Does Every Suicidal Teen Require a Psychiatric Hospital? Navigating Levels of Treatment for Your Child

If your teenage child talks about suicide – which means they think about suicide – the first thing you should know is that you must take it seriously.

Do not ignore it.

Do not assume they’re joking, being dramatic, or saying it only to shock you.

While you may be right – it may be one or a combination of all three of those – the consequences of you being wrong are unthinkable.

And if you think your teen is in immediate danger, call 911 immediately, or take them to an emergency room at a general hospital or a psychiatric hospital.

Which brings us to the question posed in the title of this article: does every suicidal teen require a psychiatric hospital?

The answer:

Every suicidal teen requires some level of professional mental health treatment and support.

The exact level of treatment – known as the level of care – depends on the unique and specific mental health needs of the teenager. If your teenager talks about suicide, you know you need to take it seriously. Once you understand that, the next thing you must – must – do is contact a mental health professional at a behavioral health, mental health, or psychiatric treatment center that specializes in adolescent treatment to arrange for a full mental health evaluation.

At a high-quality behavioral health, mental health, or psychiatric treatment center, your teenager will receive what’s called a biopsychosocial evaluation, which, as the word implies, assesses all the factors at play in your child’s life: the biological factors, the psychological factors, and the social factors.

In the case of a suicidal teen, the first thing the assessing provider will determine is your teenager’s level of acuity. In plain language, level of acuity describes how immediately or imminently serious/dangerous your teenager’s mental health issue is at the time of assessment. When your teen receives a full evaluation, the assessing clinician will recommend an appropriate level of care.

The appropriate level of care for your teen may be inpatient treatment for suicidal ideation in a psychiatric hospital. However, your teen may also receive a recommendation for inpatient treatment at a residential treatment center for teens, a partial hospitalization program (PHP), or an intensive outpatient program (IOP).

This article will describe those levels of treatment, and help you understand what they are and why your teenager needs the level of care indicated by their biopsychosocial evaluation.

First, though, to ensure we’re on the same page, we’ll offer basic definitions of suicide-related phenomenon and behaviors, and present the latest statistics on suicide in teens.

Teen Suicide in the U.S.: Definitions, Facts, and Figures

First, the definitions.

The National Institute of Mental Health (NIMH) defines suicide and suicide-related behaviors as follows:

• Suicide is death caused by self-directed injury with intent to die.
• Suicide attempts are non-fatal, self-directed, potentially injurious behaviors performed with the intent to die.
• Suicidal ideation refers to thinking about, considering, or planning suicide.

Now, the statistics, starting with basic facts for the U.S. population as a whole. These statistics appear on the public websites of the American Foundation for Suicide Prevention (AFSP) and the Centers for Disease Control (CDC). The latest complete data sets we have on suicide prevalence rates for the general population are from 2018.

General Suicide Facts 2018

• 48,344 people died by suicide
• 4 million people attempted suicide
• Men died by suicide 3.6 times more often than women
  • White males accounted for 69% of suicide deaths
• There were an average of 130 suicide deaths per day

Now, the statistics on teen suicide.

General Teen Suicide Facts

The latest data on suicide rates among teens, from the 2019 National Youth Risk Behavior Survey (2019 YRBS) are cause for concern:

• In 2014, suicide surpassed homicide as the second leading cause of death for people age 10-24
• An average of 3,703 adolescents in grades 9-12 attempt suicide every day.
• The suicide rate for adolescents (14-18) increased by 61.7% % between 2009-2018
• More teenagers and young adults die from suicide than from cancer, heart disease, AIDS, birth defects, stroke, pneumonia, influenza, and chronic lung disease,
• 80% of adolescents who attempt suicide give clear warning signs beforehand.
• About a third of those who die by suicide have made previous attempts
• During the year following a suicide attempt, risk of a fatal suicide attempt increases 100 times
• A majority of teens who attempt suicide also suffer from a mental health disorder such as depression.

