Adolescent Inpatient Treatment: How to Choose a Level of Care

Inpatient Treatment Options for Teens with Mental Health/Addiction Issues

In most cases, inpatient treatment for teens with mental health and/or addiction disorders occurs in an adolescent residential treatment center (RTC) or a psychiatric hospital for teens. These two levels of care are similar, but there are important differences. This article helps parents understand those differences. We’ll discuss what distinguishes the support and care offered during inpatient psychiatric hospitalization from the support and care offered in a program at a residential treatment center (RTC) for teens.

The first difference to be aware of is that inpatient hospitalization for teens is a more immersive and intensive level of care than residential treatment. It’s reserved for teens in severe crisis – what mental health professionals call high acuity teens – who are in danger of harming themselves and/or others.

That’s why inpatient treatment in a psychiatric hospital is relatively short, and typically lasts for around a week. The goal of inpatient hospitalization is to get a teen past the crisis and help them reach a psychological, emotional, and physical state that allows them to participate in therapy and begin their recovery journey.

Residential treatment at an adolescent RTC, on the other hand, is for high acuity teens who are not in immediate crisis and do not pose an imminent threat to themselves or others. Teens in an RTC may have a severe, disruptive disorder – such as major depression that prevents them from participating in daily life – but they’re neither in crisis nor a danger to themselves or others.

Whereas a teen in crisis needs the highest level of intensive support to help them past and through the crisis, so they can begin therapy and treatment, a teen with a severe mental health disorder who’s not in crisis may be ready to engage in the type of therapy and treatment offered at a teen RTC.

Residential Treatment Center or Inpatient Psychiatric Hospitalization: How do Mental Health Professionals Determine Which the Best Choice for My Teen?

The most appropriate level of care for your teen depends on the outcome of a full psychological assessment administered by a mental health professional. These evaluations are called biopsychosocial assessments. They’re designed to identify all the factors in your teen’s life that can affect their disorder and their treatment.

Biopsychosocial assessments help clinicians arrive at an accurate diagnosis, determine the severity of any present disorder and its symptoms, and recommend a level of care that meets the specific needs of your teen and your family.

During a biopsychosocial evaluation/assessment, clinicians collect the following data:

• Biological information:
  • Personal medical history, including developmental issues
  • Family medical history
  • Present physical condition
• Psychological information:
  • Present and past psychological/psychiatric issues/diagnoses/symptoms
    • Includes present and past psychiatric medication/treatment
  • Present and past family psychological/psychiatric history
  • Personal history of trauma
  • Recent significant life events
  • Present level of stress
• Social information:
  • Current risk factors
  • Current protective factors
  • Academic history
  • Relevant information regarding gender and sexual identity
  • Present level of function in home, school, and social life

Once a clinician administers the biopsychosocial and arrives at an accurate diagnosis, they have another step. They need to determine your teen’s current level of acuity. This phrase – level of acuity – addresses this question:

How serious and disruptive are the symptoms of the disorder right now?

In general, symptoms of mental health and/or addiction disorders present at three basic levels:

Mild

Mild symptoms may be uncomfortable, difficult, and disruptive. However, symptoms considered mild do not significantly impair your teen’s ability to function at home, school, work, or in their social life. Teens with mild symptoms typically do not require inpatient treatment such as a residential treatment program or inpatient hospitalization. If your teen has mild symptoms with little functional impairment, they’re more likely to receive a referral for outpatient treatment.

Moderate

Moderate symptoms are more uncomfortable, difficult, and disruptive than mild symptoms. In some cases, they impair your teen’s ability to function at home, school, work, or in their social life. In other cases, they make those things difficult, but not impossible. If your teen has moderate symptoms, it’s likely they will not require residential treatment or inpatient treatment. However, that decision is for a mental health professional to make, rather than an article like this. With that said, if your teen has moderate symptoms, it’s more likely they’ll receive a referral for an intensive outpatient program (IOP) or a partial hospitalization program (PHP), rather than a referral for residential treatment or inpatient psychiatric treatment.

Severe

Severe symptoms are more uncomfortable, difficult, and disruptive than mild or moderate symptoms. In almost all cases, severe symptoms related to a mental health or addiction disorder impair and/or prevent your teen from participating in the most basic aspects of home, school, work, or social life. If a biopsychosocial assessment indicates severe symptoms, your teen may require residential treatment or inpatient treatment. However – as mentioned above – a licensed, credentialed mental health professional is the only person qualified to determine an appropriate level of care. With that said, if your teen has severe symptoms that prevent them from participating in the routine elements of home, school, work, or social life, it’s likely they’ll receive a referral for residential treatment.

If your teen is in immediate crisis, they may require inpatient psychiatric hospitalization.

Those are the criteria a mental health professional will use to determine how you can choose a level of care for your teen.

Next, we’ll discuss the differences between residential treatment and inpatient psychiatric hospitalization.

