Why Substance Use Has Its Own Levels of Care The continuum of mental health care has a parallel continuum specifically for substance use disorders, with its own terminology, its own clinical structures, and its own evidence base. The American Society of Addiction Medicine, often called ASAM, has codified this continuum into a set of levels that providers, … Read more
Hannah grew up in Provo. Her family was eighth-generation Mormon. She served a mission in São Paulo at twenty-one, married in the Salt Lake temple at twenty-three, and by thirty-one was a stay-at-home mother of three who could no longer make herself believe. She did not announce it. She kept showing up to sacrament meeting … Read more
Why Couples Therapy Is Different From Individual Therapy Couples enter therapy with a different set of constraints and goals than individuals. Two people are in the room. The therapeutic alliance is not with one patient but with the relationship itself. The skills the therapist needs are not the same as those used in individual mental health … Read more
Frank, a 67-year-old former hospital systems engineer in Tucson, retired on a Friday afternoon in March with a sheet cake, an engraved clock, and a folder of HR paperwork his wife Marta still has somewhere in a kitchen drawer. By the following October, Frank had stopped shaving on weekdays, was sleeping until 9:30, and had … Read more
Marcus, a 34-year-old combat veteran living in Austin, Texas, came home from his second deployment with PTSD that nightmares could not loosen. He tried weekly therapy. He tried sertraline. He tried a meditation app his wife downloaded for him. The first time the panic crested in line at H-E-B, he abandoned a half-full cart and … Read more
Reece Tomlinson had survived two combat deployments to Helmand Province with the Marines and the homicide of his older brother in 2019. By the time the 38-year-old San Antonio veteran walked into a Sheppard Pratt admissions office in December 2024, he had completed two 30-day stays that had not held. The first program in Arizona … Read more
Adolescent Mental Health Care Is Its Own System The continuum of mental health care for adolescents looks superficially similar to the adult continuum, with outpatient therapy, intensive outpatient, partial hospitalisation, residential, and inpatient levels. The actual experience inside each level is dramatically different. Adolescent programs incorporate school components, family work, developmental considerations, and identity-formation issues that adult … Read more
Adolescent Mental Health Care Is Its Own System The continuum of mental health care for adolescents looks superficially similar to the adult continuum, with outpatient therapy, intensive outpatient, partial hospitalisation, residential, and inpatient levels. The actual experience inside each level is dramatically different. Adolescent programs incorporate school components, family work, developmental considerations, and identity-formation issues that adult … Read more
Priya, a 34-year-old software engineer in Oakland, called Kaiser Permanente’s appointment line in March after her postpartum anxiety became unmanageable. The intake clinician booked her for a 50-minute initial assessment four days later, which felt encouraging. Then came the catch: her follow-up therapy session was scheduled seven weeks out. Priya knew she could not white-knuckle … Read more
Tyler Bishop was 27, a freelance video editor in Austin, Texas, and proud of being smart with money. He had crunched the numbers on the marketplace plans during the previous open enrollment and concluded that a catastrophic plan was the right choice. Premium under $230 a month. Three primary care visits before the deductible. Coverage … Read more