Residential Treatment for Adolescent Depression: An Overview of the Levels of Care

Residential Treatment Helps Teens With Depression

There are a wide range of treatment options for teenagers with depression. If you’re the parent of a teen who recently received a diagnosis for a depressive disorder, finding the best support available is a priority for you and your family. We assume you’ve already taken the first step by arranging for a full biopsychosocial evaluation for your teen, administered by a licensed mental health professional.

That’s why you’re reading this article about residential treatment.

That’s also how you know your teen has an accurate diagnosis, which is critical. Many people with depressive disorders do not receive the help they need, when they need it, because they never receive a comprehensive, professional evaluation. In the absence of a complete assessment and accurate diagnosis, they may not know they need treatment. If they don’t know they need treatment, then they never explore the variety of effective, evidence-based treatment options available to them.

Treatment for clinical depression is essential.

Without treatment, a depressive disorder can escalate. A teenager with untreated depression can experience significant problems during adolescence. These may include difficulty with academics, social isolation, and a lack of motivation to participate in social and/or extracurricular activities. If depression goes untreated throughout adolescence, it can have a long-term, negative impact on physical health, emotional health, and cognitive development. These negative consequences can, in turn, disrupt plans for college and/or vocational training, which ultimately affect gainful employment as an adult.

An accurate diagnosis – achieved by receiving a high-quality assessment – allows you and your family to take the next step on the road to health and wellbeing.

That means exploring all the treatment options available to your teen.

This article will address those options, with a focus on residential treatment, which is typically appropriate for teens with what clinicians call major depressive disorder.

Treatment for Adolescent Depression: Intro to Levels of Care

Most people know the basics of what treatment for depression entails.

The entry-level of treatment for adolescent depression is outpatient treatment (OP). This type of support involves once-a-week office visits with a psychiatrist, therapist, or counselor. Outpatient treatment is the least immersive level of care available, and the one most people are familiar with. It’s a good fit for teens or youth whose depressive symptoms are severe enough to merit professional support, but not so severe they impair their ability to go to school and live at home.

Most people are also familiar with intensive outpatient treatment (IOP) or partial hospitalization treatment (PHP). Both those levels of care – which is how clinicians and mental health professionals describe the various degrees of treatment intensity for teen depression – typically involve treatment 3-5 days a week for three hours or more per day. Teenagers, youth, and/or minors who participate in IOP or PHP programs for depression may have major depressive disorder, but their symptoms are not so severe that they disrupt their ability to go to school or live at home.

Outpatient treatment typically takes place in a therapist’s office. Sometimes, though, outpatient treatment for teens with depression takes place in specialized psychiatric facilities. IOP or PHP treatment may also take place in inpatient mental health hospitals. Intensive outpatient treatment and partial hospitalization treatment programs, on the other hand, typically take place in psychiatric hospitals, inpatient mental health hospitals, or residential treatment centers. Teens in an IOP or PHP depression treatment program that’s part of an inpatient treatment center typically do not mix with the teenagers in residential or inpatient treatment. However, they often receive treatment and support from the psychiatrists, nurses, therapists, and counselors that support teens in residential or inpatient programs.

We’ll now discuss residential treatment for teens.

Immersive Levels of Care: Residential Treatment for Teens with Depression

A teen with severe major depressive disorder may need a more intensive level of care than those mention above. Sometimes, the symptoms of depression are so intense and disruptive that they make it impossible for a teenager to participate in the activities of daily life. Teens with severe depression may not be motivated to get out of bed, talk to anyone – including family and best friends, attend to their personal hygiene, or eat more than a few bites of food at mealtimes.

Teens with depressive symptoms that severe will likely receive a referral from a mental health professional for residential treatment. This level of treatment occurs in the following settings:

• Psychiatric hospitals
• Specialized mental health treatment facilities
• Residential treatment centers

In some cases, teens with major depressive disorder with severe/disruptive symptoms receive a referral for inpatient psychiatric care. For parents new to all this terminology, inpatient psychiatric care for depression and residential treatment for depression might sound like the same thing. They are similar, but they’re not the same. Inpatient treatment for depression most often occurs in inpatient psychiatric hospitals or in the psychiatric ward of a regular hospital, whereas residential treatment occurs, as mentioned above, in residential treatment centers that specialize in support adolescents with depression.

This leads to a question:

What’s the difference between inpatient treatment and residential treatment?

We’ll answer that question now.

Residential Treatment and Inpatient Treatment for Teens: Similarities and Differences

We’ll start with the ways in which these two levels of treatment are similar.

In residential treatment and inpatient treatment for depression, teens:

• Live on-site, in-house, around the clock
• Receive 24/7 medical and psychiatric monitoring from licensed mental health professionals
• Receive treatment and/or participate in therapeutic activities throughout the day, and often participate in peer/community support meetings in the evening or have personal recovery homework to complete (when appropriate).
• Concentrate on treatment and recovery, with few outside distractions. For teens, this may mean academics temporarily take a back seat, while they focus on learning to manage their symptoms.

