Higher Level of Care: A Clinician’s Referral Guide

When and how to step a patient up to a higher level of care, by service line, plus Discovery’s partnership with LifeStance Health to expand access.

Outpatient clinicians are often the first to see a patient stall or slide. The hard question is when therapy or medication management alone is no longer enough. This guide lays out the signals to watch for by service line, and how Discovery Behavioral Health makes stepping a patient up straightforward.

• Knowing when to refer a patient to a higher level of care is one of the hardest calls in outpatient practice. This guide gives clear signals for each service line.
• A higher level of care, such as residential, PHP, or IOP, may be warranted when a patient needs more support than outpatient therapy or medication management can provide.
• Discovery Behavioral Health partners with LifeStance Health to expand access to residential, partial hospitalization, and intensive outpatient treatment.
• Mental health, eating disorders, substance use, and TMS and ketamine candidacy each have their own signs that it may be time to step care up.

Outpatient clinicians are often the first to see a patient stall, or slide. The question is when therapy or medication management alone is no longer enough, and a higher level of care is the safer, more effective path. 

This guide, built for referring clinicians, lays out the specific signals by service line, and how Discovery Behavioral Health, in partnership with LifeStance Health, makes stepping a patient up straightforward.

A higher level of care is any structured program more intensive than weekly outpatient therapy, including residential treatment (RTC), partial hospitalization (PHP), and intensive outpatient (IOP). It may be needed when a patient requires more support or structure than an outpatient setting can provide. Learn about our levels of care.

• ✓Stabilization needed for self-harm, bipolar disorder, major depressive disorder (MDD), trauma, or PTSD
• ✓A plateau in treatment with talk therapy or medication management
• ✓Symptoms disrupting everyday activities
• ✓Problems at school or work, or DUIs
• ✓Absenteeism or presenteeism at work
• ✓Inability to maintain healthy relationships with family or friends
• ✓A need for more support than can be provided in an outpatient setting

• ✓Large weight fluctuations
• ✓Abuse of diet pills, diuretics, or laxatives
• ✓Compulsive or excessive exercise
• ✓Avoidance of food or food groups
• ✓Bingeing and/or purging with regularity
• ✓Food refusal

• ✓Relapse after medical detox, or previous treatments haven’t been successful
• ✓Substance use negatively affecting work or school, including absenteeism or presenteeism
• ✓Fights with peers, teachers, or colleagues
• ✓Legal troubles (such as a DUI), noncompliance with legal entities, or a court order due to relapse
• ✓Multiple positive urinalysis tests
• ✓A need for additional support for co-occurring mental health conditions
• ✓Continued consequences of relapse, with little understanding of how to cope with cravings and triggers
• ✓Continued use despite ultimatums, or little motivation to leave unhealthy environments
• ✓Worsening mental health symptoms that make outpatient recovery unlikely and call for stabilization in a co-occurring setting

For depression that hasn’t responded to traditional treatment, interventional options may be appropriate. Candidates may include patients with:

• ✓Major depressive disorder (MDD), persistent depressive disorder, postpartum depression, or seasonal affective disorder (SAD)
• ✓Symptoms that persist despite talk therapy, medication management, or other traditional interventions
• ✓One or more medication trials without success
• ✓A preference not to take medication, or concerns about medication side effects
• ✓Concerns about medication because of addiction recovery or sobriety

Learn about TMS and ketamine through our outpatient services.

Refer through our Refer a Patient page or your outreach representative, and we’ll help match your patient to the right program and level of care.

After your patient completes residential, PHP, or IOP care within the DBH system, we coordinate their transition back to you for ongoing outpatient treatment.

Refer a PatientFind Your Outreach Rep

Clinician resources:

• Refer a patient
• For professionals
• Levels of care
• Find a treatment center
• Payer resource center

Consider a referral when a patient needs more support than outpatient therapy or medication management can provide, such as a plateau in treatment, safety concerns, declining function at work or school, or relapse. Specific signs vary by service line.

A higher level of care is any program more intensive than weekly outpatient therapy, including residential treatment (RTC), partial hospitalization (PHP), and intensive outpatient (IOP).

Signs include a need for stabilization for self-harm, bipolar disorder, MDD, trauma, or PTSD; a treatment plateau; symptoms disrupting daily life; problems at work or school; or an inability to maintain healthy relationships.

A referral may be warranted after relapse following detox or unsuccessful prior treatment, legal trouble or court-ordered treatment, multiple positive urinalysis tests, co-occurring mental health needs, or continued use despite consequences.

Candidates may include patients with MDD, persistent depressive disorder, postpartum depression, or seasonal affective disorder whose symptoms persist despite therapy and medication, or who prefer to avoid medication or its side effects.

Yes. After your patient completes residential, PHP, or IOP care within the DBH system, we coordinate their transition back to you for aftercare.

Discovery Behavioral Health partners with LifeStance Health to expand access to residential, partial hospitalization, and intensive outpatient treatment for eating disorders, depression, anxiety, trauma, and substance use.

Use our Refer a Patient page, contact your outreach representative, or call (855) 777-4769. We’ll help match your patient to the right program and level of care.