Understanding Inpatient and Residential Care

When your teenager receives a diagnosis for a clinical mental health, behavioral, or addiction disorder, it can come as a shock. You may not be prepared for the diagnosis or your responsibilities related to the diagnosis. Your first responsibility is to get your emotions under control and understand that what matters is not what happened leading up to the diagnosis.

What matters is what happens next.

To help you understand what we mean by that, please read these two articles we published recently:

A Letter to Parents with a Depressed Teenage Girl

A Letter to Parents with a Depressed Teenage Boy

Once you sort your emotions out, get grounded, and get centered, what should happen next is this: you find the best and most appropriate course of treatment for your child.

In some cases, that can bring another shock. Teens with a severe and disruptive disorder may receive a referral for inpatient psychiatric care or treatment at a children’s mental health hospital.

Those two phrases alone might scare you.

If they do, we need to explain something: with some exceptions, when a referring mental health professional uses those phases, what they most often mean is that your teen needs residential treatment.

The confusion – along with the fear and the fear of stigma – comes when you associate the words or phrases inpatient or inpatient psychiatric care or children’s mental health hospital with what you imagine a psychiatric ward in a typical hospital or psychiatric hospital for adults might be like.

We understand that completely. Placing your teen in an institutional-feeling hospital environment might be the last thing you imagined doing. And – while we don’t know their diagnosis or the details of their current situation – it’s likely that’s not what they need.

It’s more likely they need a residential treatment program in a residential treatment center (RTC) for adolescents.

Residential Treatment and Inpatient Psychiatric Care: Similarities and Differences

Let’s clarify something: there’s a time when inpatient psychiatric hospitalization is one hundred percent necessary and appropriate.

That time is when your teen is in crisis.

In the language of mental health treatment, a teen is in crisis when the symptoms of their disorder create an imminent threat to their safety or the safety of others, or when the symptoms of their disorder prevent them from carrying out basic daily activities such as getting out of bed, eating, and tending to the essentials of personal hygiene and physical health.

In that case, your teen would need immersive, 24/7 psychiatric and medical monitoring to ensure their safety and stability.

A Word About Stigma

Let’s clarify something else. A majority of teens who receive a diagnosis for a mental health disorder are not in crisis. Most do not need inpatient psychiatric hospitalization. In fact, one reason teens with a diagnosis reach a state of crisis is that their families opt-out of treatment in the beginning. The primary reason families resist treatment is because of the stigma surrounding mental health disorders and mental health treatment.

We’ll address that right now. The stigma around mental health treatment is a holdover from the 20^th century when most people believed mental illness/addiction was a character flaw, a sign of weakness, or the result of poor decision-making and an inability to simply suck it up and move on.

Those ideas are last century.

In the 21^st century, we know that mental health, behavioral, and addiction disorders are medical conditions that respond positively to evidence-based treatment. Receiving a mental health diagnosis is the same as receiving a diagnosis for a heart condition or diabetes.

When you receive a diagnosis for a medical condition, what you do is listen to the doctor. You follow the course of treatment they recommend. If you don’t follow doctor’s orders, the condition gets worse. The same is true for mental health disorders. We know now that what you do is listen to the doctor. You follow the course of treatment they recommend. If you don’t follow doctor’s orders and leave them untreated, they get worse.

When they get worse, they can lead to crisis.

To avoid crisis, it’s important to move past the stigma around treatment. Which brings us back to what we really want to talk about now: treatment. Specifically, the similarities and differences between residential treatment and inpatient psychiatric care.

Residential Treatment and Inpatient Psychiatric Care

First, the similarities. During both 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 need

Now, the differences. The best way to think about the differences between these two levels of treatment is by considering these two factors:

Treatment Focus

• Residential: During residential treatment, the focus is on therapy, treatment, and recovery. Your teen takes the time to learn 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. That takes time. Your teen may spend two to four weeks in residential treatment. Their length of stay is determined by treatment progress monitored by clinical staff.
• Inpatient Hospitalization: During psychiatric hospitalization, the focus of treatment is safety and stability. The length of stay is typically short, around three days minimum or ten days maximum, depending on the individual. 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 residential treatment.

Type of Admission

• Admission to a residential treatment center for teens is typically voluntary. In most cases, admission to an RTC program happens after collaboration between your family, your teen, and treatment center clinicians.
• 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.

Let’s sum this up.

Residential treatment, which is a type of inpatient psychiatric hospitalization with a much less scary name, helps teens with severe mental health, behavioral, or addiction disorders learn to develop the practical skills they need to manage their disorder and return to life at home, at school, and with their peers. In contrast, inpatient psychiatric hospitalization – in the strict clinical sense of the phrase – is for teens in crisis who either cannot manage anything for themselves or pose an imminent threat to themselves or others.

The Right Care Right Now Can Be Life Changing and Life Saving

If you’re the parent of a teen diagnosed with a mental health disorder and they receive a referral for inpatient treatment, what we want you to learn from this article is that in order to help your child heal and grow, they may need residential treatment. That level of care will likely be sufficient and can prevent the need for psychiatric hospitalization.

We know from experience that when a teen with a mental illness or addiction gets the treatment they need when they need it, outcomes improve. This is an important thing for you to understand: delaying treatment can lead to serious problems. In the case of addiction disorders, this can mean escalating risky behavior that can lead to overdose and/or death. In the case of disorders like severe depression, bipolar disorder, or psychosis, delaying treatment can lead to suicidal ideation and suicide attempts.

That’s why it’s crucial to get treatment for your teen. And that’s why it’s crucial to understand that the stigma against treatment is based on old, outdated knowledge that had no real basis in scientific evidence. We now know that evidence-based treatment works. We also know the sooner a teen who needs treatment gets the treatment they need, the more likely they are to learn to manage their disorder and lead a full and fulfilling life.