The Tsiyon Grid

Care is meant to be a ladder you can step down as things get steadier, and step back up if you need to.

1. Crisis and acute care. A crisis stabilization unit, crisis receiving center or psychiatric hospital unit, usually days to a couple of weeks, to get safe and stable. A detox unit plays this role for withdrawal.
2. Residential care. Live-in treatment around the clock, usually weeks to a few months. For substance use this is ASAM Level 3; mental-health residential programs exist too, but there are far fewer of them.
3. Partial hospitalization (PHP). Treatment most of the day, about 20 hours or more a week, while sleeping at home or in supportive housing.
4. Intensive outpatient (IOP). About 9 to 19 hours a week, often three to five days, so people can return to work, school or family life.
5. Outpatient and recovery housing. Weekly therapy, medication and peer support, often while living in a sober or recovery home, then independent living.

PHP or IOP with a bed. Some programs pair PHP or IOP with on-site or nearby housing. That can be a recovery residence (a “sober home”) or a licensed residential bed. Ask whether the housing is licensed, who staffs it overnight, and whether it is certified.

Why mental-health-only beds can be hard to find. Most states have used Medicaid waivers to pay for residential addiction treatment, but far fewer have done the same for mental-health residential care, because of a federal rule known as the IMD exclusion. Many states fund recovery housing for substance use too. So someone who needs residential mental-health care without an addiction can find far fewer options. Ask your state agency and NAMI chapter about crisis residential, peer respite and “step-down” mental-health programs, and say clearly that the need is mental health only.

Levels follow The ASAM Criteria, 4th edition (2023), and SAMHSA’s national crisis care guidelines.

A first hospital stay shapes how someone feels about care for years. Where you have a choice:

• Ask about the mix of patients. Some units mainly take people held involuntarily (Florida’s Baker Act, California’s 5150 and similar laws elsewhere) or people transferred from jail. Others focus on voluntary admissions, young adults, adolescents, or first episodes. A calmer unit for first-time patients can make a real difference.
• Ask about the milieu. How do staff de-escalate? How often are restraint and seclusion used? Can families visit and call? Is there an outdoor space, peer support, and a plan for discharge?
• Going voluntarily often opens more doors. If the person can agree to care, going together to a hospital or crisis center of your choosing usually means more choice than waiting until an emergency hold is needed.
• Check licensing and accreditation. Look for state licensing and accreditation from The Joint Commission or CARF, and read state inspection reports where your state posts them.

• People in crisis react strongly to how they are treated. A calm voice, space, choices and respect lower the temperature; crowding, shouting, uniforms and threats raise it. Keep it simple, slow and kind.
• Offer choices, not orders. “Would you rather go this morning or after lunch?” “Do you want me to drive, or your sister?” Let them pack a bag, bring a comfort item and say goodbye to pets.
• You can hold firm boundaries without threatening. “I love you, and I’m not able to keep you safe here tonight, so we’re going to get help together.” Say what you will do, not what will be done to them.
• Plan ahead when things are calm. A crisis plan or psychiatric advance directive records what helps, who to call, which hospital they prefer and which medications work. See the National Resource Center on Psychiatric Advance Directives.
• Take care of yourself too. NAMI Family-to-Family classes and the NAMI HelpLine (800-950-6264, or text “NAMI” to 62640) are free.

• If there is immediate danger to life, call 911.
• If your city or county has a mobile crisis team or crisis center, call early rather than waiting for things to boil over. 988 can often send a mobile crisis team, and a crisis center can take someone without an emergency-room wait.
• If only police respond where you live, go carefully. Ask for a Crisis Intervention Team (CIT) officer, say clearly that this is a mental-health emergency and that you are seeking treatment, not arrest. Describe specific behavior, mention any weapons honestly, and meet officers outside to explain before they go in.
• If you can safely drive them, going together to a crisis receiving center or an emergency department can avoid a police response altogether.

Based on NAMI’s guidance for families and SAMHSA’s national crisis care guidelines. This is general information, not medical or legal advice.

• State licensing. Each state licenses its own treatment programs (detox, residential, PHP, IOP) through its behavioral health agency, and hospitals and crisis units through the health department. The agency for your state is in the list above.
• Accreditation. The Joint Commission and CARF accredit hospitals and treatment programs nationally. CARF also certifies programs against ASAM levels of care.
• Recovery residences (sober homes). Many states have an affiliate of the National Alliance for Recovery Residences (NARR) that certifies homes against national standards; some states require certification for referrals or funding. Your state’s certifier, if it has one, is listed above.
• Search every licensed program near you on FindTreatment.gov (SAMHSA). Filter by “Partial hospitalization/day treatment,” “Intensive outpatient,” “Residential” or “Hospital inpatient,” and by mental health or substance use.