Right now, in the U.S., a confluence of conflicting trends in adolescent behavioral health gives us a mix of optimism and concern. On the one hand, the latest data from the Substance Abuse and Health Services Administration (SAMHSA) indicates that with each passing year, more and more teens who need help for behavioral health issues get the specialized treatment they need. On the other hand, the events of 2020 elevated levels of stress across the board for the teen population, which increased demand for specialized behavioral health treatment.

Isolation, lack of social contact, reduced access to extracurricular activities, and a host of other associated factors place adolescents in a vulnerable position. Various reports from the local, state, and federal levels show that in 2020, our teens experienced significant surges in behavioral health symptoms associated with mental and behavioral health disorders.

In case you’re unfamiliar with the terminology, behavioral health is a broad category that includes mental health. Behavioral health refers to the things people do that affect their health – their behaviors – whereas mental health refers to the aspects of health that most people think of a psychological. It’s easy to see how they’re related, since behavior includes the things we do, like eat, sleep, exercise, and interact with others – and all of those things have an impact on how and what we think and feel, i.e. our mental or psychological health.

For the rest of this article, when we use the term behavioral health, you can substitute mental health, and vice-versa, because what we’ll talk about relates to both, and for the purposes of this article, the terms are interchangeable.

Which brings us to the topic at hand:

If your teenager needs treatment for a behavioral health issue, what kind of program will help them the most?

Behavioral Health Programs for Teens: Levels of Care

First, we’ll define the context of the information you’re about to read.

Level of care is a phrase that refers to the frequency, degree of immersion, and duration of a mental or behavioral health treatment program for any age group, from children to adolescents to adults. The terms you see in the title of this article – psychiatric hospital, inpatient, residential, and outpatient – correspond to different levels of care.

Type of care or therapeutic approach both mean something different. They refer to the specifics of the treatment your teen may receive at the various levels of care available. For instance, a type of care or might refer to group counseling, individual talk therapy, or family therapy. A therapeutic approach might mean cognitive behavioral therapy (CBT), dialectical behavior therapy (DBT), or motivational interviewing (MI), which are specific techniques that a therapist may employ at any level of care.

All the levels of care we refer to above – with exceptions based on acuity (immediate seriousness/danger of condition) – may be appropriate for teens diagnosed with the following psychiatric, mental, or behavioral health disorders:

• Mood disorders
  • Depressive disorders
  • Bipolar disorder
  • Co-occurring disorders (mental health/behavioral disorder + substance use disorder)
• Anxiety disorders:
  • Generalized anxiety disorder
  • Social anxiety disorder (social phobia)
  • Panic disorder
  • Post-traumatic stress disorder (PTSD)
  • Obsessive-compulsive disorder (OCD)
• Behavioral disorders:
  • Oppositional defiant disorder (ODD)
  • Disruptive mood dysregulation disorder (DMDD)
  • Conduct disorder
• Non-suicidal self-injury
  • Self-harming behaviors such as cutting
• Suicidal ideation

If your teenager received a diagnosis for any of these behavioral or mental health disorders, they’re not alone – and neither are you. Before we give you details on levels of care and insight as to which level might be appropriate for your child, we’ll share the data on the prevalence of these mental health disorders in teens.

Prevalence of Mental and Behavioral Health Disorders Among Teens

These numbers will give you proof that millions of other families can relate – at least at the most basic level – with what you’re going through. It will also confirm that while our teens do need help, the number of teens and families seeking help is rising – which is a good thing.

Here’s the data from the  2019 National Survey on Drug Use and Health (NSDUH) on rates of depression and mental health treatment:

• 3.8 million adolescents were diagnosed with major depressive disorder (MDE)
  • That’s a 73% increase over the past 15 years
  • This trend coincides with increasing levels of suicide attempts and death by suicide among adolescents over the past 15 years
• 1.6 million adolescents received treatment for MDE
  • That’s a 95% increase over the past 15 years
• 601,000 adolescents received treatment for a MDE with severe impairment
  • That’s a 115% increase over the past 15 years

Families across the U.S. seek treatment and support for their teens every day – and every day, teens with mental and behavioral health disorders enter treatment. Each of those families makes decisions similar to the one you’re in the process of making right now, and each of them had to learn the facts about levels of care in order to choose the right behavioral health program for their teen.

Behavioral Health Programs and Levels of Care Explained

We’ll start with the least immersive level of care and continue to the most immersive level of care.

Outpatient

In outpatient teen mental health treatment, parents take teens to an office visit once or twice a week. This is a typical entry level of treatment for a teen who needs help and support with psychological or emotional issues, but whose issues do not significantly disrupt their ability to function in school and do not significantly impair their family or peer relationships.

This level of care is appropriate for teens with a relatively low level of impairment or acuity who are seeking treatment for the first time, or for teens who have been through the more immersive levels of care and have learned the skills and practiced the coping tools that enable them to participate in typical daily life.

