people need more support than their primary therapist can offer, we talk about helping them access a higher level of care, which just means getting more support than what I can offer you as a solo practitioner. There are lots of ways to get higher level of care, but a few common ones are explained here.

Intensive Outpatient Programs (IOPs) + Partial Hospitalization Programs (PHPs)

PHPs and IOPs are generally short-term, group-based therapy programs that offer multiple hours of group and individual therapy over a short period of time (1 – 3 weeks is common in our area). PHPs are usually more involved, and offer more hours of contact per week, than IOPs; however, both offer more than a typical outpatient therapy setting. A PHP or IOP is often recommended for a week or two after leaving inpatient, to help you adjust to life on the outside. They can also feel supportive if you’re worried things seem to be getting worse and worse, therapy and meds / other wellness practices aren’t helping (or aren’t helping enough), and you want to get a greater amount of support proactively, to avoid hospitalization or other more restrictive care settings.

In Metro Detroit, commonly known PHP programs include…

PHPs in other parts of the state include…

For youth and young adults, Ellie Mental Health provides an option for online intensive outpatient therapy

Peer Respite

Peer Respites are a popular alternative to psychiatric hospitalization, which some folks experiencing mental health or addiction-related crises find helpful. Peer respites are 100% voluntary, and 100% peer-run, which means they don’t offer any clinical care (therapy, psychiatry, primary care, detox, addiction treatment, case management, etc.); however, they do offer authentic support from others who can relate, who have “been there” in different ways, in their own lives, and who have a genuine desire to support and hold space for you, as you navigate difficult times, while valuating your decision-making and autonomy. You can learn more about the history of peer respites by watching this video from the Wildflower Alliance, in Boston, MA.

Last year, two peer respites (the first in the state) were launched in Michigan. Hope 365 serves Oakland County. In order to access the respite, call ahead. If your reason for attending is connected to mental health / madness / emotional overwhelm / trauma / extreme states / addiction, you may be required to present to Common Ground Resource and Crisis Center first, for eligibility. Please check out my page on Urgent, In-Person Crisis Support, to find out more about the risks and benefits of pursuing this option.

Still Waters peer respite serves the community surrounding Grand Rapids, Michigan. It’s open to current residents of Kent County, regardless of insurance status. Currently, some of us support the emergent development of Detroit Peer Respite; however, unfortunately, Inner Justice Works clients are not eligible to be DPR guests due to conflicts of interest with volunteers and clinicians on staff 😦

Detox + Inpatient Substance Addiction Treatment

Detox programs offer short-term, medically-monitored, in-person support for individuals withdrawing from substances. Substance addiction treatment (sometimes called Substance Use Disorder or SUD treatment) provides longer-term care for folks who are not or are no longer medically detoxing. It’s important to know many so-called SUD treatment programs want to know if a person is seeking care for an addiction alone, or if there are other mental health experiences you’re hoping for support around. If you’re hoping to get support with more than addiction alone, it can be good to inquire about Co-Occurring services.

Meridian Health Services in Waterford accommodates trans people according to where they feel most comfortable. 18+, accepts a range of insurances. Has outpatient, residential, and detox services.

Sacred Heart Rehabilitation Center collects clients’ chosen names and gender identities, not all staff are equally affirming but the organization’s policy is affirming and staff are trained to be. Multiple locations in SE Michigan and one in St. Ignace, also has residential center that is trans-affirming.

Great Lakes Recovery in UP, adolescents only (12-17). Small facility, 12 beds. Residential program, does outpatient locally, says there is no IOP in the UP and no adolescent detox in the state. Trans-inclusive policies including housing, can take residents from all over state. Takes private insurance. For Medicaid, has a contract with most regions of the state except SE Michigan. Has a Medicaid contract for Macomb County, but not Oakland, Wayne, Washtenaw. If there isn’t a contract, the regional PHIP would need to be contacted to set up a single case agreement or contract. 906-228-4692

Sobriety House seems to include cis men and trans people who have a penis, although it houses trans people with other trans people and is affirming of all gender identities and expressions. This resource has a long way to go but is trying to be affirming and is included because it is located in Detroit and appears to be run by people of color who genuinely wish to be accepting of trans and nonbinary clients. Has outpatient, IOP, and residential, but not detox.

Assertive Community Treatment (ACT) + Wraparound

These are programs administered by Community Mental Health (the network of county-administered mental health programs and services funded by a specific pool of federal dollars, which are designed to serve low-income folks and people with more intense symptoms). These programs provide you with a team of providers that come to you in the community — at home, at work, at school, or at a coffee shop — rather than you having to come to them. Wraparound is generally offered to children, and ACT is the adult equivalent. These programs are billed as holistic, and typically offer any number of optional services, including psychiatry, case management, peer support, primary care, and Individual therapy (but you can also receive this service without the therapy, if you’d like to continue working 1:1 with me). Eligibility is based on county of residence, income level, insurance type, and severity of symptoms / need.

