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My Teen has Depression, Anxiety, Psychosis and is Cutting: What Behavioral Health Inpatient Facility Would Be the Best Choice?


Treatment for Depression, Anxiety, Psychosis, and Nonsuicidal Self-Injury in Teens

There are some mental health disorders in teenagers that are straightforward. As are their diagnoses. That’s not to say that any mental health disorder is simple or easy for the teen who has it. Each teen with a disorder such as depression or anxiety has a unique history and a set of factors specific to their lives that led to the development of the disorder. Yet the assessment and recovery process is well-established and well-traveled. They need to get an accurate diagnosis, commit to treatment, put in the effort, learn to manage their symptoms, and apply their recovery skills every day.

That takes work – and the work is not easy.

With that said, a teen diagnosed with a mild depressive disorder with no additional features typically follows an evidence-based treatment path based on best practices that are proven effective in countless academic and clinical studies. Medication, talk therapy, lifestyle changes, and consistent use of coping skills to process stress, anxiety, and challenging emotions can help that teen live a productive and fulfilling life in recovery.

Again – it’s never easy. Any form of depression can escalate and include patterns of thought that lead to behaviors that may result in significant distress, discomfort, and harm.

However, the symptoms a teen with mild depression experiences are typically not as disruptive as the symptoms a teen with both depression and anxiety experiences. Those symptoms – though challenging and potentially debilitating – are typically not as disruptive as the symptoms a teen with depression, anxiety, and psychosis experiences. Those symptoms – as frightening as the delusions and hallucinations that characterize psychosis are for a teen – may not be as difficult to manage as those of a teen with depression, anxiety, psychosis, and non-suicidal self-injury (a.k.a. self-harm) experiences.

That’s a complex situation that requires a refined approach to treatment.

Inpatient Treatment for Teens with Depression, Anxiety, Psychosis, and Self-Harming Behavior

It’s a complex situation – but that doesn’t mean a teen with this combination of co-occurring disorders has no alternatives. On the contrary, there are treatment approaches designed for teens with these diagnoses and symptoms. One specific approach to treatment for teens with depression, anxiety, non-suicidal self-injury, and psychotic symptoms is dialectical behavior therapy (DBT). Granted, this article cannot diagnose a teenager. That’s for a mental health professional – and only a mental health professional – to do.

Click here to learn more about co-occurring disorders.

If you’re the parent reading this article, we assume you’re at a time and place where you’ve already done the following:

  1. Had your teen evaluated and assessed by a licensed and qualified mental health practitioner.
  2. Received an accurate diagnosis for your teen. In this case, your teen received these diagnoses:
    1. Depression
    2. Anxiety
    3. Psychosis
    4. Nonsuicidal self-injury (NSSI), a.k.a. self-harm, i.e. behaviors like cutting.
  3. Received a referral for inpatient treatment.

Assuming all of the above is true, you’re now deciding what kind of behavioral health inpatient facility is appropriate for your teen.

We can offer information that can help you with that decisionwith the disclaimer that this article is neither a diagnosis nor referral nor does it offer medical advice.

We can also share the criteria licensed and qualified practitioners use when making these case-sensitive and teen-specific recommendations.

We’ll start by defining what we mean by the phrase behavioral health inpatient facility:

A behavioral health inpatient facility is a specialized location where people with severe and acute mental illness go for immersive treatment. The word inpatient means that the patient – in this case, we’re talking about your teen – lives at the facility full time and receives 24/7 medical monitoring and care for their overall health and safety.

Generally speaking, there are two types of inpatient facilities that support teens with depression, anxiety, psychosis, and self-harming behaviors:

A mental health professional will determine the appropriate level of care for your teen based on two primary factors:

  • Their level of acuity – i.e. how immediately serious their symptoms are right now
  • The level of severity of their symptoms

The guiding principle is safety: teens who are an imminent danger to themselves or others require one type of facility, while teens who are not an imminent danger to themselves or others require another type of facility.

Which Inpatient Behavioral Health Facility is Right for My Teen?

If your teen is in crisis right now, or they’re in imminent danger of harming themselves or others, then you should take your teen to the emergency room at a regular hospital, call 911, or take them to a specialized psychiatric hospital if you know of one nearby.

What that means is that if your teen – with the diagnoses listed above – is in crisis and poses an imminent danger to themselves or others, then the type of behavioral health inpatient facility they most likely need is a psychiatric hospital.

What that also means is that if your teen – with the diagnoses listed above – is not in crisis and does not pose an imminent danger to themselves or others, then the type of behavioral health inpatient facility they most likely need is a residential treatment center for teens.

Both types of facilities qualify as inpatient facilities. They’re both intensive and immersive. Both involve your teen living at the treatment center and receiving 24/7 medical and psychiatric monitoring.  That’s what makes them qualify as inpatient treatment: the fact that your teen lives onsite, in the treatment facility, while they receive mental health treatment.

However, there are important differences between the two types of facilities. For a detailed explanation of those differences, please read our article:

What Level of Inpatient Treatment is Right for My Teen Who Is Cutting?

For the purposes of this article, there are two basics thing you need to know about the difference between a psychiatric hospital and a residential treatment center: the treatment focus and the treatment environment.

Residential Treatment and Inpatient Hospitalization: Key Differences

As we mention above, residential treatment centers for teens and inpatient hospitalization for teens both involve your teen living at the facility and receiving 24/7 support and monitoring from skilled and qualified mental health professionals.

Treatment Focus: Psychiatric Hospital

Inpatient treatment at a psychiatric hospital is two goals: safety and stability. Clinicians and staff monitor the physical and emotional safety of your teen until as long as they’re in crisis or present a danger to themselves or others. Once a doctor determines your teen is past the crisis, they’ll probably discharge them to a less immersive level of care, such as residential treatment.

