Does My Teen Need A Residential Treatment Center, a Psychiatric Hospital, or Inpatient Treatment for Depression?

When you think your teen is depressed, the first thing you try to do is cheer them up.

Smiles, hugs, and special dinners come first. Then maybe activities related to their passions. Some teens live for a live pro sports event or a big, loud arena rock concert. Others might want a day at a fine art museum or an evening at the symphony, opera, or a cozy show featuring a small jazz ensemble. Still, others might want a new video game console or phone.

Some teens might simply want and need more one-on-one time with you, so you take a day trip and go hiking. Or you do something tried-and-true, like go to a movie and have ice cream afterward.

When none of that works, you start to worry.

You might ask yourself:

Is my kid depressed? As in clinically depressed? At the level where they need a therapist? Do teens even get clinical depression?

We’ll with that last question. The answer is yes.

Teens do get depressed. They get more than your typical teen sad and moody. Like adults, they can develop the clinical mental health condition known as major depressive disorder (MDD).

With regards to the first three questions, the person who can answer them is a licensed mental health professional. If your teen is persistently sad and shows signs and symptoms of depression – which we’ll outline below – then the first thing you need to do is arrange a full evaluation with a mental health professional.

These evaluations are called biopsychosocial assessments. A clue to what they are is in the name. A full biopsychosocial assessment – when administered by a qualified clinician – is the first step toward getting a teenager with depression the help they need.

And this is no exaggeration: that help could save their life.

Treatment for Teen Depression: The Sooner the Better

If you suspect your teen has depression, one of the most important things to understand is that if they have clinical depression, evidence shows that when it goes untreated, clinical depression rarely resolves on its own. What most often happens is that overt, symptoms become worse, and the condition becomes more disruptive.

That’s why it’s important to act quickly to find out exactly what’s going on with your teen. A teen who receives a diagnosis for depression and gets appropriate, evidence-based treatment quickly has a better chance at making a full recovery than a teen who receives a diagnosis and defers treatment.

The first step toward appropriate, evidence-based treatment is an accurate diagnosis. And the way to get an accurate diagnosis is – as mentioned above – a complete biopsychosocial assessment. During this assessment, a clinician collects all the relevant information in the following three areas:

Biological:

• All medical information
• Family medical information
• Personal history of development or developmental issues
• Current level of physical function and abilities

Psychological:

• Past mental health symptoms or disorders
• Current mental health symptoms or disorders
• Current mental health status
• Family history of mental illness
• Present or past mental health symptoms or disorders
• Present or past mental health medication or treatment
• Full history of stress, trauma, or major life events

Social:

• Present ability to function at home and in social situations
• Gender identity and sexuality
• School, learning, and education history
• Relevant legal issues
• Risk factors
• Protective factors

Once your teenager receives a comprehensive evaluation, they should receive a recommendation for a course of treatment. A clinician will likely advise support and treatment at one of the four most common levels of care. These include:

1. Outpatient office support
2. Intensive outpatient program (IOP)
3. Partial hospitalization program (PHP)
4. Residential treatment program (RTC)

Only one of these levels of care, however, meets criteria that make it inpatient treatment: a residential treatment program, or RTC. The level of care we do not mention here is inpatient psychiatric hospitalization. While both these levels of care involve your teen living on site at a behavioral health treatment center for adolescents, the two levels of care are not identical.

We’ll talk about the differences between a residential treatment center for teens and an inpatient psychiatric hospital for teens in a moment. First, we’ll outline exactly what it takes for a teen to meet the clinical criteria for major depressive disorder (MDD), outline the common symptoms, then define the three levels of severity most common to MDD. That will lead directly to a more detailed discussion of residential treatment centers (RTCs) and inpatient psychiatric treatment for teens with depression.

Teenage Depression: What are the Signs and Symptoms?

The Diagnostic and Statistical Manual of Mental Disorders (DSM-V) is responsible for the official name for depression we mention above: major depressive disorder (MDD). The DSM-V calls MDD “…an overwhelming feeling of sadness, isolation, and despair that last two weeks or longer at a time.”

