The Difference Between Teen Inpatient Treatment and Teen Outpatient Treatment
Depression in teens comes in many forms.
Some teens have mild depression. Their symptoms are uncomfortable, disruptive, and the emotions they experience are difficult to process without help. These teens most often participate in outpatient treatment, which means they go to a psychiatrist, counselor, or therapist’s office once a week – sometimes more, sometimes less – and work with them to learn to manage the symptoms of their disorder.
Other teens have moderate depression. Their symptoms are like those associated with mild depression, but they’re more uncomfortable, disruptive, and more difficult to process without the help of a mental health professional. Most of these teens also participate in outpatient treatment. However, they typically see their psychiatrist/counselor/therapist more often than a teen with mild depression.
Whereas a teen with mild depression might see a therapist once a week or once every other week, a teen with moderate depression might see their therapist twice a week. They may also attend or participate in peer support groups for additional help between sessions. Some teens with moderate depression may participate in intensive outpatient treatment (IOP), which we’ll discuss in a moment.
Still, other teens have severe depression. Their symptoms are like those associated with mild and/or moderate depression, but they’re far more uncomfortable and disruptive. They last longer and are more intense and overwhelming than the symptoms of mild or moderate depression. In fact, the emotions are so disruptive and cause so much pain and difficulty that teens are often unable to process them at all without the intensive, immersive support offered by either a partial hospitalization program (PHP) or a program at a residential treatment center (RTC).
This article will talk about these levels of treatment – known as levels of care – and help you determine what type of treatment might be appropriate for your teen.
How Professionals Decide What Your Teen Needs
We should clarify an important point about the language mental health professionals use to discuss the different levels of care.
One thing you might need to learn is that in mental health care, inpatient does not mean quite the same thing as it does in other areas of healthcare. You probably know inpatient means the patient – in this case, your teen with depression – stays in a facility overnight. However, in the language of mental health treatment, there’s a distinction between inpatient psychiatric hospitalization and residential treatment.
It can be confusing because both those levels of care involve your teen living at the treatment facility – i.e. staying overnight – which implies they’re both inpatient treatment. But that’s where the similarity ends. Inpatient psychiatric hospitalization is for teens who are in immediate crisis. They need to be removed from their current environment for their safety and the safety of others. On the other hand, residential treatment is for teens with severe depression who are not in crisis – meaning at risk of imminent danger – but who do need immersive and intensive care as soon as possible.
That brings us to the question at hand.
How does a professional determine what level of care your teen needs?
They use the following criteria:
- The severity of the symptoms of your teen’s depression
- The acuity of their depression. Acuity means the immediate seriousness of their disorder, and the level of risk or danger posed by the symptoms and/or the behaviors associated with those symptoms
- The level of disruption caused by their depressive symptoms
- Previous treatment history
When a mental health professional administers a full biopsychosocial evaluation of your teen, they cross-reference those criteria with the information they gather in the assessment to determine which level of support your teen needs.
Stages of Progression in Treatment for Adolescent Depression
If you read this far, you learned that a mental health professional will match the level of acuity of your teen’s depressive disorder with a specific level of care.
The stages of treatment can progress in either direction. In some cases, teens with a depressive disorder don’t receive treatment until they’re in crisis – meaning their behavior presents an imminent risk of harm to themselves or others. For a teen with a depressive disorder, this could mean they’re suicidal. It could mean they’re aggressive and/or violent. Or, it could mean they engage in escalating risky behavior that’s objectively dangerous.
A teen at that level of acuity would likely start at the most immersive level of care – inpatient psychiatric hospitalization – and follow a progression from the most immersive level of care to the least immersive level of care. In the language of mental health, this is called stepping down through the levels of care. Each step-down corresponds with positive treatment progress. The ultimate goal is for that teen to return home and engage in ongoing outpatient treatment as needed.
The opposite progression – from least immersive to most immersive – is more common. We’ll use that progression as a way to describe the levels of care. We’ll go from least immersive to most immersive, from outpatient to inpatient, with the hope that it may help you – with the input you receive from mental health professionals – decide which level of care is best for your teen.
Least Immersive: Outpatient Programs
If your teen is diagnosed with depression – called major depressive disorder (MDD) by clinicians – and their symptoms do not disrupt their ability to function in school or impair their relationships with family or peers, they will probably begin with outpatient treatment. Outpatient treatment involves office visits with a psychiatrist, therapist, or counselor one or two times per week. Outpatient treatment is the entry-level of treatment for depression in teens.
More Immersive: Intensive Outpatient Programs
Intensive outpatient treatment is the next step up from outpatient treatment. If your teen is diagnosed with MDD and their symptoms are disruptive but do not prevent them from living at home or going to school, they may receive a referral for an IOP program. When your teen attends an IOP program, they participate in treatment for a half-day, three to five days a week.
Immersive/Intensive Without Living at the Facility: Partial Hospitalization Programs (PHP)
Partial hospitalization programs are the next step up from intensive outpatient programs. If your teen has depressive symptoms that disrupt daily life and prevent them from functioning in or attending school, they may receive a referral for a PHP program. In most PHP programs, your teen will participate in treatment for a full day, five days a week. Teens in a PHP program typically live at home, and not at the treatment center.
Immersive and Intensive: Residential Treatment Programs (RTC)
Residential treatment is a step up from partial hospitalization, and it’s the first level of care that can be considered inpatient. If your teen has symptoms so severe they can’t participate in family life, school, extracurriculars, or social life, they may need the full-time support and monitoring offered by a residential program at an adolescent RTC. During a residential program, they’ll live at the treatment center and have the time and support they need to focus on recovery, without the distractions of home, school, or peers.
Most Immersive and Intensive: Inpatient Psychiatric Hospitalization
Psychiatric hospitalization is the most immersive and intensive level of care available for teens with depression and involves the most intensive monitoring of all the levels of care. If your teen is in crisis, and their depressive symptoms are so extreme they lead to behavior that puts themselves or others at risk, they may receive a referral for inpatient psychiatric hospitalization. During inpatient care, the goals are safety and stability: doctors, nurses, and other clinicians will monitor your teen around the clock until their crisis passes, their symptoms stabilizes, and they’re ready to engage in the type of treatment and recovery activities – such as psychotherapy – that help them take their first steps on the road to recovery.
If Your Teen’s Current Level of Care Does Not Help, Consider a More Immersive Option
One thing that’s crucial to understand about treatment for depressive disorders is that recovery rarely happens in a tidy, linear fashion. There are good and bad days, weeks, and even months. We presented the material above from both directions, as if that’s the way things usually go. We defined levels of care beginning with the most immersive and ending with the least immersive, and vice-versa.
But for teens in treatment – or anyone, for that matter – it doesn’t always happen like that.
In reality, your teen may take steps forward and back during their recovery journey.
For instance, they may start with outpatient treatment, but their condition deteriorates, rather than improves. Then they may have a crisis, but not a dangerous crisis, and enter a PHP program. That PHP program may be just what they need, and they may make progress, step down from PHP to IOP, and then back down to outpatient treatment. Or the PHP may not work for them, either. Which might mean they need to step up to a residential program to make real progress.
In every case, you make the decision about what to do and what level of care your teen needs – outpatient or inpatient – based on the input you receive from your teen and their clinical treatment team.
We know it would be comforting to know exactly when treatment will begin and when treatment will end. It would help to know they’ll reach a specific milestone by a specific date. But that’s not how treatment for depression works.
Every teen is different, every case of depression is different, and every recovery journey is different.
One thing you can know, though, is that treatment does work.
We know because see it work every day.