Residential Treatment Center or Inpatient Psychiatric Hospitalization: What’s Different and What’s the Same

We’ll start with what’s the same. It’s a short list. During residential treatment and inpatient psychiatric hospitalization, teens:

• Live at the treatment facility
• Receive 24/7 monitoring and support provided by doctors, nurses, and staff
• Receive treatment, support, and care appropriate for their symptoms and level of acuity

In most cases, that’s where the similarities end. The best way to think about the primary differences between these two levels of care is by considering these three factors:

1. Focus and Length of Treatment

• During psychiatric hospitalization, the focus of treatment is safety and stability. Therefore, the length of stay is typically short – three days minimum, ten days maximum – although there are exceptions, based on medical necessity. As mentioned above, adolescent inpatient treatment is for teens in immediate and severe crisis as a result of their mental health or addiction disorder. When a psychiatrist determines your teen is safe and stable enough for discharge, they’ll release them to a less immersive level of care, such as a residential treatment or partial hospitalization program for adolescents.
• During residential treatment, the focus is on therapy, treatment, and recovery – with safety first, always. If your teen receives a referral for residential treatment or steps down to residential treatment from inpatient hospitalization, that means they’re in a physical and emotional place where they can engage in and benefit from therapy and therapeutic activities. During a residential program, your teen focuses on learning to manage and process the disruptive symptoms and difficult emotions associated with their disorder. The goal is to provide them with practical tools that enable them to return to life at home, school, and with peers. This takes time. Therefore, your teen may spend two to four weeks in residential treatment. However, the length of stay depends on treatment progress as determined by clinical staff.

2. Treatment Environment and Rules of Contact

• This is one area where the differences are like night and day. Inpatient psychiatric hospitalization for teens most often occurs in the psychiatric wing of a general hospital or in a specialized psychiatric hospital. In most cases, the environment is sterile and institutional. Doors between all areas of these facilities are typically locked at all times, with access and movement between area strictly controlled by hospital staff. In addition, most psychiatric hospitals allow staff to make physical contact with teen during a crisis. These are called hands-on
• The treatment environment in most teen adolescent residential treatment facilities, compared to teen inpatient psychiatric hospital facilities, is far different – beginning with the physical structures themselves. Many residential facilities for youth are in renovated homes in residential areas. These treatment homes are redesigned to meet clinical treatment and safety standards. But they retain the look and feel of a real home. In most cases, residential treatment centers for teens have a small census. That means they limit the number of teens in residence at any given time. Teens do receive around the clock support and close monitoring by medical professionals, 24/7. In a teen RTC, though, there’s often more freedom of movement. Doors between common areas, eating areas, treatment areas, and recreation areas may be unlocked. In addition, most teen RTCs are hands-off facilities.  That means treatment center staff are not allowed to make direct physical contact with teens during crises. While the treatment in an RTC is immersive, the feel is far less restrictive than in a psychiatric hospital.

3. Type of Admission

• Admission to an inpatient psychiatric hospital for teens may be involuntary. If your teen is in severe crisis, a psychiatrist may refer them for mandatory psychiatric hospitalization for their safety and the safety of others.
• Admission to a residential treatment center for teens, in contrast, is typically voluntary. In most cases, a teen’s participation and an RTC program happens after mutual consent and collaboration between your family, your teen, and treatment center clinicians.

Residential Treatment Center or Inpatient Psychiatric Hospitalization: How Treatment Can Help Your Teen

The goal of treatment is to give your teen the skills they need to regain control of their life.

You learned from this article that psychiatric hospitalization is the first choice in a crisis. If your teen is a danger to themselves or others, they need the unique, intensive level of care available offered by inpatient psychiatric hospitalization. Teens who are suicidal, teens who engage in violent, unpredictable actions, and/or teens whose mental health disorder – including addiction problems – involves escalating dangerous or risky behavior may need to spend time in a completely controlled and immersive environment like an inpatient psychiatric hospital.

Time in this environment can prepare your teen for the work of healing and recovery offered in residential treatment.

And that’s what residential treatment is about: immersive, 24/7 care that’s designed to promote healing, growth, and recovery. In residential treatment, your teen will have time to learn about their disorder. They’ll interact with treatment peers and learn from them. They take the time to learn practical skills they can apply when they’re ready to return home. If you admit your teen to an RTC, their treatment will most likely involve a combination of the following treatment components.

Residential Treatment for Teens: Common Elements

• Individual therapy:
  • Dialectical behavior therapy (DBT)
  • Cognitive behavior therapy (CBT))
• Group therapy:
  • Group DBT/ Group CBT
• Family therapy
  • Your family and your teen
  • Multi-family groups (may occur without your teen present)
• Mindfulness
  • Yoga
  • Meditation
  • Stress-reduction techniques
• Experiential activities:
  • Sports
  • Exercise
  • Hiking
  • Equine therapy (horses)
• Expressive therapies:
  • Art
  • Music
  • Writing
  • Dance
  • Drama
• Medication (if needed)

The exact makeup of your teen’s treatment plan will depend on the information gathered in the initial biopsychosocial assessment we described above. The plan will change to match your teen’s progress. Each element leads to one primary goal. Residential treatment helps teens restores balance to their thoughts behaviors and emotions, return home, and rebuild their life on their terms.

Treatment is work, but treatment works. Evidence shows that the sooner a teen who needs treatment gets the treatment they need, the more likely they are to achieve lifelong recovery.

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.