When Do Teens Need Inpatient Treatment for Depression?

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There are two types of inpatient treatment for adolescent depression: residential treatment and inpatient psychiatric hospitalization.

Both types of inpatient treatment support teens with severe depression characterized by extremely painful, difficult, disruptive, and debilitating behavioral and emotional symptoms. Clinicians describe this level of depression with the term high acuity. In plain language, high acuity means the symptoms are very serious right now and the teen experiencing them needs an immersive, intensive level of treatment and support right away.

High acuity teens who need inpatient treatment for depression have depressive symptoms that prevent them from:

• Living at home
• Carrying out the most basic functions of daily life, such as managing personal hygiene, eating enough to satisfy their most basic nutritional requirements and staying active enough to maintain a healthy body
• Participating in school, work, or extracurricular activities
• Engaging in family, peer, or other social relationships

Teens with symptoms that severe will typically receive a referral for residential treatment at a specialized residential treatment center for teen depression.

In some cases, teens have symptoms that are more severe and more extreme than teens who require residential treatment. These teens may have emotional and behavioral symptoms that:

• Make them a danger to themselves. These teens may engage in suicidal ideation or make suicide attempts. They may also make decisions and engage in other behavior that puts their health and safety at risk.
• Make them a danger to others. They may engage in behavior that threatens the health and safety of family, friends, and others. Their emotions are so powerful they compromise decision-making and result in risky and dangerous behavior
• Make them unable to care for themselves in any way. These teens may reach a depressive state so extreme they cannot get out of bed to eat, drink, or carry out the most basic functions most of us take for granted.

Teens with symptoms that severe will typically receive a referral for inpatient psychiatric hospitalization at a regular hospital, a psychiatric hospital, or a specialized psychiatric hospital for adolescents.

We’ll now explain the similarities and differences between these two types of inpatient treatment for adolescent depression, and give you an idea of what your teen will experience in residential treatment and inpatient psychiatric hospitalization.

Inpatient Treatment and Residential Treatment: Similarities and Differences

We’ll talk about the similarities first. In both types of inpatient treatment for depression, teens:

• Live on-site
• Receive 24/7 medical and psychiatric monitoring
• Participate in treatment and/or therapeutic activities several times a day
• Focus on treatment with minimal external distraction

Now we’ll address the differences:

Treatment Focus and Goals

• Inpatient psychiatric hospitalization has two primary goals: safety and stability. Since many teens referred to inpatient treatment are at risk of suicide or self-harm, safety is goal number one. Once safety is ensured, emotional stability comes next: when a teen reaches a point where they can do things like get out of bed, eat, and proactively participate in psychotherapy, clinical staff may determine they’re ready for discharge to a less immersive level of care.
• Residential treatment prioritizes safety and stability, of course. However, the focus and goal of residential treatment is recovery. Teens engage in individual therapy, group therapy, educational workshops, and complementary activities. They work with clinical staff and peers to develop skills and practical coping mechanisms that allow them to manage their emotional and behavioral symptoms so that they can return to home life, school life, and take steps to re-engage in social life and other activities typical in the life of a teen.

Treatment Environment

• Inpatient psychiatric hospitalization most often occurs in psychiatric units in hospitals or specialized treatment facilities for adolescents. Admission may be voluntary or involuntary. Psychiatric nurses, physicians, and clinical staff monitor teens closely. Movement and activity within inpatient hospitals is tightly controlled, and doors to living quarters and other areas may be locked during predetermined times. Inpatient hospitalization typically lasts 3-10 days. Discharge depends on treatment progress as determined by clinical staff. In most cases, teens step down from inpatient hospitalization to residential treatment.
• Residential treatment for teen depression occurs at specialized facilities called Residential Treatment Centers (RTCs). In many cases, the environment of an RTC is the opposite of a psychiatric hospital. Whereas hospitals may feel cold, impersonal, and clinical, RTCs are often located in homes repurposed for teen depression treatment. This puts teens at ease and creates an environment conducive to recovery.

Inpatient Treatment for Teen Depression: Summary

Inpatient treatment – whether residential or psychiatric hospitalization – is reserved for teens with severe depression characterized by symptoms that are either debilitating, create a safety risk, or both. Psychiatric hospitalization is for the most extreme cases when a teen needs time under close supervision to become safe and stable. Residential treatment is for teens with severe depression who are not in crisis, and ready to engage in the kind of treatment and recovery activities that enable them to return home, consider returning to school, and take steps to resume typical daily activities outside of the treatment environment.

Teen depression is a serious issue. For severe cases, treatment for teen depression is the first step toward regaining balance and returning to life as usual.