Specific Teen Suicide Facts

In 2019, among high school students (9^th-12^th grade):

• 8.9% reported at least one suicide attempt in the past 12 months
  • • Up from 7.4% in 2017
  • 11.0% of females
    • Up from 9.3% in 2017
  • 6.6% of males
    • Up from 5.1% in 2017
• 23% of LGBTQI+ students reported at last one suicide attempt in the past 12 months (no change from 2017)
  • 6.4% of heterosexual students
    • Up from 5.4% in 2017
  • 16.4% of students who were not sure of their sexual orientation
    • Up from 14.3% in 2017
• 18.8% reported seriously considering suicide in the past 12 months (up from 17.2% in 2017)
  • 24.1% of females
    • Up from 22.1% in 2017
  • 13.3%of males
    • Up from 11.9% in 2017
• 47% of LGBTQI+ high school students reported seriously considering suicide (no change from 2017)
• 14.4% of non-LGBTQI+ students
  • • Up from 13.3% in 2017
• 30.4% of students who were not sure of their sexual orientation
  • • Down from 31.8% in 2017

These numbers are cause for concern because they show, in almost all categories, an increase in rates of suicide and suicide-related behaviors among teens. These increases, when read in light of the stress of 2020, mean parents around the country need to be aware of the fact of suicide among teens and young adults. It’s hard to wrap your mind around the fact that suicide is the second leading cause of death for people age 10-24 – but it’s true.

That’s why parents of teens need to understand these two facts:

1. Suicide, in most cases, is preventable.

2. Evidence-based, effective treatment for suicidal ideation, suicide-related behaviors, and suicidal teens is available.

We’ll now circle back to where we left off before sharing the facts and figures with you: an explanation of the different levels of treatment, a.k.a. levels of care, that you will encounter when you seek professional behavioral health support for a suicidal teen.

What Are the Levels of Care?

Depending on the severity of your teen’s distress – i.e. their level of acuity – common treatment options include:

• Psychiatric Hospitalization
• Residential Treatment Programs
• Partial Hospitalization Programs
• Intensive Outpatient Therapy
• Outpatient Therapy

That list goes from the most intensive and immersive level of care to the least immersive level of care. We’ll describe each one – from the most to least immersive – below.

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. Psychiatric hospitalizations typically occur on the recommendation of mental health professionals after a crisis situation.

This level of care is appropriate for adolescents in crisis or whose level of suicidality is 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 for suicide-related behaviors may have attempted suicide or engaged in self-harming behaviors.

Residential Treatment (Residential Programs for Suicidal Teens)

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.

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 issues.

Partial Hospitalization (PHP Programs for Suicidal Teens)

In PHP programs, teens with suicide related behaviors or issues attend treatment for a full day, five days a week. This level of treatment is appropriate for teens with mental health issues that are significant enough to disrupt day-to-day living. Teens in PHP programs typically do not go to school while receiving this level of care although most PHP programs have an academic component. Participants in PHP programs live at home, and do not live on-site.

Intensive Outpatient Therapy (IOP Programs for Suicidal Teens)

In IOP programs, teens with suicide related behaviors or issues attend treatment for a half-day, three to five days a week. This level of mental health treatment is appropriate for teens with mental health and/or suicide-related issues that are significant enough to disrupt day-to-day living but can still live at home and go to school.

Outpatient Therapy

In outpatient teen mental health treatment, parents take teens to an office visit once or twice a week. 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.

What Level of Care is Best for My Teen?

The decision on the most appropriate level of care for your teen will be collaborative. You’ll consult with your teenager’s assessing clinician, psychiatrist, primary care provider, your family, and anyone else directly involved in the mental health of your teen to determine what level of care will give them the best chance of treatment success. In this context, treatment success means your teen reaching a place where they can manage and process their emotions without suicidal ideation, suicide attempts, or any other suicide-related behaviors.

Many parents think that psychiatric hospitalization is the only level of care for a teen who is actively suicidal – and in many cases, they’re right. However, not every teen who engages in suicidal ideation receives a recommendation for psychiatric hospitalization. Some receive a referral for inpatient residential treatment at an adolescent RTC that specializes in working with suicidal teens.

