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Residential Treatment for Teens: When is it the Right Choice?


If you’re the parent of a teenager in 2022, the past two years have most likely been challenging for everyone in your family. You and your teen faced new circumstances. Some were no big deal, while others may have caused significant stress. In some cases, the stress and disruption led to the development of mental health issues. As a parent you wonder if your teen needs professional support – and if so, you wonder what kind and how much. Do they need to see a therapist once a week to learn to cope with their new emotions, or do they need something more immersive, like an adolescent psychiatric facility that offers residential treatment for teens?

Before we answer that questions, let’s back up and walk through everything that led up to today.

Let’s say your teen is now a rising junior in the class of 2024. That means during their last semester of middle school – March of 2020 – the pandemic arrived.

And everything changed.

Not for everyone, of course. In many states, particularly rural states in the Midwest, public health officials did not order blanket orders that affected businesses or schools.

For most everyone else in most other areas of the country, though, everything did, indeed, change. Here’s a list of what most of us experienced that Spring.

March 2020: The Changes

  • Shelter-in-place orders
  • Travel restricted to essential trips only
  • Social distancing
  • Closed or severely limited business operations, including:
    • Restaurants
    • Bars
    • Gyms
  • Severely limited or restricted public gatherings, including:
    • Cultural events: symphony, theater
    • Entertainment: movie theaters, pop music concerts
    • Social: any events involving ten or more people were strongly discouraged
  • Masks, masks, and more masks: we all had to get used to wearing masks.

In addition to all that, our teens experienced disruptions that may have seemed small to adults, but were a big deal for them.

Let’s go back to that hypothetical rising junior, class of 2024.

The High School Experience, 2020-2022

A teen who’s now a rising junior who lived in an area where most of the public health measures were implemented did not finish middle school or start high school in the manner in which they expected. In many cases, they didn’t finish middle school or start high in the manner they wanted to, visualized, or looked forward to for years. That’s no exaggeration. Many of our kids start watching shows about high school, or watching siblings and neighborhood kids go to high school – meaning they pay attention – when they’re in elementary school.

That means they may spend years building up expectations about what the transition from middle school to high school might be like. During those years, the anticipation builds. They look forward to the change in school buildings, the new peers, and the added freedoms and responsibilities that accompany 9th grade.

That’s not all.

Many also looked forward to a triumphant middle school graduation, and a final week of school riding a wave of accomplishment and anticipation. Still others had their first big summer trips planned: they signed up with the Spanish Club to go to Spain, the debate club to go to Washington D.C., or were ready to go on a wilderness adventure program or an all-fun teen tour somewhere exciting.

The pandemic stopped all that.

That spring, all sports ground to a halt. Graduations moved online. Teens didn’t get their fun last week of school or their graduation day. That summer, all trips were cancelled. No one went on teen tours to Italy or France. People in those countries were sheltering in place. Borders were closed. Even wilderness trips were cancelled: travel restrictions and other public health measures made them virtually impossible.

Then, when the 2021 school year rolled around – when our hypothetical teen from the class of 2024 was supposed to walk onto campus for their first day of 9th grade – they didn’t. Instead, they logged into a video app for virtual school.

In a word: anticlimactic.

In another word: disappointing.

How Did All That Affect Our Teens?

According to the Surgeon General of the United States, the stressors associated with the pandemic took our teens from a state of “at risk” to a state of “significant challenge in need of immediate awareness and action.” That means that some of our youth may need significant help. Some may need outpatient therapy or counseling, while some may need support in an adolescent psychiatric facility that offers residential treatment for teens.

While we have returned to a default state that’s close to normal – which we suppose we can call our new normal – the mental health effects of the pandemic are different than a business or a school. Okay – that’s obvious. But what we mean is that whereas we can reopen a school or a business, we can’t go back and erase the feelings of disappointment our teens felt in 2020 and 2021. Our hypothetical rising junior most likely went to a full year of in-person school last year, and resumed clubs, sports, and other activities the pandemic curtailed.

That’s good news. At the same time, though many of those teens – just like our hypothetical 16-year-old – had a rough year or two, whether they’ll admit it or not. And many of them developed a mental health disorder, whether they’ll admit it or not. In some cases, as we mention above, they may need the support that’s only available in a facility that offers residential treatment for teens.

In order to answer the question “How did all that affect our teens?” let’s take a look at the latest data on teen mental health.

Teen Mental Health in 2020: An Update

The following data was published by the U.S. Department of Health and Human Services (HHS) and the Substance Abuse and Mental Health Services Administration (SAMHSA) in the National Survey on Drug Use and Health (NSDUH) and the Monitoring the Future Survey (MTF). We also used public information maintained on the Centers for Disease Control (CDC) and National Institute on Drug Abuse (NIDA) websites. As a whole, these sources are reliable, and offer parents, teachers, therapists, and anyone interested in teen mental health the latest facts, resources, and statistics available.

For a deep dive into these facts and figures, please read this article, published in the Parenting Tips and Advice section of our website:

Surgeon General’s Advisory: Youth Mental Health in 2021

For a summary, please continue reading. We’ll give you the basic facts you need to know, then move on to a discussion of the factors to consider if you think your teen needs support in an adolescent psychiatric facility that offers residential treatment for teens.

Here are the latest statistics.

Youth Mental Health: 2021 Compared to 2019

  • Anxiety and depression symptoms:
    • 20% of youth reported depressive symptoms
      • That’s double, compared to 2019
    • 25% of youth reported anxiety symptoms
      • That’s also double, compared to 2019
    • Psychiatric Emergencies:
      • Emergency rooms for mental health issues for adolescents 12–17 increased 31% from 2019 to 2021
      • Emergency rooms visits for suicide attempts:
        • Increased 51% for adolescent girls
        • Increased 4% for adolescent boys

Now let’s look at the rates of anxiety for U.S. teens in 2021.

Anxiety: Prevalence Among U.S. Teens 12-17

  • Anxiety disorders (AD):
    • Diagnosed with AD: 32.9%
      • Severe AD: 8.3%
    • Diagnosed with generalized anxiety disorder (GAD): 2.2%
      • Severe GAD 0.9%
    • Diagnosed with panic disorder (PD): 2.3%
      • Severe PD: 2.3%
    • Diagnosed with social anxiety disorder (SAD): 9.1%
      • Severe SAD: 1.3%
    • Diagnosed with obsessive-compulsive disorder (OCD): 2.5%
    • Diagnosed with post-traumatic stress disorder (PTSD): 5.0%
      • Severe PTSD: 1.5%

Next, let’s review the numbers on teen depression.

Depression: Prevalence Among U.S. Teens 12-17

  • Major depressive episode (MDE):
    • Diagnosed with MDE:17%
    • Severe MDE: 12%
  • Major depressive disorder (MDD):
    • Diagnosed with MDD: 6.5%
    • Diagnosed with bipolar disorder (BD): 2.9%
      • Sever BD: 2.6%
    • Diagnosed with seasonal affective disorder (SAD): 3.6%

While rates of anxiety, depression, and other mental health disorders increased during the pandemic, as the experts predicted, there was good news in the data from 2021. We’ll look at that news now.

Alcohol and Drug Use in 2021: The Pandemic Effect

The effect of the pandemic on alcohol and drug use among teens was the opposite of that predicted by the experts: rates of alcohol and drug use decreased. That was unexpected, positive news in a year that was filled with rather bleak news for teen mental health. For a full report on alcohol and drug use among teens during the pandemic, please read this article, published in the Parenting Tips and Advice section of our website:

The Results Are In: Adolescent Drug and Alcohol Use During the Pandemic

Here’s a quick summary of the statistics presented in that article:

Alcohol and Drug Use Among Teens, 2021 Compared to 2020

  • Illicit drug use decreased:
    • 34% for 8th graders
    • 38% for 10th graders
    • 13% for 12th graders
  • Alcohol use decreased:
    • 15% for 8th graders
    • 30% for 10th graders
    • 16% for 12th graders
  • Marijuana use decreased:
    • 38% for 8th graders
    • 39% for 10th graders
    • 13% for 12th graders

Let’s take a moment to consider all the data we present above. Better yet, let’s think about it through the lens of our hypothetical rising junior, a sixteen-year-old in the graduating class of 2024. While we know people are not numbers, it’s okay to apply them to our teen, because they’re hypothetical.

Our teen:

  • Missed milestone events at the end of middle school
  • Missed milestone events beginning of high school
  • Spent most or all of the 2020-2021 year in virtual school
  • Participated in attenuated versions of clubs, sports, or other activities
  • Is at increased risk of depressive symptoms and clinical depression
  • Is at increased risk of the symptoms of anxiety and clinical anxiety
  • Most likely did not initiate or continue use of illicit drugs, alcohol, or marijuana

While that last bullet point is positive, the first five indicate that our hypothetical teen may have developed a mental health disorder over the past two years as a result of the cumulative stress, uncertainty, and grief associated with the pandemic.

If they did, then how do you know, as a parent, if they need typical outpatient support, or the intensive care available at an adolescent psychiatric facility that offers residential treatment for teens?