The differences between inpatient treatment at a residential treatment center for teens and inpatient treatment in a psychiatric hospital or in-house care at a mental health hospital involve the following elements:

The Focus of the Treatment

• Inpatient treatment at a teen psychiatric hospital revolves around safety and stability. Some teens with major depressive disorder are at high or imminent risk of suicide or self-harming behaviors. Therefore, the focus of the treatment is stabilizing the teen so they can step down to a less immersive level of care, where they can make steps toward managing daily symptoms and returning home.
• Residential treatment at a residential treatment center is for teens who need a high level of support and care, but are not in immediate crisis. Their level of acuity (seriousness) is not as extreme as a teen who needs inpatient treatment at a psychiatric hospital or inpatient mental health facility. However, their level of acuity is high enough that they need time away from home and school to focus on making progress in recovery.

The Facilities and Treatment Environment

• Psychiatric hospitals and inpatient mental health facilities often look and feel like typical hospitals, which means the environment is typically sterile, clinical, and institutional. There are some exceptions, of course, but the norm is a standard hospital environment.
• Residential treatment centers – in most cases – are completely different. They’re often located in repurposed family houses in quiet, peaceful suburban neighborhoods. Treatment center staff work to create a home-like atmosphere and a family feel. This helps teens in immersive depression treatment relax, feel supported, and concentrate on the work of recovery.

Locked/Unlocked Doors

• Psychiatric hospitals and inpatient mental health facilities typically keep all the doors locked. Staff closely monitor and control any movement between common areas, treatment areas, and living areas/bedrooms.
• Residential treatment centers for adolescents typically allow more freedom of movement within the facility. Treatment center staff monitor their movement and keep them safe, but do not control movement as closely as in a psychiatric hospital.

Type of Admission

• Admission to an inpatient psychiatric hospital may be involuntary. A psychiatrist may recommend mandatory hospitalization in a crisis situation, or a teenager may be sent to a psychiatric hospital by local child services or judicial authorities.
• In contrast, admission to a residential treatment center for teens is almost always voluntary. Admission is typically through a referral from a primary care physician or psychiatrist.

Type of Contact

• A psychiatric hospital with inpatient programs is most often a hands-on facility, depending on specific local and state laws. What that means is that in the case of an emergency or crisis, hospital staff may be allowed to put hands on the teen in order to restrain them until the emergency or crisis is over.
• In contrast, a residential treatment center for teens is typically hands-off. In an emergency, treatment center staff do not use direct physical contact in order to manage or control the teen.

Length of Stay

• The time a teen spends in a psychiatric hospital or an inpatient mental health facility is relatively short. A typical stay lasts three to ten days. When a psychiatrist or other qualified mental health professional determines the teen is no longer in imminent danger of harming themselves or others, they will discharge them to a less immersive level of care, such as residential treatment.
• The time a teen spends in a residential treatment center depends on several factors. These include treatment progress, insurance coverage, and family choice. Teens typically spend at least a month in residential treatment, but treatment time may last as long as 60 days, and in some cases, 90 days or more.

As the previous paragraphs show, the differences in the types of residential treatment – i.e. the various levels of care and levels of immersion involved when a teen with depression lives at the facility where they receive treatment – are related to the level of acuity the teen displays at the time of admission. A teen in crisis most likely needs total immersion and the highest level of monitoring possible. A severely depressed teen who is not in crisis, on the other hand, may need immersive care, but not the most immersive care available.

What Level of Residential Treatment is Right for My Teenager?

If your teen is suicidal or actively engages in suicidal ideation, they may need time in a locked psychiatric hospital. If your teen has severe depression and disruptive symptoms, but is not a danger to themselves or others, they may be better suited to the immersive and intensive level of treatment offered by a residential treatment center. They may not require the level of monitoring or control that occurs in a psychiatric hospital.

With that said, this article cannot diagnose your teen’s level of acuity. Nor can it determine what level of treatment they need. Only trained, licensed mental health professionals can diagnose and make referrals for treatment.

We can tell you, though, that in both types of facilities, treatment center staff and clinicians have one priority. They’re committed to the health and safety of your child. If your teen receives a diagnosis for depression and a referral for residential treatment, we can also tell you something else: evidence shows that treatment for depression works. Teenagers with depression can learn to manage their symptoms and live a full and productive life.

We know because we see that kind of healing, recovery, and growth every day.

To learn about how to find the best treatment center for your teenager with depression, please read our article Mental Health Treatment for Adolescents: An Overview or read and download this helpful guide: How to Find the Best Treatment Programs for Teens.