Inpatient and Residential Treatment Helps Teens Who Engage in Cutting
When you learn that your teenager is cutting, it probably comes as a shock. You may be at a total loss. The behavior most people call cutting – which mental health professionals call non-suicidal self-injury (NSSI) – is not easy to understand, at first. However, reliable statistics show that millions of teens each year engage in self-harming behaviors like cutting.
In 2018, the American Journal of Public Health published a study that showed an alarming group of facts about the prevalence of NSSI and other self-harming behaviors among teens in the U.S. Here’s what they found:
- Close to 20% of teens said they engaged in self-harming behavior
- Over 10% of teenage boys said they engaged in self-harming behavior
- Almost 24% of teenage girls said they engaged in self-harming behavior
The reason we take this study seriously is because of the sample size. If you’re not familiar with that phrase, it means the number of teens involved in the study. In comparison to most, this study was large. Researchers analyzed data from over sixty thousand teenagers. According to statisticians and mathematical experts, sixty thousand subjects is more than enough to make population-level generalizations based on the percentages reported in the study.
Those generalizations lead us to observe that over the period examined in the study – 2001-2015 – more than seven million teenagers engaged in self-harm each year. Breaking that down by gender, the numbers tell us nearly two million boys and more than five million girls intentionally harmed themselves.
That’s per year, for each year the study examined.
We tell you all this because if you’re reading this article, it’s likely you learned recently that your teenager has been cutting. If that’s the case, you need to know something important:
You and your teen are not alone.
The numbers tell us – and you – that millions of families have firsthand experience with what you’re going through right now.
We also share those statistics because it’s likely your teen has received a full biopsychosocial (biological, psychological, social) evaluation administered by a mental health professional. That professional also likely recommended inpatient psychiatric treatment in a behavioral health, mental health, or residential treatment center.
That recommendation – like the revelation your teen is cutting – may be disconcerting. Learning your teenage may need to leave home for inpatient mental health treatment at a hospital or inpatient treatment center is not an easy thing to hear.
We understand. And we want you to know something else: there are evidence-based, effective treatments available that can help your teen. During treatment at an inpatient behavioral health facility, your teen can learn to identify, process, and manage the emotions that lead them to engage in behavior like cutting.
To learn more about effective treatment for cutting and NSSI, please read this article:
Mental Health Treatment for Teens Who Are Cutting
Now we’re ready to answer the question posed in the title of this article:
What Level of Inpatient Treatment is Right for My Teen Who is Cutting?
As a disclaimer, we need to tell you that an article like this cannot replace a diagnosis or treatment recommendation made by a mental health professional. They’re the only people qualified to determine a diagnosis. They’re qualified to give you specific advice for your teen, their diagnosis, and their current circumstances. We can, however, share the criteria mental health professionals use when making these crucial recommendations.
Here’s the first part of the answer.
If your teen is in crisis right now, or they’re in imminent danger of harming themselves, then you should take your teen to the emergency room at the hospital. You can also take them to a behavioral health treatment center or psychiatric facility that offers inpatient support for teens engaging in NSSI.
If you don’t have transportation, please call 911 and get help now.
What that means is that if your teen is in crisis and imminent danger, the type of inpatient treatment they most likely need is inpatient treatment in a psychiatric hospital. We’ll define what we meant by that, with more detail, in a moment.
If your teen is not in imminent crisis or danger, and after a full evaluation, a qualified professional recommends inpatient treatment, then the type of treatment they likely require is residential mental health treatment at a behavioral health center for teens.
To clarify, both types of treatment qualify as inpatient. They’re both intensive and immersive. Both involve your teen living at the treatment center and receiving 24/7 medical and psychiatric monitoring. That’s what makes them qualify as inpatient treatment. An inpatient stay means your teen lives onsite, in the treatment facility, while they receive mental health treatment.
Inpatient Psychiatric Care or Residential Treatment: What’s the Difference?
Inpatient mental health treatment for cutting at a psychiatric hospital and inpatient mental health treatment for cutting in a residential treatment are similar. But they’re not identical. Generally speaking, the differences are related to:
- Treatment focus
- Treatment environment
- Admission type
- Rules around contact
- Duration of treatment
We’ll take these one by one.
