If you’re the parent of a child with a mental health, behavioral, or alcohol/substance use disorder, you know it’s your responsibility to get them the best treatment and support available. Once they receive a comprehensive evaluation, assessment, and referral for treatment – the first step on the recovery journey – your next step is deciding how to act on the referral.
You know you need to find them help no matter what diagnosis they receive. With very few exceptions, children or adolescents with depression, anxiety, bipolar disorder, and other mental health issues need professional support. The same is true for children or adolescents with behavioral disorders such as conduct disorder (CD), disruptive mood dysregulation disorder (DMDD), or oppositional defiant disorder (ODD). Adolescents diagnosed with alcohol use disorder (AUD) or substance use disorder (SUD) most often need professional support as well, as do children and adolescents with co-occurring disorders – meaning they have more than one mental health, alcohol/substance use, or behavioral disorder at the same time.
After the evaluation and assessment process – which is essential – your child or adolescent will most likely receive a referral for one of the following levels of care:
- Outpatient Treatment
- Intensive Outpatient Treatment
- Partial Hospitalization Treatment
- Residential Treatment
You may find three of these levels of care referred to by their acronyms. You frequently see:
- Intensive outpatient programs called IOPs
- Partial hospitalization programs called PHPs
- Residential treatment programs called RTCs
For a thorough explanation of levels of care, please read our article:
If your child or teen receives a referral for residential treatment but they’re unsure they want to participate or actively resist residential treatment, this article offers advice on how to get them to turn the corner and commit to treatment.
How to Talk to Your Child or Teen About Residential Treatment
The first thing you should know is that it’s not uncommon for a child or teen to be wary of residential treatment, unmotivated to participate in residential treatment, or actively resistant to residential treatment. That’s true for all the levels of care, but the more immersive the recommended treatment, the more resistance you can expect to find.
Studies published over the past thirty years suggest that only twenty to thirty percent of parents who seek treatment for an adolescent with a substance use disorder get their child into treatment without outside assistance. Additional data from the 2017 and 2019 Monitoring the Future Surveys (2017/2019 MTF) indicate that only five percent of teens diagnosed with alcohol addiction (AUD) and ten percent of teens diagnosed with drug addiction (SUD) received appropriate treatment at a specialty facility.
The difference between the number of people who need treatment for a mental health or drug use disorder and the number of people who receive treatment for that disorder is called the treatment gap.
As you can see above, the treatment gap for teens with alcohol and drug problems is an enormous problem. The treatment gap for mental health disorders such as depression is less alarming, but it’s still a very real problem. Data from the 2019 National Survey on Drug Use and Health (NSDUH) on rates of depression and mental health treatment show the following:
Prevalence of Teen Depression and Treatment: United States (2019)
- 49.3% of teens diagnosed with major depressive disorder (MDE) received treatment.
- This shows an increase of 5.5% from 2005-2019
- 49.7% of teens diagnosed with MDE with severe impairment received treatment
- This shows an increase of 5.8% from 2005-2019
We share these statistics here to affirm our point that it’s not unusual for a teen with any kind of mental health disorder – including an alcohol or substance use disorder – to resist treatment. While the data do not show why teens did not receive treatment, we can safely assume that a percentage of them either actively refused treatment when recommended, or demurred treatment in some way, thereby contributing to the treatment gap.
Since the numbers we’re talking about here are in the millions, it’s also safe to say to parents with a treatment-resistant child or teen that you are not alone. Parents address this issue every day, all over the country, and so do we. That’s why we know the advice we offer in the rest of this article is good: we talk to parents and therapists regularly, read the latest data, and keep up on the most effective ways to get the children and adolescents who need treatment into treatment.
Talking to Your Child or Teen About Residential Treatment: The First Two Hurdles
There are two major problems anyone who needs treatment for any mental health and/or addiction issue needs to meet and overcome. The first is the stigma that our culture places on mental health/addiction in general, and the second is the result of that stigma on self-esteem. The first is external, while the second is internal. Children and teens who need residential treatment for a mental health or alcohol/substance use disorder need their parents to protect them from both these phenomena.
The former – the cultural stigma – stems from ignorance about mental health and mental health treatment. We can cut through that quickly: a mental health disorder or condition is no different than a physical health disorder or condition. We don’t shun or stigmatize people for getting a cold, breaking a leg, or getting cancer. Nor should we stigmatize them for developing depression, anxiety, a conduct disorder, or an alcohol/substance use disorder.
It’s really that simple.
The latter – the internal consequences of cultural stigma – is more difficult to address. A child or adolescent needs to know that developing a mental health, behavioral, or alcohol/substance use disorder does not make them a bad person, an incomplete person, or a broken person. It has nothing to do with their quality of character or their worth as a person.
It makes them a person with a mental health, behavioral, or alcohol/substance use disorder. Nothing more, and nothing less.
That’s a straightforward sentence for us to write. It may not be as straightforward for a child or teenager to understand, though. In this context, your job as a parent is to remind them that a mental illness is an illness, full stop – just like any other illness. And getting treatment for that illness is the right thing to do, full stop – just like any other illness.
Talking to Your Child or Teen About Residential Treatment: Having the Conversation
Once you clear those first two hurdles – which may not be easy – the most important element of your approach is open and honest communication. It’s important for you to be clear on where you stand. You need to know your child’s diagnosis, why they need residential treatment, what’s going to happen during residential treatment, and how it’s going to help them. You also need to resolve any misgivings or ambiguity you yourself have about mental health issues or mental health treatment. If you doubt the necessity or validity of treatment, your child or teen will pick up on it, whether you say it out loud or keep your thoughts to yourself.