If you think your teen may be developing MDD, here’s what to watch for:

The Signs of Depression in Teens

• Daily sadness
• Daily crying
• Persistent low mood
• Daily feelings of hopelessness or pessimism
• Uncharacteristic anger or hostility
• Uncharacteristic irritability
• Daily/near daily sense of worthlessness
• Lack of interest or declining participation in favorite activities
• Constant fatigue
• Withdrawal from and intentional isolation from social situations
• Poor or deteriorating communication with family and friends
• Persistent boredom
• Persistent restlessness
• Difficulty with concentration, memory, and/or decision-making
• Disrupted sleep: oversleeping or insomnia
• Extreme gain or loss of weight
• Phantom ailments like headaches or stomachaches that don’t get better with typical remedies
• Suicide-related thoughts, talk, or behavior*

* If your teen is in immediate danger or poses an imminent threat to themselves or someone else, call 911 immediately or take them to an emergency room at a regular hospital or a psychiatric hospital.

It’s true that almost all teens show these symptoms – sometimes. Most are examples of typical teen moods and adolescent ups and downs. What you need to know, as a parent, is that if your teen shows at least five symptoms from the list above every day for at least two weeks, that’s a legitimate red flag.

To a mental health professional, that’s an indication of the potential presence of clinical depression.

To help clarify that, we’ll put it another way. A teen who has a social disappointment on a Saturday, gets sad and angry about it and stays that way until Tuesday, then goes to the pool with friends on Wednesday and is back to their typical self by Friday probably does not have clinical depression. In contrast, a teen who has a negative experience on a Saturday, gets sad and angry about it, but – rather than reconnecting with friends by midweek and rebounding by Friday – stays sad, moody, and angry for a month might meet the criteria for clinical depression.

Teen Depression Can Be Mild, Moderate, or Severe

The three levels of depression are defined by the intensity of the symptoms, the duration of the symptoms, and how much disruption the symptoms cause. Within a diagnosis of major depressive disorder (MDD), clinicians identify the following three levels of disruption/severity:

1. Mild

If your teen has a mild depression, the symptoms typically do not prevent them from meeting the daily responsibilities of school, social, or family life. If your teen has mild depression, they probably don’t need inpatient treatment.

4. Moderate

If your teen has moderate depression, their symptoms may prevent them from going to school and engaging in common social activities, but do not prevent them from living at home. If your teen has MDD with moderate symptoms, they will probably receive a recommendation for an intensive outpatient program (IOP) or a partial hospitalization program (PHP). In most cases, a teen with MDD with moderate symptoms will not receive a referral for inpatient treatment.

3. Severe

If your teen has severe depression, their symptoms may prevent them from participating in family, school, or social activities. Severe depression can lead to suicidal ideation, non-suicidal self-injury, and suicide attempts. If your teen has severe MDD, they will most likely receive a referral for inpatient treatment at a residential treatment center (RTC) or an inpatient psychiatric hospital for adolescent depression.

Let’s shift gears now and talk about what we introduce in the title of this article:

Inpatient treatment options for teenage depression.

As mentioned, inpatient treatment for teen depression most often occurs in a residential treatment center (RTC) for teens or an inpatient psychiatric hospital for teens. Although both levels of care are similar in that teens live on-site while receiving treatment, they’re not considered the same level of care by providers or insurers.

We’ll talk about the differences between those two levels of care now.

Inpatient Treatment for Teen Depression

Residential Treatment Centers for Teen Depression

The residential level of care is most often recommended for teens with severe depression. If your teen has symptoms that significantly disrupt their life and prevent them from participating in family, school, or social activities and they’re unable to live at home, then you can expect your teen to receive a referral for the 24/7 support and monitoring available in an adolescent residential treatment center.

In an RTC program, your teen lives on site and focuses on recovery. The treatment and support is immersive and intensive. They have time for everything they need: individual therapy, family therapy, and group therapy. They’ll learn and practice skills to manage their symptoms, such as distress tolerance, stress management, and emotional regulation. During residential treatment, they have the time and space to develop their skills with direct feedback from professional clinicians and treatment peers. The time and energy they spend in a residential program prepares them with the practical tools they need to step down to a less immersive level of care or return home.

Psychiatric Hospitalization for Teen Depression

Psychiatric hospitalization is most often recommended for teens with severe depression who are in active crisis and in imminent danger of harming themselves or someone else. If your teen is in crisis when they’re evaluated or a clinician identifies a high risk of self-harm or a suicide attempt, the clinician may recommend psychiatric hospitalization. They may also recommend psychiatric hospitalization if your teen has severe symptoms at the time of assessment and has a history of suicide attempts or self-harming behavior. If this is the case, clinicians default to the idea that your teen needs time spent in an immersive treatment environment until their crises passes.

Psychiatric hospitalization is the most immersive of all levels of care. It generally takes place in a psychiatric ward in a hospital, or in a specialized psychiatric hospital for adolescents. In these facilities, all movement and activity is monitored and controlled. Doors to personal rooms, common areas, and treatment areas are typically locked at all times, and staff closely monitor any movement between areas.

Two More Things: Length of Stay and Hands-On/Hands-Off Crisis Policies

Psychiatric Hospitals for Teen Depression: Length of Stay

The typical length of stay in and inpatient psychiatric hospital is around 3-10 days. The length of stay is determined by the reason for admission, the level of severity of the symptoms, and treatment progress as determined by psychiatric staff. Teens discharged from inpatient psychiatric care most often step-down to a residential treatment center (RTC).

Psychiatric Hospitals for Teen Depression: Hands-On Policies

Rules and regulations in psychiatric hospitals vary from state to state, but in general, during inpatient psychiatric treatment in a psychiatric hospital for teens, rules allow hospital staff to put hands-on patients during a crisis, until the crisis passes.

Residential Treatment Centers for Teen Depression: Length of Stay

A typical length of stay in an adolescent residential treatment center is longer: a teen with severe depression may stay on-site for one month, two months, or longer. The length of stay is determined in the same way a length of stay in a psychiatric hospital is determined: the reason for admission, the severity of the symptoms, and recovery progress as determined by treatment center staff. Teens discharged from RTCs most often step down to a partial hospitalization program (PHP) or an intensive outpatient program (IOP).

Residential Treatment Centers for Teen Depression: Hands-Off Policies

While regulations vary state-to-state, most adolescent residential treatment centers have hands-off policies for managing teens in crisis. A crisis typically involves a situation where a teen is a danger to themselves or others. During a crisis, treatment center staff do not restrain teens physically, but rather maintain their safety and the safety of the other teens through de-escalation or other evidence-based techniques.

The Benefits of Inpatient Treatment for Teen Depression

Whether your teen receives psychiatric inpatient treatment or treatment at a residential treatment center for their depression, the goal of treatment is for them to reclaim power and agency in their lives. Depression, like many mental health disorders, can take over their lives and make them feel hopeless. In extreme cases, their symptoms cause such intense negative feelings that they no longer want to live. In all cases, the symptoms of depression make life difficult.

Things that seem easy to people without depression are not easy at all.

Treatment can change all that. The most highly regarded treatment programs for teen depression include a mix of the following techniques:

• Individual therapy (dialectical behavior therapy (DBT), cognitive behavior therapy (CBT))
• Group therapy (group DBT, group CBT)
• Family therapy (with your family and teen, with other families without your teen)
• Mindfulness (yoga, meditation, self-relaxation)
• Experiential therapies (sports, exercise, hiking, equine therapy)
• Expressive therapies (art, music, writing, dance, drama
• Medication (as needed)

The treatment plan your teen follows will be unique to your teen. You, your teen, and the treatment center staff will collaborate on a plan and design an approach that gives your teen the best chance at treatment success. The plan will change as your teen grows and changes, and the skills they learn in treatment will be durable, adaptable, and applicable to life in the real world. When they finish treatment, they should be ready to return home and participate in family, school, and social life. They’ll have the tools they need to meet the world on their terms and in the manner of their choosing.

Treatment takes work, time, and commitment – but it’s well worth the effort. Sustained, long-term recovery is within reach: the first step is finding a treatment center that meets your family’s needs.

Finding Help: Resources

If you’re seeking inpatient depression treatment for your teen, please navigate to our page How to Find the Best Treatment Programs for Teens and download our helpful handbook, A Parent’s Guide to Mental Health Treatment for Teens.

In addition, the American Academy of Child and Adolescent Psychiatry (AACAP) is an excellent resource for locating licensed and qualified psychiatrists, therapists, and counselors in your area. Both the National Institute of Mental Health (NIMH) and the National Alliance on Mental Illness also provide and high-quality online resources, ready and waiting for you right now.