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Understanding Inpatient Teen Depression Treatment: Residential Treatment vs. Psychiatric Hospitalization

Written by Evolve's Behavioral Health Content Team​:

Alyson Orcena, LMFT, Melissa Vallas, MD, Shikha Verma, MD, Ellen Bloch, LCSW, Lianne Tendler, LMFT, Megan Johnston, LMFT Meet The Team >

When your teen receives a diagnosis for depression, the first thing you want to know is what you can do to help them. You wonder what kind of treatments are available. You know their depression is a serious issue, and finding appropriate treatment is one of the most important steps you and your family will take on the journey back to total health, harmony, and wellbeing.

You’ve probably heard about many of the options available to you. You may know about outpatient treatment (OP), which involves office visits with a psychiatrist, counselor, or therapist once a week or more. You may have also heard of 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 – involve office-based treatment, but typically involve treatment 3-5 days a week for three hours or more per day.

However, if your teen receives a diagnosis for major depressive disorder (MDD) and their therapeutic team – their primary care physician, psychiatrist, and/or therapist/counselor – determines your teen needs a more intensive level of care than OP, IOP, or PHP, they may recommend the 24/7 support and monitoring offered by inpatient treatment.

Two potential inpatient treatment options for teen depression are residential treatment and psychiatric hospitalization.

While they may sound like the same thing, there are important differences every parent who seeks treatment for their teen should understand.

We’ll describe those differences below.

Residential Treatment vs. Psychiatric Hospitalization for Teen Depression: What’s the Difference?

We’ll start this section by talking about the big-picture similarities and differences between residential treatment and psychiatric hospitalization. Then we’ll offer brief descriptions of residential treatment facilities for teen depression and psychiatric hospitalization facilities for teen depression.

First, the similarities.

In both residential treatment and psychiatric hospitalization for depression, teens:

  • Live on-site 24/7
  • Receive around-the-clock medical and psychiatric monitoring
  • Participate in treatment and/or therapeutic activities several times a day
  • Focus on treatment first, with minimal external distraction

Now, the differences:

Treatment Focus

The primary goals of psychiatric hospitalization for depression are safety and stability. When a teenager, minor, or young person experiences symptoms of depression extreme enough to threaten their safety or the safety of the people around them, a psychiatrist may recommend psychiatric hospitalization until their symptoms stabilize and the safety of the teen – and the safety of others – is no longer a primary concern. Teenagers who experience depression-related symptoms such as suicidal ideation, non-suicidal self-injury, or a suicide attempt may be referred for psychiatric hospitalization.

Facilities

Psychiatric hospitalization often occurs in standard hospitals or specialized inpatient psychiatric hospitals. These facilities, in general, have a clinical, dispassionate, antiseptic feel to them because they are, in a word, hospitals. That’s not to say the staff are dispassionate or lack empathy: they’re caring, dedicated professionals who simply work in a traditional clinical environment. Residential treatment centers, on the other hand, often look and feel more comfortable and home-like. Many residential treatment centers are, in fact, located in repurposed residential homes that have been renovated to accommodate the needs of teenage psychiatric patients and meet the licensing requirements for residential treatment centers (RTCs). These facilities offer many of the same supports as an inpatient psychiatric facility, but the environment and atmosphere is often designed to be more kid- and teen-friendly than a psychiatric hospital.

Admission

In some cases, admission to a psychiatric hospital may be involuntary, whereas admission to a residential treatment center for teens is most often voluntary.

Freedom of Movement

In most psychiatric hospitals, all the doors are locked, and hospital staff monitor movement between bedrooms, common areas, and treatment areas. In most residential treatment centers for minors or youth, however, teens have the freedom to move between different parts of the facility, as specified by facility rules and clinical staff. Their movement is still monitored closely, but not to the same degree as in a psychiatric hospital.

Duration

The length of stay in a psychiatric hospital is typically short – three to ten days – and teens are discharged when medical staff determines they are no longer a danger to themselves or others, and their symptoms are no longer so acute they interfere with engagement in treatment at a less intensive level of care. The length of stay in a residential treatment center is determined by a variety of factors, including treatment progress and cost. A typical length of stay for a teen in a residential treatment facility is 30-60 days.

Contact

The type of physical contact permitted between staff and youth/minors at psychiatric hospitals and residential treatment facilities is determined by local and state laws. In general, most psychiatric hospitals are hands on, meaning that in cases of emergency – when the safety of the teen or other patients is in jeopardy – staff may physically restrain the teenager until the crisis passes. Residential treatment centers for teens, though, are most often hands off, meaning that in an emergency, staff do not use direct physical force to maintain the safety of the teen or the other residents of the treatment facility.

As you can see, the major difference between residential treatment for depression and psychiatric hospitalization for depression is the current condition or state-of-mind of the teenager. Teens in acute crisis or in need of immediate stabilization often need the more intensive monitoring and safety precautions common to psychiatric hospitals. Teens who have extreme depressive symptoms that interfere with their ability to participate in day-to-day activities like school, but are not in immediate crisis or danger, often need the less intensive – yet still immersive – level of support offered by residential treatment facilities.