That’s why reading this article is a good thing to do. If you have questions about their diagnosis or specific questions about their disorder, we recommend you arrange a personal talk with their therapist to address any and all questions you have. We also recommend navigating to the For Parents section of our website. We have helpful Parent Guides on everything from ADHD to Social Anxiety Disorder, a Tips and Advice section with hundreds of articles on adolescent mental health issues, and a Parent Resource section with videos from our parent workshops and downloadable pdfs written to help your family navigate the treatment experience.
Now we’ll offer our top five tips for getting buy-in from your child or teen with regards to their participation in residential treatment.
How to Get Your Child to Commit to Residential Treatment
If your teen does not want to go to residential treatment, it’s best for you to start at the beginning. Ask them why they don’t want to go. Their reasons may surprise you. They may think they’ll miss too much school or be afraid they’ll miss their friends. They may be embarrassed by their diagnosis and the fact they have a mental health or addiction issue. Or they may think their time in residential treatment will reflect poorly on their permanent record and prevent them from getting into the college of their choice. It’s your job to anticipate and have answers to all of these questions and concerns. And again – that’s why you’re reading this article: you need to have solid, fact-based answers ready.
Once you understand why they’re resistant to treatment, validate their concerns. We mentioned you need to have answers to their question, concerns, and fears, but there’s a catch, here. Do not lead with your researched and rehearsed answers. Lead with empathy and compassion. This is important. The emotional validation needs to come first. Tell them “I hear you and understand why you’re scared. I know it’s hard.” Sit with them for a while and let them know you get it. If they cry, hug them. If they get mad, wait them out. When the emotions pass, it’s time for the next phase of the conversation.
Tell them everything you know about their diagnosis. Tell them everything you know about treatment, too. If you have any friends or family members with a history of mental health disorders, tell them everything you know – leaving out the names when appropriate, of course. Share all the knowledge you have. Tell them everything you’ve learned about the residential treatment center you want them to go to. Share everything about the type of treatment they’ll receive. Show them pictures of the facility. Give them a copy of the daily schedule.
Let them know that treatment works.
Affirm for them that, in some cases, people with mental health or alcohol/substance use disorders need to go to residential treatment, in the same way that, in some cases, people with physical disorders or conditions need to go stay in the hospital. Make sure they know that experienced doctors with years of knowledge and experience think that residential treatment can help – and that they should listen to those doctors just like they should listen the doctor’s advice when they have an accident or an illness.
You know as well as any parent that a child or teen has the most chance of success at any given endeavor when they do it of their own volition. This is as true for mental health or addiction treatment as it is for anything else. Most teens want to get better and resist treatment because they don’t understand how it will help. To motivate them, you can ask open ended questions, such as “Why do you think treatment won’t help?”
Also, you can draw your questions directly from the therapeutic technique called motivational interviewing. You want to find out if they want to change, and if so, how they want to change. You want them to discover change talk themselves. For instance, you can ask “Is there anything about your current situation you want to change?” You can also ask “What would positive change look like for you?” or “How do you think things will go if you don’t change what you’re doing now?” The goal of this approach is to turn them into the driving force seeking change. If that happens, chances of treatment success increase dramatically.
5. Solidarity and Outcomes
This last tip has two parts that may seem contradictory at first – but they’re not.
The first part, solidarity, means that you participate in treatment, too. The highest quality residential treatment programs for teens emphasize family participation and family engagement. Therefore, let them know that as they receive treatment and support in order to make changes, you’ll also engage in the treatment process. You’ll go to family therapy and take the workshops and exercises seriously. You’ll work on communication, compassion, and understanding. If you’ve been enabling the mental illness or addiction, you’ll learn how to stop enabling. If you have issues you need to work on that are relevant what they’re going through, you need to promise to work on those issues as they work on theirs.
The second part of this last tip is almost self-explanatory. If your child or teen refuses treatment, despite all your efforts to convince them it’s for the best, you may need to define the clear outcomes – i.e. consequences – that will follow their refusal. And you need to be ready to enforce them. If your teen refuses to participate in treatment, you can:
- Restrict their use of the family car – or their car, if they have one
- Restrict access to money – your credit card, for example
- Limit access to their phone
- Limit access to the internet
The catch here is that if you establish these outcomes, you need to adhere to them. They won’t work if you back down. Explain the reasons behind each outcome and tell them they can change the outcomes if they commit to, and complete, the residential treatment program recommended by their counselor, psychiatrist, or therapist.
Full Family Engagement
Getting buy-in for residential treatment from your child or teen may be a challenge, but it’s a crucial piece of the puzzle. One important element of everything we say above is respect. They’re your child and you’re the boss, of course, but they need to know you respect and honor their thoughts, feelings, and points of view on the subject of their treatment. They’re the ones who have to change, after all.
Which brings us to our final point.
In the 21st century, treatment for a child or teen is a family affair – and that means they’re not the only ones who have to change. You’ll have to change, too. During the treatment and recovery journey, you’ll learn new ways to love and support your child. When they see you commit to and work to change as they commit to and work to change, their chances of treatment success increase. The whole family participates, the whole family heals, and the whole family learns to move forward to a better, brighter future.