Residential Treatment

In a residential program, teens receive more intensive therapy and psychiatric care than in an outpatient program. These programs occur at Residential Treatment Centers, known as RTCs. Residential treatment programs give teens with behavioral and mental health disorders more time for individual, family, and group therapy. Teens in residential treatment programs learn and practice coping skills, distress tolerance techniques, and relapse prevention strategies. They practice what they learn and develop coping skills with direct coaching and support from therapists, counselors, and peers. This prepares them for success when they finish treatment or step down to a less immersive level of care, such as outpatient treatment.

This level of care is appropriate for teens with mental health or behavioral that are so severe they need 24/7 support and monitoring. Teens who participate in a residential treatment program do not live at home and need a high level of care to manage their mental health or behavioral issues.

Psychiatric Hospitalization (Inpatient Psychiatric Programs for Teens)

Psychiatric hospitalization is the most immersive and involves the most intensive monitoring of all the levels of care. Inpatient psychiatric hospitalization occurs in psychiatric units in general hospitals or in private psychiatric hospitals. Treatment is supervised by psychiatrists and delivered by group therapists and/or psychiatric nurses. Movement within a psychiatric hospital is more restricted and more tightly controlled than in an adolescent RTC. Doors to living quarters, dining areas, and common areas are typically locked when they’re not being used for specific purposes. It’s important to understand that regulations in psychiatric hospitals often allow staff to put “hands on” teens in crisis situations, whereas most adolescent RTCs have “hands off” policies for dealing with teens in danger of harming themselves or others.

Psychiatric hospitalizations typically occur on the recommendation of mental health professionals after a crisis situation. These voluntary stays may last 3-10 days, depending on the reason for admission and level of acuity.

This level of care is appropriate for adolescents in crisis or whose behavioral or mental health symptoms are significantly more acute than teens in residential treatment centers. Their risk of self-harm is the highest. Teens, minors, or youth recommended for psychiatric hospitalization may have attempted suicide, experienced a drug overdose, or engaged in self-harming behaviors.

How to Decide Which Program is Best for Your Teen

When your teen needs treatment for a mental or behavioral health disorder, the decision between a psychiatric hospital (inpatient treatment), a residential program, or an outpatient program depends on three things:

1. The severity of their symptoms
2. The degree of disruption their symptoms create in their daily life
3. Whether they present an immediate danger to themselves, their families, their friends, or their caregivers
4. Their treatment history

Note: If you think your child is in immediate danger, or presents an imminent danger to your family or anyone else, call 911 right away.

If your teen receives a diagnosis for a mood disorder such as depression or anxiety, or a behavioral disorder such as oppositional defiant disorder (ODD), disruptive mood dysregulation disorder (DMDD), or conduct disorder, the diagnosis itself does not determine the type of program they need.

Outpatient, Residential, or Psychiatric Hospitalization?

For instance, an adolescent with depression or anxiety may be able to participate in academic activities or fulfill their family obligations despite their symptoms. The same is true for a teen with obsessive-compulsive disorder (OCD) or post-traumatic stress disorder (PTSD).

For teens at this level of acuity, a psychiatrist or assessing psychologist is likely to recommend outpatient treatment to begin with. Treatment may occur once a week, twice a week, or every other week – it all depends on their symptoms and treatment history. Their treatment team – meaning their primary care physician, psychiatrist, and therapist – will monitor their progress. If this level of care works for them – meaning it results in a decrease in symptom frequency, intensity, and duration – then they’ll stay at that level of care. If they don’t make progress, then the treatment team may recommend a more immersive level of care.

A teen diagnosed with a behavioral, mood, or conduct disorder whose symptoms cause such severe disruption that they impair their ability to participate in school or family life – but are not an immediate danger to themselves or others – will likely receive a recommendation or referral for residential treatment. This level of care gives them the time and space they need to learn to manage their symptoms before returning home – which typically also involves stepping down to an outpatient program.

Finally, a teen in crisis diagnosed with a behavioral, mood, or conduct disorder who presents an immediate danger to themselves or others may receive a recommendation or referral for inpatient psychiatric hospitalization. These are teens at the most extreme end of the treatment continuum, and need intensive monitoring and oversight by mental health and medical professionals until the crisis passes or they’re no longer a danger to themselves or others.

Note: A teen who has a history of treatment at any level and has a relapse of symptoms may receive a recommendation or referral to any of the three levels of care we discuss in this article.

A Collaborative Decision

In the end, the choice you make will be the result of a collaborative effort between you, your teen, and your teen’s treatment team. All the factors we discussed above are in play and will affect the type of mental or behavioral health program that’s most appropriate for your teenager. This is not an easy process for any parent, and you can forgive yourself for feeling overwhelmed, stressed, or otherwise uneasy as you make this decision.

We’ll be honest: it’s tough. But developments in treatment over the past two decades mean that families participate in the treatment process more often than not – and that means that as your teen learns to heal and grow vis a vis their diagnosis, you learn to heal and grow, too. Almost all high-quality treatment programs involve family therapy, because evidence shows that when families participate in the process, teens have a greater chance of success. In fact, if a program does not involve family participation, then it’s a good idea to find one that does.

We want you to understand that treatment works, and treatment that involves the family works even better.

One last thing: the sooner your teen gets the treatment they need, the better chance they have at restoring internal balance, managing their symptoms independently, and participating in all the things that make life as a teenager fun and fulfilling.