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Does My Child Need Inpatient Treatment?

Written by Evolve's Behavioral Health Content Team​:

Alyson Orcena, LMFT, Melissa Vallas, MD, Shikha Verma, MD, Ellen Bloch, LCSW, Lianne Tendler, LMFT, Megan Johnston, LMFT
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How to Decide if Your Child Needs an Inpatient Mental Health Treatment Program

Every teen with a mental health, behavioral, or alcohol/substance use disorder is unique. The same is true of any disorder for which they receive a clinical diagnosis. Each disorder develops in different ways for different reasons. A mental health disorder – a category that includes behavioral disorders and addiction – follows its own trajectory and is influenced by a variety of factors. Childhood trauma, a family history of mental illness or addiction, major life changes, the death of a loved one, the emotional challenges associated with public health crises, and the stress that accompanies adolescence are a few – but certainly not all – of the things that can lead to or influence the development of a mental health disorder.

If a mental health professional diagnoses your child with a mental health disorder, it may take you by surprise at first. Many people think that mental illness develops later in life – early adulthood, for instance – but the truth is that many mental illnesses first appear in childhood or adolescence. Clinicians call the time a mental health disorder first appears the age of onset.

All of the following types of mental illness may appear before the age of 18. This means that if your adolescent child is diagnosed with any of these disorders, they fall within an age of onset that is within the typical range:

The exception on this list is schizophrenia, which, along with similar psychoses or psychotic disorders, may appear during the teenage years, but most often first appear in the early- to mid-twenties. Schizophrenia can appear during adolescence, though – that’s why it’s on the list.

What Level of Mental Health Treatment Does My Child Need?

If your child receives a diagnosis for any of the disorders listed above, the first thing you want to know is how you can help them. You already know they need professional support from a psychiatrist or a therapist. That means you already know the most important fact you need to know, which is that treatment works. And since you’re reading this article, you also know the most important step you need to take.

You need to find appropriate treatment for your child.

But how do you know what’s appropriate?

How do you decide if they need outpatient treatment, an intensive outpatient program (IOP), a partial hospitalization program (PHP), treatment in a residential treatment center (RTC), or inpatient psychiatric treatment?

The answer depends on two things:

1. The level of severity of the disorder.

You may also find this called the level of acuity, where acuity means how immediately dangerous/serious/disruptive the disorder is at the time of assessment/diagnosis. Most mental health/behavioral/addiction disorders have three levels of severity/acuity: mild, moderate, and severe. As a rule of thumb, the higher the severity or level of acuity, the more intensive/immersive level of treatment a child or teenager needs.

2. Treatment history.

A child or adolescent with a mental health disorder who has received treatment at one of the less immersive levels of care – IOP or PHP for instance – may need a more immersive level of care, such as a residential program for teens (RTC), or inpatient treatment for teens.

At this point we should clarify some of the terminology we’re using. First, you should understand that outpatient treatment, IOP treatment, and PHP treatment are not inpatient treatment. All three are considered outpatient treatment, which, broadly speaking, means the person in treatment does not live at the treatment center during treatment. Next, you should understand that RTC treatment and inpatient treatment are both forms of inpatient treatment, which, broadly speaking, means that the person in treatment does live at the treatment center during treatment.

Now we’ll explain the criteria a mental health professional uses to determine whether a child needs inpatient treatment or another, less immersive level of care.

Inpatient Treatment for Children or Teens: What’s the Criteria?

[Disclaimer: this article cannot diagnose your teen, determine their level of severity/acuity, or recommend the appropriate level of care. We provide the information below to help you understand the recommendations for treatment you may receive from a licensed and accredited mental health professional.]

Let’s break down three terms: mild, moderate, and severe.

Mild

If your child or teen has a mild mental health disorder, they experience symptoms common to the disorder, but the symptoms are not significantly disruptive. When a disorder is mild, outpatient treatment is generally appropriate. The symptoms your teen has are probably uncomfortable, difficult, and disruptive. However, in the case of a mild disorder, their symptoms are not so disruptive that they impair their ability to carry out typical daily activities, participate in family life, go to school, and live at home.

Moderate

If your child or teen has moderate mental health disorder, their symptoms fall between mild and severe. In most cases, some form of outpatient therapy is appropriate for a moderate mental health disorder.

When the symptoms of their disorder are disruptive but do not impair their ability to go to school or participate in family life, then an IOP program may be appropriate. When the symptoms of a moderate disorder are disruptive and impair your child or teen’s ability to go to school, but do not impair their ability to live at home, then a PHP program may be appropriate. In an IOP program, teens or children receive treatment 3-5 days a week for around three hours per day. During a PHP program, teens or children receive treatment five days a week for around 5-6 hours per day. In both IOP and PHP programs, children and teens live at home while receiving treatment.

Severe

If your child or teen has a severe mental health or substance use disorder, it’s likely they experience symptoms so disruptive they cannot participate in daily life, family life, go to school, or participate in any extracurricular activities at all. In some cases, a child or teen with a severe mental health disorder engages in behaviors that present a danger to themselves, their friends, or their family. Severe mental health or substance use disorders can lead to disordered thinking, suicidal ideation, non-suicidal self-injury, and suicide attempts. Severe behavioral disorders may lead to aggression, anger, hostility, and risky or violent behavior. In most cases, a child or teen with severe mental health disorder will need some form of inpatient treatment.

Inpatient Treatment for Children or Teens: Immersive Care, Around the Clock Supervision

If your child or teen has a severe disorder, then, depending on the level of danger they present to themselves or others, they may require either inpatient psychiatric hospitalization, which is the most immersive level of care, or inpatient treatment in a residential treatment center (RTC), which is the next less immersive level of care.

Here’s a description of these two common forms of inpatient treatment for children or teens:

Inpatient Psychiatric Hospitalization

Teens or children receive this level of care in a specialized treatment facility such as a general hospital, a children’s psychiatric hospital, or a general psychiatric treatment center. Teens or children live on-site and receive medical and psychiatric treatment and support 24-7. This is the most immersive level of treatment available. The primary goals of psychiatric hospitalization are stabilization and safety. Therapy comes after a teen or child is safe and stable, as determined by medical staff. When a teen or child is stable and safe enough to initiate treatment such as psychotherapy, they may begin in the hospital or switch to the next less immersive level of care, which is residential treatment.

Inpatient Residential Treatment

Mental health professionals provide this level of care in specialized residential treatment centers known as residential treatment centers (RTCs). In RTCs, children and adolescents live on-site and receive treatment and support 24-7. These children or teens are stable enough that they’re not an imminent danger to themselves or others. They’ve learned to manage their symptoms well enough to allow them to begin therapy, counseling, and participate in other modes of support.

As you can see, inpatient psychiatric hospitalization is for children or teens in crisis. They’re in immediate, imminent danger. They need to be removed from their present environment and receive the highest level of support available. On the other hand, teens who are not in crisis – but do have a severe disorder – are often better served at a residential treatment center (RTC).

What Level of Care Does My Child or Teen Need?

If you and your child or teen’s therapist or psychiatrist determine your teen has a severe mental health disorder and needs inpatient treatment, then the choice between the two most common levels of inpatient care – psychiatric hospitalization or residential treatment – depends on whether or not they’re in crisis.

A child or teen in crisis most likely needs to get to a hospital right away, both for their safety and yours.

A child or teen with a severe mental health disorder who is not in crisis will likely benefit more from a residential treatment program. At an RTC, children or teens spend time learning about their disorder, practicing the skills necessary to manage their symptoms, and preparing for an independent life after treatment.

Whether your child or teen needs hospitalization or residential treatment, it’s important for you to understand that treatment works.

Inpatient psychiatric hospitalization creates the safety and stability your child or teen needs to begin treatment. Inpatient residential treatment can give them the practical skills and tools they need to manage their symptoms when they return home. With new knowledge at their fingertips, they can get back to school, re-engage with peers in extracurricular activities such as sports or school clubs, and begin socializing as soon as they’re ready.

Inpatient treatment is a big step. It may not be easy to accept the fact your child or teen needs to leave home to heal, but for children or teens with severe mental illness, it may be the most important step they ever take. It’s the beginning of their healing process. It’s an important step for you and the rest of your family too. You’re on the journey right there with them, and they need your love and support as they navigate the journey toward health, balance, and lifelong recovery.

Our Behavioral Health Content Team

We are an expert team of behavioral health professionals who are united in our commitment to adolescent recovery and well-being.

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