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The Treatment or School Conundrum: Which Comes First?

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 >

Your parents say you need to go to a teen rehab or mental health treatment center.

You have depression, anxiety, prodromal psychosis, PTSD, a substance abuse problem, or another mental health or behavioral issue.

You know that. Your parents know that. The psychiatrist who assessed you and recommended residential treatment knows that.

The problem is – you don’t want to go to residential treatment.

You don’t want to live somewhere 24/7 for a few weeks – maybe even longer – to get mental health or dual diagnosis treatment.

Because that means you’ll miss school.

And you don’t want that.


You Don’t Want to Fall Behind

First, you should know that a lot of teens in your position feel exactly the same way.

Hardworking straight-A students typically feel uneasy about missing even one day of class, let alone weeks. If you’re academically oriented, study hard for tests, diligent about doing homework, and already dreaming about college, you might think skipping weeks of class to get mental health or substance abuse treatment is a terrible idea. Even teens who struggle with grades and have a hard time completing homework might agree with you on that, because they know they’d run the risk of falling even more behind than they already are.

You might be nervous about missing AP or IB classes and exams. Or SAT/ACT prep classes and exams. Or college application deadlines. Not to mention extracurriculars. You’d miss sports practices, student government events, and band/orchestra rehearsals and performances. You’d totally miss everything and be set way back on all levels in all areas of your life.

That’s why you’re reluctant about getting mental health or substance abuse treatment at a residential treatment center or partial hospitalization program.

Why Teen Treatment Comes Before School

We completely understand your worries about school.

We empathize.

But here’s the thing.

Mental health or substance abuse treatment comes before school.

If a mental health professional tells you that you need treatment, then you need treatment.

Sure, you can get a second opinion.

But if a licensed and practicing professional has given you a full assessment and made a recommendation for residential treatment, it’s unlikely another professional will look at the same set of facts and make a different recommendation, especially if you’ve already been through a referral process through your school and your parents are fully on board.

Here’s the other thing.

Your anxiety, depression, psychosis, trauma, addiction or other mental health issue is not going to get any better if you stay in school. In fact, it will probably get worse. And the dangers of not going to a mental health treatment center are much worse than the risks of missing school.

Dangers of Not Receiving Mental Health or Substance Abuse Treatment

This is the first thing you should know:

If you have a serious mental health or addiction issue and don’t get treatment for it, you could be risking your life.

That’s not an exaggeration or a scare tactic.

If you’re living with drug addiction or a substance abuse problem, your problem might escalate and lead to overdose and even death.

You might think this will never happen to you, but facts are facts.

Overdose deaths happen.

We’re not being dramatic. Teens have actually died because they refuse to get help for their substance abuse issue.

The same is true for mental health treatment.

If you live with depression, anxiety, trauma, self-harming behavior, suicidal ideation, prodromal psychosis, or anxiety-induced panic attacks, then declining treatment can put your life at risk.

That’s not dramatic either. The statistics say people with a mental health disorder are far more likely to attempt suicide than those without a mental health disorder.

Here’s the second thing you should know:

Untreated mental health disorders can cause serious problems in the most basic functions of your mind and body.

The short-term cognitive (mind-related) symptoms of an untreated mental health disorder may appear as impaired focus, inability to concentrate, problems with memory, and impaired executive function. Symptoms of mood disorders may appear as anger, irritability, sadness, and hopelessness.

If your mental health issue has already progressed past the initial stages, you might have already experience some, if not all, of these symptoms.

The short-term physical symptoms of an untreated mental health disorder can may appear as headaches, nausea, chest pain, insomnia, phantom aches and pains, and increased rate of colds and minor infections.

But that’s not all.

The chronic stress associated with some mental health disorders can lead to more serious physical problems later in life. These include heart attack, stroke, high blood pressure, and cardiovascular disease. Some of these issues, left untreated, can also result in death.

If you’ve read all this and your primary reason for declining treatment is still the fact you’ll miss too much school, don’t worry: in most cases, you won’t totally stop doing academics.

Teachers, Therapists, and Treatment Center Staff Will Help

Teachers and staff at your school – even the strictest – will understand that mental health comes before academics. Once you or your parents explain the situation, they’ll be sympathetic. Teachers will want you to get treatment. They’ll work with you, whatever your particular circumstance, both during and after treatment. They’ll want to help you keep up with everything and stay on track.

You should also know that going to treatment doesn’t mean you’re one hundred percent out of school. Many residential, partial hospitalization, and intensive outpatient programs include schoolwork in their daily or weekly schedule. That means they dedicate specific times for teens to catch up with school. Staff at mental health treatment centers will also work with your teachers and school administrators so you can get the assignments and homework completed like everyone else. In some cases, you’ll be able to communicate with your teachers to keep up with projects and assignments. You may not take every single exam at the same time as your classmates, but your therapists will can proctor tests and work with you to come up with a realistic academic plan.

This is true at every level of care: residential treatment, partial hospitalization, intensive outpatient. Most teen treatment centers even have dedicated school rooms equipped with desks, computers, printers, and resources to help you stay on top of your schoolwork, grades, and college plans.

And upon discharge from treatment and your return to school, your teachers will help you catch up. There’s another thing that may not have occurred to you. After treatment for a mental health or substance use disorder, many teens perform at a higher academic level than before treatment.

When you look at it that way, treatment actually improves your overall academic situation.

It’s Not a Zero-Sum Game

Ever heard of a zero-sum game? It refers to a situation in which the wins or losses of one participant exactly balance the wins or losses of the other.

In this situation, it would mean that if treatment wins, schoolwork loses.

That’s not what choosing treatment over school means, however. When you choose treatment, everything wins. And the most important thing that wins is not a thing.

It’s you.

Yes, going to residential treatment or a partial hospitalization program means you may miss days, weeks, or even months of school.

But in the big picture, the consequences of not going to treatment outweigh the consequences of missing school.

That’s a fact.

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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