Treatment Focus: Residential Treatment Center

A residential treatment facility prioritizes therapy and treatment, as opposed to immediate safety and stability. Safety comes first at any behavioral health facility for teens – that’s a given. But since teens in residential treatment are not in active crisis, that means they’re physically, mentally, and emotionally stable enough to participate in therapy. Teens in residential treatment will spend their time learning to process the difficult, uncomfortable, and overwhelming emotions and symptoms that accompany co-occurring diagnoses of depression, anxiety, psychosis, and NSSI (cutting).

Treatment Environment: Psychiatric Hospital

A psychiatric hospital is what you might expect from the name. In most cases, the environment is sterile, impersonal, and institutional. They look and feel like hospitals, because they are hospitals. In most psychiatric hospitals, all the doors that connect the various locations in the facility are locked. Clinicians and staff decide who goes where, why, and when. Safety and stability are paramount, and all the rules and regulations revolve around those core considerations.

Treatment Environment: Residential Treatment Center

A residential treatment center for teens, on the other hand, typically has a different environment than a psychiatric hospital. To most parents and teens, they feel almost the opposite. Residential treatment centers for teens are often in repurposed homes in residential neighborhoods. They typically have a small census, meaning a small number of teens live on-site and receive treatment at a time. Doctors, nurses, and staff will monitor your teen 24/7, and ensure their ongoing physical, mental, and emotional safety. In contrast to a psychiatric hospital, residential treatment centers offer more freedom of movement. Doors between the various locations in the facility are often unlocked. Treatment and support are immersive, but the feel is less restrictive. The environment and the focus of treatment is the next step after safety and stability: teens begin to learn how to manage their symptoms and move gradually towards moving back home.

Treatment for Teens with Depression, Anxiety, Psychosis, and Self-Harming Behavior

Earlier in this article, we wrote that there is a specific type of evidence-based treatment that can help teens with this group of co-occurring mental health disorders: depression, anxiety, psychosis, and NSSI. That type of treatment is dialectical behavior therapy (DBT).

But there’s more to the answer than that.

Within the overall framework of DBT, there’s a type of residential program called Comprehensive Dialectical Behavior Therapy.

There’s still more. Within the framework of Comprehensive DBT, there’s a more specific type of residential treatment known as Comprehensive DBT for Adolescents.

What is DBT and Why is it Effective For Teens With Severe Mental Health Issues?

Dialectical behavior therapy (DBT) is an evidence-based treatment developed by Dr. Marsha Linehan in the 1980s. DBT is an effective treatment for teens with severe, disruptive mental health symptoms, such as those experienced by teens that have the types of mental health disorders that are the topic of this article. A DBT program helps teens transform extreme, negative, life-interrupting behaviors into effective, positive, life-affirming ones.

In a residential DBT program at a behavioral health inpatient facility, your teen can learn the skills they need to manage their problematic symptoms and live life on their own terms. DBT for teens includes five core modules:

1. Mindfulness

Your teen learns to accept the reality of the present moment.

2. Emotion Regulation

Your teen learns to manage tumultuous feelings and thoughts.

3. Interpersonal Effectiveness

Your teen learns to manage relationships with others.

4. Distress Tolerance

Your teen learns how to process and cope with stressful situations.

5. The Middle Path

Your teen learns how to find a balance between extreme states of thinking and feeling.

In addition to the five core modules of DBT, a comprehensive DBT program includes the following four components:

1. Individual Therapy

Your teen engages in one-on-one psychotherapy with a DBT-trained therapist.

2. Skills Training

In a group of recovery peers, led by a DBT-trained therapist, your teen learns the five core DBT skills listed above.

3. Skills Coaching

When your teen needs immediate support, a DBT-trained therapist is available to coach them through the practical application of the core DBT skills.

4. Consultation Teams

Therapists in a comprehensive DBT program meet weekly to assess both how they’re doing as therapists and the progress the teens they work with are making. DBT therapists in comprehensive DBT programs use this time to apply the skills they teach to their own lives.

Teens who need immersive support to acquire the skills necessary to manage overwhelming emotions, get control of potentially damaging, risky, and impulsive behaviors, and build the knowledge and experience to effectively navigate family, school, and peer relationships benefit from comprehensive DBT programs. A comprehensive DBT program can give them what they need to return home and return to school. A DBT program can help them live the life they choose, rather than a life dominated by the symptoms of their mental health disorder or disorders.

What’s the Right Type of Treatment Program for My Teen?

A comprehensive residential DBT program is not the only type of residential DBT program available to your teen. There are also DBT-informed programs. The thing that distinguishes a DBT-informed program from a comprehensive DBT program is the makeup of the individual treatment plan. If your teen participates in a comprehensive DBT program, they’ll engage in all four core components of comprehensive DBT. If your teen participates in a DBT-informed residential program, they participate in one, two, or three of the core components of DBT. During the remainder of their treatment time they participate in therapies and receive support appropriate to their specific needs.

Not every teen needs comprehensive DBT. The teens who do need comprehensive DBT, though, experience progress in treatment that does not often occur when they participate in other types of treatment programs. In fact, evidence shows that for teens with severe emotional dysregulation, DBT programs – either comprehensive or informed – are one of the only types of programs that are truly effective. To read in-depth, peer-reviewed journal articles about DBT for teens with severe mental illness, click here, click here, and click here.

To read our articles on DBT, please follow these links:

Comprehensive DBT vs. DBT-Informed Teen Treatment Centers: What’s the Difference?

What is the DBT House of Treatment?

How do Adolescent DBT Programs Help Depressed and Anxious Teens?

Family DBT at Evolve: How We Do It

New Study Confirms DBT Effective Treatment for Teens who Self-Harm

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