Level 4 - High-Intensity Services
Definition
High-intensity services include periods of intensive service that usually involve multi-disciplinary support and care coordination as multiple services are likely to be involved. Services may need to be provided over a long period of time or periodically as a person’s mental health fluctuates. Level 4 is usually designed to support people experiencing severe symptoms (domain 1), significant functional impairment (domain 3), or significant concerns about harm (domain 2).
Care environment
High-intensity services are typically provided by mental health professionals in community settings but can also be delivered in hospital or via hospital out-patient programs (usually voluntary programs). This service level can also include outreach to the person within their home or another environment (e.g., school, community services and general practice).
Core mental health treatment/intervention services
A comprehensive biopsychosocial assessment (if not already undertaken) is recommended for all people suited to this level of care. This may be done as part of the initial assessment when the person presents to primary care with mental health symptoms and/or psychological distress or may occur at the service the person is referred to for assessment and/or intervention.
As noted above, services at this level typically involve multi-disciplinary support and care coordination as multiple services are likely to be involved. Care coordination may be managed by the GP, psychiatrist, paediatrician, or state-based community mental health team.
Evidence-informed, appropriate, and culturally safe psychological services delivered by a suitably qualified and experienced mental health professional.
Psychiatric opinion, referral, management, including medication management, and/or treatment.
Specialist mental health services (including consultation or management by a psychiatrist or state-based mental health team) for assessment, management, consultation liaison, and advice if needed and in accordance with local assessment and care pathways.
May include periods of in-patient or out-patient hospital services.
Diagnosis-specific services where indicated.
Other health services that may be required
A comprehensive physical health assessment and ongoing integrated management of physical health issues via a GP and/or paediatrician or geriatrician.
Health promotion, lifestyle interventions and social prescribing (e.g., sleep hygiene, social exercise programs).
Support services
Additional services are likely to be needed and may include:
Specific community, social, leisure, and recreational supports aimed at addressing factors that may be contributing to the onset or maintenance of the person’s mental health symptoms or distress or that the person may experience difficulty with due to their mental health, such services to help people manage daily activities, rebuild, and maintain connections, build social skills and participate in education and employment.
Accommodations and supports to minimise impacts of mental health symptoms and psychological distress on functioning and/or to reduce impacts of stressors that may exacerbate symptoms or distress, including supports or accommodations at school or work.
Supports targeting situational stressors, such as housing, legal support, financial support, relationship counselling, parental/family focused education and support, and support for grief and loss.
Formal and informal individual and group peer support for the person or their parent/caregiver (including online peer support forums and chats).
Services and support focussed on connections with community and culture.
Care coordination services, service navigation, and advocacy.
Referral criteria
A person requiring this level of care usually has severe symptoms. A person with a severe presentation is likely to be experiencing moderate or higher problems associated with domain 2 - harm, domain 3 - functioning, and domain 4 - impact of co-existing conditions. Where problems are assessed as very severe in domain 1 - symptom severity and distress, domain 2 - harm, and domain 3 - functioning, a referral to Level 5 care should be considered.