Symptom severity determines for the most part whether a teen or young adult receives inpatient or outpatient mental health treatment. Inpatient treatment is typically provided in psychiatric hospitals, psych units of general hospitals, and other residential facilities. Since an inpatient stay can interrupt education, social support activities, and employment, outpatient care is generally considered preferable for teens and young adults living with mental health disorders.
Explore this guide
Meanwhile, recent findings published in JAMA Psychiatry revealed a persistent trend in the US toward increased depression among adolescents. If you are the parent of a depressed teen (or young adult) expressing frequent suicidal thoughts, acquiring mental health treatment as quickly as possible is critical to preventing a potential suicide attempt.
Compare levels of mental health care
| Level of care | Where the young person stays | What to clarify |
|---|---|---|
| Inpatient hospital | At the hospital, with 24-hour care. | The immediate treatment goals and discharge plan. |
| Residential treatment | At a treatment residence. | Clinical staffing, education, family involvement, and how it differs from hospital care. |
| Partial hospitalization (PHP) | Usually at home overnight, attending a substantial daytime program. | Daily hours, transport, school arrangements, and safety outside program hours. |
| Intensive outpatient (IOP) | At home, attending several scheduled sessions. | The weekly schedule and support between visits. |
| Routine outpatient | At home, with scheduled appointments. | Therapy, medication follow-up if needed, and when to reassess the level of support. |
AACAP’s continuum of care distinguishes these settings. The assessment should consider safety, functioning, medical needs, available support, and the young person’s participation in care.
When inpatient treatment may be needed
Teenagers and young adults with major mental health disorders (such as Schizophrenia and Bipolar Disorder) may require continuous oversight and monitoring to ensure their personal safety and adherence to the treatment plan. According to the National Alliance on Mental Illness, the usual Schizophrenia age of onset is adolescence in males and late-twenties in females. In contrast, Bipolar Disorder onset typically occurs between 16-25 years of age. Stabilization on psychiatric medications is often the main therapeutic approach utilized by psychiatrists for both Schizophrenia and Bipolar Disorder, and this can take time to be achieved.
If treated on an outpatient basis, a teenager newly-diagnosed with Schizophrenia may attempt to walk through a brick wall or tree due to a delusion, and thereby sustain a serious injury. Likewise, a teenager with Bipolar Disorder may – during a manic episode – go on a massive shopping “spree”, resulting in tremendous credit card debt beyond that young person’s ability to ever pay. Therefore, a period of inpatient treatment to ensure a secure environment for the newly-diagnosed teen or young adult with a major mental illness may be preferable.
Likewise, teens or young adults with a co-disorder of substance abuse may need a period of inpatient (rather than solely outpatient) treatment. This is to reduce the likelihood of relapse to abusing the substance, since most substance-abusing youth have friends who are also substance abusers.
Facilities and payment options
The primary insurance payers in the US for inpatient psychiatric hospitalization are private health insurance plans and Medicare (or Medicaid). State psychiatric hospitals and the psychiatric units of general hospitals are the most likely to accept governmental insurance, while private psychiatric facilities are most likely to accept only those patients covered by private insurance or who can pay “out-of-pocket” for their hospitalization.
Meanwhile, some private facilities are run by nonprofit organizations, and others are administered by “for-profit” organizations. In general, those run by nonprofit organizations are more likely to offer financial assistance to patients who are low-income, but not covered by Medicare/Medicaid. (The Mayo Clinic in Minnesota is such a nonprofit organization that has an on-site inpatient psychiatric unit for teens.)
While some inpatient mental health treatment settings (and especially state hospital settings) for teens and young adults have few on-site recreational options available, some offer resort-like amenities. For example, Newport Academy has residential sites nationwide that frequently offer hikes in state parks, yoga, and equine-assisted therapy, besides different types of therapy and medication management.
Outpatient therapy
The usual options available on an outpatient basis are individual therapy, group therapy, and family therapy. However, the most common type of therapy available to both adults and teens is individual therapy (in which the client meets on a one-to-one basis with a mental health therapist). Outpatient therapy to teens and young adults are usually offered in the following settings:
- In an office for therapy sessions in a mental health center;
- In the private office of a licensed psychotherapist or other mental health counselor;
- In an office for therapy sessions in a clinic within a hospital
Unless a teen or young adult has expressed suicidal or homicidal thoughts, a referral for outpatient mental health treatment is usually provided by the individual’s medical provider (and/or insurance company case manager) rather than inpatient treatment.
Eating-disorder treatment
The appropriate setting for eating-disorder treatment depends on an assessment of physical health, mental health, and the support available outside hospital. NICE guidance recommends medical inpatient or day-patient care when physical health is severely compromised and stabilization cannot be managed safely through outpatient care.
Admission decisions should consider the rate of weight loss, the need for medical monitoring, and whether family or carers can help keep the young person safe outside hospital. A single weight or BMI threshold should not determine admission. The care team should explain why the proposed setting meets the young person’s needs.
Historical context: pandemic-era waiting times
Teens and college-attending young adults had their education disrupted at the beginning of the Covid-19 pandemic due to pervasive fears of spreading infection. The switch to remote learning was difficult for some adolescent and young adult students, and especially for those already struggling with their academic performance in high school or college. A research article in Frontiers in Psychology in 2021 concluded an adverse effect of Covid-19-resultant school closures on overall student achievement.
Meanwhile, the increased social isolation from friends and classmates due to Covid-19-necessitated “remote learning” fostered worsened loneliness and depression among adolescents. Consequently, the demand for mental health therapy sessions to treat depression in teens has dramatically increased (per the American Psychological Association). The result has been far longer waiting times by clients in the US to acquire a first therapy session than prior to the Covid-19 pandemic.
Choosing the next step
Teens and young adults suffering from depression may exhibit different symptoms, and the effect on daily functioning can also differ tremendously. While some depressed young people cry more often in the presence of their family and friends, others lose interest in formerly-enjoyed social activities or self-medicate with alcohol/drugs.
Meanwhile, a major mental health disorder (such as Bipolar Disorder) may remain undiagnosed until symptoms become clearly noticeable to the affected person’s friends – and result in the loss of those friendships. The type of mental health treatment chosen for a teen or young adult suffering from a mental health disorder depends on the one that is most likely to be effective, as well as the trust level of the teen for the mental health providers at that facility.
As a parent of a teen or young adult with symptoms of a mental health disorder (or as a teen or young adult experiencing a mental health disorder), acquiring inpatient or outpatient mental health treatment before the symptoms become even more severe can prevent acting in ways that can ruin interpersonal relationships and future adult career opportunities. Therefore, entering the treatment that is most quickly available – but fits your actual needs and financial capacity – is recommended as opposed to waiting until the symptoms become unbearable.
Questions for the first call
If there is an immediate danger, use emergency services. In the US, call or text 988 for crisis support. An intake waiting list is not an emergency-care plan.