Levels of Care: How Severe are the Symptoms?

If you think your teen developed a mental health disorder as a result of the stress and disruption of the past two years, the first thing to do is arrange for a full biopsychosocial evaluation administered by a licensed mental health professional with experience working with adolescents. A biopsychosocial evaluation is more than a quick mental health screen. As the name implies, this type of evaluation accounts for all the life elements or domains that may affect your teen’s emotional or psychological wellbeing, including family dynamics, medical history, and social factors.

In 2022, it also means any assessing therapist will ask how your teen coped – or failed to cope – with the challenges presented by the end of the 2019-2020 school year, and the entire 2020-2021 school year. After a comprehensive evaluation of this type, a clinician can diagnose the presence or absence of a mental health disorder. If they diagnose a mental health disorder, they’ll make a recommendation for a course of treatment and a specific level of care.

The level of care appropriate for your teen depends on three primary factors:

1. Level of Acuity

The assessing clinicians determines the level of acuity, or the immediate seriousness of the symptoms of the disorder. In some cases, teens in crisis need immediate hospitalization. Most teens do not need immediate hospitalization, but some will need residential treatment.

2. Symptom Severity

The assessing clinician considers the severity of the disorder. In most cases, mental health disorders are either mild, moderate, or severe. Teens with mild or moderate symptoms typically do not need an immersive level of care, while teens with severe symptoms typical do need an immersive level of care.

3. Treatment History

If your teen received previous treatment at an entry level of care and did not experience significant progress or improvement, then they’ll likely receive a referral for a more immersive level of care.

Now we’ll discuss the four most common levels of care for teens diagnosed with a mental health disorder. These levels of care are the same at most adolescent psychiatric facilities that offer residential treatment for teens. We list them here in order from least immersive to the most immersive:

Outpatient Programs (OP Programs for Teen Mental Health Treatment)

During outpatient treatment, your teen engages in on-on-one sessions with a psychiatrist, therapist, or counselor once or twice a week, for about an hour each session. This is an entry level of care. Teens diagnosed with a mental health disorder with mild or moderate symptoms that do not prevent them participating in school, family, or social life often start with outpatient treatment.

Intensive Outpatient Programs (IOP Programs for Teen Mental Health Treatment)

IOP programs are a step up in intensity and immersion from outpatient programs. If your teen participates in an IOP program, they receive treatment for 2-4 hours a day, three to five days a week. Teens with symptoms that are disruptive but do not prevent them participating in school, family, or social life may start with intensive outpatient treatment.

Partial Hospitalization (PHP Programs for Teen Mental Health Treatment)

PHP programs are a step up in intensity and immersion from IOP programs. If your teen participates in a PHP program, they’ll most likely receive a full day of treatment, five days a week. If the symptoms of your teen’s mental health disorder disrupt day-to-day living and prevent them from functioning at school, they may start with a PHP program.

Residential Treatment Programs (RTC Programs for Teen Mental Health Treatment)

Residential treatment programs – called RTC programs – are the most immersive level of treatment available for teens, with the exception of inpatient psychiatric hospitalization. If the symptoms of your teen’s mental health disorder are so severe and disruptive they prevent them from participating in school, home, or social life, then they may need the immersive, intensive care available in a residential treatment program. In contrast to outpatient treatment, intensive outpatient treatment, and partial hospitalization treatment, teen in RTC programs live at the treatment center. They receive 24/7 support and monitoring. During residential treatment, your teen will have the time to focus on recovery, without the distractions of family, peers, or the responsibilities associated with typical daily life. In other words, residential treatment allows your teen to direct all their energy toward one thing: healing.

We’ll end this section with a maxim we live by: the earlier a teen who needs treatment gets the treatment they need, the better the outcome – for the teen, the family, and everyone involved. That means that if you think your teen developed a mental health disorder over the past two years, the best thing you can do – right now – is arrange for a full assessment performed by a mental health professional.

An assessment will also answer the question we pose in the title of this article: residential treatment is the right choice when a mental health professional determines your teen needs the time, space, and level of immersive care only available in a residential treatment setting.

Finding Help: Resources

If you’re seeking treatment for your teen, please navigate to our page How to Find the Best Treatment Programs for Teens and download our helpful handbook, A Parent’s Guide to Mental Health Treatment for Teens.

In addition, the American Academy of Child and Adolescent Psychiatry (AACAP) is an excellent resource for locating licensed and qualified psychiatrists, therapists, and counselors in your area. Both the National Institute of Mental Health (NIMH) and the National Alliance on Mental Illness also provide and high-quality online resources, ready and waiting for you right now.

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