The treatment focus during inpatient treatment at a psychiatric hospital is twofold: safety and stability. Medical and psychiatric staff ensure your teen’s physical and emotional safety until the crisis has passed, at which point they’re likely to discharge them to a less immersive level of care, such as residential treatment. In contrast, the treatment focus at a residential facility prioritizes therapy and treatment, as opposed to immediate safety and stability. Of course, at a residential treatment facility, safety comes first, but since teens in residential treatment are not in active crisis, they have the mental capacity and emotional space to engage in therapy. Teens in residential treatment spend time learning to process the difficult, uncomfortable, and overwhelming emotions that can lead to behavior like cutting.
The treatment environment in a psychiatric hospital is what you might expect: most often, they have a sterile, institutional, impersonal feel. They look and feel like an actual hospital, because that’s what they are. In most psychiatric hospitals, all the doors are locked. Clinicians and orderlies control who goes where, why, and when. In contrast, the treatment environment in a teen residential behavioral treatment facility is often completely different. Almost the opposite. Teen residential facilities are often in repurposed homes, with a small number of teens receiving treatment at a time. While teens are closely monitored, 24/7, there is more freedom of movement, and doors between common areas and treatment areas are often unlocked. The treatment is immersive, but the feel is less restrictive, which encourages therapeutic success.
In some cases, admission to an inpatient psychiatric hospital is involuntary. If a teen is in crisis, a psychiatrist may recommend mandatory hospitalization for their safety. Admission to a residential behavioral health treatment center, on the other hand, is typically voluntary, and agreed upon by the family, teen, and treatment team.
Rules of Contact
Psychiatric hospitals often allow staff to use physical contact to control or restrain a teenager when they’re in crisis. These facilities are often known as hands on facilities. Residential treatment centers, however, are typically hands off facilities, which means that treatment center staff are prohibited from using direct physical contact to control or restrain a teenager in crisis.
Duration of Treatment
The duration of treatment – i.e. the length of stay – in an inpatient psychiatric hospital is typically short. Most teens in crisis will stay three days at minimum or ten days maximum. Exceptions are determined by medical staff and dictated by safety and stability. When a teen is no longer in immediate crisis and ready to engage in therapy, doctors will discharge them to a less immersive level of care. In inpatient treatment at a residential treatment center, though, the duration of treatment may be longer. Most teens will stay a minimum of three weeks to thirty days, and a maximum of ninety days or more. The length of stay is determined by clinicians and dictated by treatment progress. When a teen has the skill necessary to manage their emotions and return home – without the danger of engaging in cutting/NSSI – then treatment center staff will discharge them.
What Level of Psychiatric Treatment Does My Teen Need For Cutting?
Behavioral health experts most often recommend the least restrictive level of care that ensures the safety and stability of the patient. In this case, that patient would be your teenager.
If your teen engages in cutting and is in active crisis – meaning they’re a danger to themselves right now – a mental health professional would most likely recommend inpatient treatment at a psychiatric hospital. A hospital stay may be necessary until the crisis is over. A doctor will determine when your teen is safe and stable enough to engage in therapy and treatment.
If you learn your teen has engaged in cutting – but is not in active crisis and not an immediate danger to themselves – then it’s likely a mental health professional would recommend inpatient treatment at a residential treatment center for teens.
At this point, we need to reiterate the disclaimer from above. Here it is, in case you missed it: this article cannot diagnose or recommend a level of treatment for your child.
The information we provide above can be useful. It can help you make an informed decision based on the treatment recommendations you receive from your teen’s provider. You can review the similarities and differences above. They give you a greater understanding of the two main types of inpatient mental health treatment for teens.
To recap, those types are psychiatric hospitalization at a psychiatric hospital and residential treatment at a behavioral health treatment center. Hospitalization revolves around safety and stability. Residential treatment (which of course prioritizes safety as a baseline consideration) revolves around therapy and treatment. In a psychiatric hospital, the purpose of the support is to keep your teen safe. Whereas in residential treatment, support focuses on teaching teens the skills necessary to manage the various disruptive emotions that can lead to cutting.
In both cases, it’s critical for you, as a parent, to understand that treatment works. For a teen who’s cutting, inpatient treatment – of either type – is often the essential first step toward healing and recovery.
To learn more about levels of care in mental health treatment, please read this article: