institutioncrpdDo you know where you are sending your loved one? If you have a friend or family member that is going to be placed in a locked facility, or a board and care, it is important to know the different levels of care to ensure your loved one gets the right placement, and treatment plan.

When I worked in inpatient psych wards in Los Angeles County Hospitals, I provided linkage to patients discharging from an acute inpatient psych wards to a lower level of care.  More often times than not, I was baffled by how many people didn’t know the system, and break down of levels of care. 

Here is a quick rundown of levels of care:

  1. Acute Inpatient Psych – This is the highest level of care.  When a patient is put on a 5150 for danger to others, danger to self, or gravely disabled, they are taken to a hospital for evaluation and treatment.  Depending on their mental state, they may be there for more than 72 hours to ensure stabilization.  Once they are stabilized, they are discharged to a lower level of care.
  2. Sub-Acute – A sub-acute level of care is a locked facility. It is one step below an acute setting.  These individuals are on a conservatorship where someone else is calling the shots, which can be the Public Guardian (PG) or a family member. Their length of stay depends on their behavior.  They must be med compliant, participate in group, and not require solitary confinement, or be a problem on the unit. 
  3. An Institute for the Mentally Ill (IMD) – An IMD is also a locked facility for patients that are higher functioning than a sub-acute level, but still require a locked setting.  Again, the PG or family member acts as the conservator, and the patients length of stay is determined by their mental stability and improvement.
  4. Enriched Board and Care – This is an open setting.  Similar to a board and care, an enriched board and care is not locked.  Patients have more liberties, and are not necessarily conserved.  An enriched board and care is for higher functioning individuals that don’t require an IMD, but still need more intense treatment than a regular board and care.
  5. Regular Board and Care – This is an open setting.  The patient is higher functioning than a patient at an enriched board and care, has more freedom and less intense treatment.

Whether you are a conservator or not, if you have a say in where your loved one gets placed upon discharge from an acute inpatient setting, take time to visit the facilities.  IMD’s are not all the same, enriched board and cares have unique settings, and treatment plans.  Take a few field trips to these facilities so you are familiar with the establishments, and be educated on levels of care, before your loved one is placed upon discharge.

Girl in an institution photo available from Shutterstock



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    Last reviewed: 29 Apr 2013

APA Reference
Loberg, E. (2013). 5 Levels of Care – Locked and Unlocked Psych Facilities. Psych Central. Retrieved on March 29, 2015, from


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