We’ll now offer more detail on the specifics of residential treatment and psychiatric hospitalization.

Inpatient Depression Treatment for Teens: Residential Treatment

Residential treatment for teen depression occurs at specialized facilities called Residential Treatment Centers. Treatment at this level of care is appropriate for teens, minors, and youth with depression that’s so severe they need 24/7 support and monitoring. Teens who attend an adolescent residential treatment center live on site and need an immersive level of care to manage the symptoms of their depression.

In a residential program, teens receive more intensive therapy and psychiatric care than in the IOP or PHP programs we mention in the introduction to this article. Residential treatment allows for more time for one-on-one therapy, more time for family therapy, and more time for group therapy and peer support. Teens learn and practice coping skills, distress tolerance techniques, and relapse prevention strategies. They have time to practice what they learn and hone their skills with feedback from therapists, counselors, and peers. This prepares them for success when they finish treatment or step down to a less immersive level of care.

Inpatient Depression Treatment for Teens: Psychiatric Hospitalization

Psychiatric hospitalization is appropriate for adolescents in crisis or whose depressive symptoms are more acute than teens in residential treatment centers. Their risk of self-harm is the highest. Teens, minors, or youth recommended for psychiatric hospitalization may have attempted suicide, experienced a drug overdose, or engaged in self-harming behaviors. These teens need time away from their current environment to concentrate on recovery and healing. Psychiatric hospitalization occurs in psychiatric units within general hospitals or in private psychiatric hospitals. Intake can be voluntary or involuntary. Care in these facilities is supervised by psychiatrists and delivered by group therapists and/or psychiatric nurses.

In general, psychiatric hospitalization involves the highest degree of monitoring of all levels of care. Movement and activity within the facility is tightly controlled, and doors to living quarters and other areas may be locked during predetermined times. As we mention above, most residential treatment centers have hands off policies for dealing with teens in danger of harming themselves or others, while the regulations in psychiatric hospitals typically allow staff to put hands on patients in crisis situations. In addition, psychiatric hospitalizations typically occur on the recommendation of mental health professionals after a crisis. These stays typically last 3-10 days, depending on the reason for admission and the seriousness of the issue. Upon discharge from psychiatric hospitalization for depression, clinicians most often recommend stepping down to a residential treatment program in a residential treatment center that specializes in treating teens with depression and other mental health issues.

What’s Best for My Teen? Residential Treatment or Psychiatric Hospitalization?

The appropriate treatment option for your teenager depends on their level of acuity – i.e. how disruptive their symptoms are in the moment. The final decision on whether to admit your teen to a psychiatric hospital or a residential treatment center should be made after a thorough assessment and evaluation performed by a psychiatrist. The psychiatrist will then discuss the two options with you, and collaborate with you on the best path forward for you, your teen, and your family. The differences we present above also include a partial description of the criteria a psychiatrist will use to make their recommendation.

It’s important to understand that psychiatric hospitalization is most often appropriate for teens with an extremely high level of acuity. Teens in crisis, teens who are suicidal, and teens who have overdosed on a drug may all meet the criteria for psychiatric hospitalization. Teens in this category, with depressive symptoms so severe they become a danger to themselves or others, will most likely receive a referral for psychiatric hospitalization. They will likely stay in this intensive level of care until the crisis passes and their treatment progress enables them to step down to the next level of care, which is residential treatment.

Teens with depressive symptoms severe enough to impair their ability to function – but who are not a danger to themselves or others – typically receive a referral for treatment at a residential treatment center. By severe enough to impair their ability to function we mean their depression prohibits them from going to school, participating in any extracurricular activities, or participating in family and/or social life. These teens need a high level of support, treatment, and monitoring, but are capable of participating in an integrated treatment program for depression that includes individual therapy, group therapy, family therapy, and various experiential therapies.

The Bottom Line

We’ll summarize the content of this article here.

Psychiatric hospitalization is for teens in acute crisis. In a psychiatric hospital, teens with depression receive intensive support, treatment, and monitoring until they can step down to a less intensive level of care such as residential treatment. Residential treatment is for teens with severe depression but who are not an immediate danger to themselves or others. Whether they enter treatment at that level or have stepped down from psychiatric hospitalization, a teen in residential treatment learns the tools and skills that enable them to return to their home, to their school, and to the activities typical in the daily life of a teenager.

If your teen receives a diagnosis for depression and needs either psychiatric hospitalization or residential treatment, please remember these important facts: decades of evidence show that treatment for depression works, and people with depression can learn to manage their symptoms and live a productive, fulfilling life.

At Evolve Treatment, we know this is true – and we offer you this hope for the future – because we see our teenagers learn, grow, and heal every single day.

Our Behavioral Health Content Team

We are an expert team of behavioral health professionals who are united in our commitment to adolescent recovery and well-being.

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