Psychiatric Hospitalization

Psychiatric hospitalization is when a person having an urgent mental health or substance-induced emergency, who is deemed medically stable, receives emergency care in an inpatient setting. Most psychiatric hospitalizations are involuntary, meaning the people being treated were required to go to the hospital, and a judge may get involved with their care if they do not comply with certain requirements. Some people self-admit to psychiatric hospitals, meaning they choose to receive this support because they believe this type and level of care is what they want and/or need. There are risks and benefits to psychiatric hospitalization, which you can read more about here. In most cases, people who need a higher level of intensive, in-person care report better outcomes when receiving support in residential treatment, IOP/PHP programs, Peer Respites, support groups, therapeutic groups, or other less restrictive settings; however, the primary benefit to hospitalization is that is an immediate option available to you in situations where waiting even 24 hours does not feel possible, and the immediate safety of yourself or someone else is at risk.

Residential Treatment

Some people who have pervasive, long-term challenges towards meeting therapy goals, or whose experience of mental health / Madness involves serious, long-term limitations to your ability to handle important tasks or otherwise function in a healthy way, decide to look into residential treatment. Residential programs can range from 1 or 2 months to over a year in duration. They often provide high-quality care by seasoned clinicians who are genuinely passionate about what they do. They can be accordingly expensive to pay for, and may or may not take insurance. Some people I’ve worked with have successfully obtained funding through Beauty After Bruises’ grant program to pay for residential care, when they otherwise could not afford it. Since I’m primarily a trauma therapist, I mostly know about residential trauma treatment programs, although there are residential options for other clinical areas of focus.

The only residential program we have personal experience of in Michigan is Rose Hill Center in Holly, Michigan. Patients at Rose Hill live in a rural / farm setting and participate in intensive DBT treatment.

Residential programs we’ve heard good things about include The Refuge, in Florida, Sierra Tuscon, in Arizona, River Oaks, in Louisiana, and Dominion, in Virginia.

Peer Support

Licensed clinicians (whether social workers, psychologists, counselors, doctors, nurses, or any others) aren’t the only people qualified to support you in a crisis. Peer warmlines are numbers you can call to get peer support when it’s not a “crisis,” by your own definition, but you really need a listening ear, and don’t know who to call. The link above will take you to info about the Warmline model, as well as to a directory of actual lines you can call. There are currently two lines listed for Michigan, but several listed under other states are open to you — feel free to check it out!

The Fireweed Collective hosts online (Zoom) peer-run support groups centering Mad/mentally ill / neurodivergent and d/Disabled folks, as well as QTBIPOC.

Liberating Jasper offers online peer-run support groups for folks navigating eating disorders and/or disordered eating.

System Speak community has a number of online, peer-run support groups for folks with complex trauma and dissociation.

TrevorSpace is an online, adult-monitored, social media site for queer and trans youth ages 13 – 24. It’s run by The Trevor Project, an is like Facebook, but for queer and trans youth, only.

Affirmations, in Ferndale, MI offers a number of virtual and in-person support and discussion groups or queer and trans folks in Michigan.

LGBT Detroit compiled a list of their peer support (and clinical support) offerings here.

Community Health Awareness Group offers in-person, peer-led support groups for folks living with HIV.

To learn more about the long, powerful history of peer support in our communities, you can check out the site for National Empowerment Center.

ACA or Adult Children of Alcoholics and Dysfunctional Children is essential a 12-step group for any adult who has survived complex childhood trauma. The group started out catering to folks who had grown up with alcoholic caregivers, but has since expanded. It follows a modified 12-step model.

Survivors of Incest Anonymous is a peer-led support space for survivors of incest and childhood sexual abuse.

Grassroots RA/MC Collective is a peer-run support space for survivors of organized abuse, trafficking, and ritual abuse (also known as RAMCOA – ritual abuse, mind control, and organized abuse)

TrevorSpace is an adult-supervised online social medial space for LGBTQ youth ages 13-24 to give and receive peer and adult support

System Speak Community is a structured, curated online space for people living with dissociative disorders and complex PTSD. It is created and run by Emma Sunshaw, who is a licensed professional counselor living with DID, and the creator of the System Speak podcast

Michigan Nightlight and Got Grief House both provide free grief therapy groups to kids — and GG’s House also provides the same to adults!

Detroit Heals Detroit provides youth living in the city with space to build community and build power while practicing healing justice and more ❤

For youth in or near Southwest Detroit, Urban Neighborhood Initiatives (one of our partner agencies) provides space to build community while exchanging support with peers and receiving care and mentorship from adults.

More resources and support courtesy of an allied community organization: SIGH inc (Support, Impact, Give Hope, Incorporated)

For more detailed information related to crisis resources (including non-mental-health related crises), check out the Detroit Peer Respite resource list!