We need to reiterate here that the above paragraph is not an attempt to diagnose or recommend a level of treatment for your teen. Rather, we’re informing you that a psychiatric hospital may not be the first option an assessing clinician recommends for your child.

Teens who engage in suicidal ideation or suicide-related behaviors may receive a referral to an RTC because an RTC can offer a high level of support and monitoring. Here’s a description of the ways the highest quality adolescent RTCs can keep your child safe.

Clinicians and staff at these centers can:

• Monitor your teen around the clock.
• Maintain a safe teen to staff ratio. Some have a teen:staff ratio of 3:1.
• Check on your teen frequently throughout the night. Some centers check as often as every 15 minutes.
• Keep eyes on your teen’s bedroom door all night.
• Offer support and monitoring from fully licensed and accredited physicians, psychiatrists, nurses, and therapists, 24/7/365.
• Minimize risk by keeping bedrooms simple. Teens keep clothes and only approved personal items in their room. In teen RTCs, bedrooms are for sleeping.
• Identifying risky behaviors.
• Perform a variety of safety checks multiple times per day:
  • Regular safety checks
  • Room checks
  • Contraband checks
  • Room checks occur several times per week – more if we identify risky behavior
• Maintain a strict line of sight rule and keep at-risk teens in view at all times.
• Maintain a strict line of hearing rule and keep at-risk teens within earshot at all times.
• Enforce a strict facility access policy: high-quality RTCs for suicidal teens ensure all internal doors are locked at all times, including bathrooms, kitchens (including kitchen storerooms/equipment), offices, and recreation rooms/areas when not in use
• Monitor the time teens spend in the shower and/or restroom
• Ensure any off-site trips are well-planned, appropriate for your teen’s level of acuity, and strictly monitored

How to Find Treatment for Your Teen

The most important element of your teen’s recovery and return to health, balance, and overall wellbeing is your unconditional love and support. If you learn your teen is thinking or talking about suicide, you need to do all the things we list above: get an evaluation, get a treatment recommendation, and follow through on getting them the appropriate level of treatment and support as determined by a psychologist, psychiatrist, or other mental health professional.

If they’re in imminent danger, then you need to attend to their immediate personal safety by calling 911 or taking them to the emergency room.

When you find out about what’s going on with them, though, it’s critical for you to stay calm, communicate in a cool and collected manner, and make sure they know you’re there for them. It may be difficult to keep your emotions out of that conversation, but it’s essential. You want to avoid adding emotion or drama or anything that resembles conflict to the situation. Your role, in that moment, is to keep them safe and make sure they feel seen, heard, and loved.

Finding treatment comes next: you do that by seeking referrals from your primary care provider, their assessing mental health clinician, friends, family, or visiting websites like those maintained by the Substance Abuse and Mental Health Services Administration (SAMHSA), the National Institute of Mental Health (NIMH), the National Alliance on Mental Illness (NAMI), or the American Foundation for Suicide Prevention (AFSP).

While you seek support for your teen, remember that treatment works, and teen suicide is preventable. Families around the country – and around the world – meet and overcome the challenge of suicidal ideation and suicide-related behaviors. With treatment and support, your teen can recover and return to a full, vibrant, and fulfilling life.

Suicide Hotlines

Teens, parents, or friends of teens who need help right now can call or text the following numbers:

• The National Suicide Prevention Lifeline (24/7/365): 1-800-273-8255
• The Trevor Project Phone (24/7/365): 1-866-488-7386
• Trevor Project Text (7 days/wk, 6am-am ET, 3am-10pm PT): Text START to 678678
• The Trevor Project Chat: CLICK HERE
• The Crisis Text Line (24/7/365): Text CONNECT to 741741
• The Youth Yellow Pages TEEN LINE (6pm-10pm PT) 310-855-4673
• The Youth Yellow Pages TEXT: Text TEEN to 839863