Inpatient, Residential, or Outpatient? How to Choose the Right Level of Care for a Child or Young Person

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Parents often ask us how they would know whether their young person requires a higher level of care, such as a hospital admission or a stay in residential treatment. Understandably parents want to balance their child’s need for the best treatment with keeping them at home and in the family.

Sometimes these decisions can feel incredibly tough, especially if it is unclear what treatment your child needs and your child is resistant to help. But the treatments and therapies you choose for your child can heavily influence outcomes.

Here we look at how parents can better understand the decision-making process to make informed choices that are right for their child.

What happens when my child first shows signs there might be a problem?

When young people first show signs and symptoms of mental health concerns or problems at home or school, they may be referred to a counsellor. This may be a school counsellor, pastoral head, NHS CAMHS service, or a specialist children’s therapist. In addition, some schools will have an educational or clinical psychologist or a child and adolescent recovery coach that can be called upon for young people with low-level concerns.

When a young person sees a counsellor at school or home, we usually expect them to be working on ‘here and now’ issues. This might include friendship problems, homework difficulties, pressure at school, or family arguments. Counsellors at school and in the community are excellent resources for problems in the day-to-day management of life for young people. This approach is often sufficient to iron out any issues before they escalate into deeper problems.

Where problems appear more complex (as is generally the case with eating disorders, for example), your child’s counsellor may refer your young person or even the family to a specialist Psychotherapist, Clinical Psychologist, or Psychiatrist.

This is the usual protocol if your child’s counsellor feels that your young person would benefit from an assessment of medical or clinical needs, or that they need more specialist levels of care. There are several different types of psychological treatments. The evaluation will determine the best approach for your child but will usually include talking therapy, like Cognitive Behavioural Therapy (CBT).

As a parent, it is crucial to understand the complexity of mental health. Sometimes, a few counselling sessions won’t provide a magical cure, and recovery is never linear for complex issues. There may be steps forward and steps back in your child’s treatment. It is helpful to be prepared for this and be aware that different treatment options may become more appropriate as your child’s treatment progresses and problems unravel. Try not to worry. The counsellor or therapist with whom your child works will inform you if they feel more intensive treatment options should be considered.

What is a higher level of care?

A higher level of care usually means a stay in a hospital psychiatric ward, a psychiatric unit, or a residential treatment centre. However, it could be a more intensive outpatient treatment program. Your child’s safety will always be at the heart of any recommendations by clinical professionals.

My child is not getting better. What do I do now? 

For some children, counselling will help to get things back on track. For others, more help may be needed, and there may be a referral to a child and adolescent specialist mental health team, psychotherapist, psychiatrist, or psychologist specifically trained to work with young people.

The family may also be referred to a family therapist and specialist mental health practitioners trained to help with specific family-oriented problems. Whatever the referral, your young person will get a treatment plan formulated after careful consideration.

As treatment progresses, parents will receive regular updates and be kept involved in decisions about ongoing care. Additional specialist services may be called upon as the plan unfolds to help with physical or psychological needs.

If your child has a higher risk level, or when outpatient treatment does not seem to be improving your child’s situation, your treatment team may recommend residential admissions or hospital care.

Your child’s mental health team will carefully consider inpatient or residential care if your child is self-harming, has suicidal thoughts, their physical health is compromised or is at risk of deteriorating or further harm.

Deciding for your child to go into a hospital or residential care treatment program can be difficult and frightening, particularly if your child resists the idea. Parents understandably feel that the safest place for their child is at home. While it may feel like you are going against your child’s wishes, you must trust the clinical guidance and process.

What if my child is resisting help?

This is such a valid question and one we are asked often. If your child is struggling with their mental health, for whatever reason, they will be behaving differently from how they did before these issues arose. You may therefore struggle to communicate with your child or adolescent, and it can feel like you no longer recognise them. You know they need help, but they try every trick in the book to convince you they don’t need it.

As a parent, you can feel like you are forcing them to do something they don’t want to, and this can feel uncomfortable. While it is essential during adolescence to allow your young person to develop independence and let them have their say, you must be careful not to let the mental health condition win.

Remember, your child is most likely terrified of treatment. Let’s consider the example of an eating disorder. Controlling what they eat has become their coping skill. It has likely begun to define them, and this means they may feel treatment will signify giving up some part of themselves.

If you find yourself in this challenging but not uncommon situation, there are many strategies to try. While it may feel overwhelming, you may have to approach things differently if you want to influence your child’s recovery.

This might involve family therapy and therapy for yourself. Importantly, don’t engage in debates or a battle of wills with your child. Ultimatums and a power struggle will make them want to reject treatment even more.

Inpatient, Residential, or Outpatient – what’s involved?

Treatment for mental health disorders is complex and may involve multiple providers and different levels of care at various stages. Therefore, it is helpful for parents to know what each level of care involves.

Having this knowledge will help to clarify what is appropriate for your child. Treatment for anorexia nervosa, for example, will usually include talking therapies (there are several types) and supporting activities that forge positive experiences around food and weight management.

Here’s an overview of what the different levels of care generally involve:

Outpatient treatment – sessions with a counsellor, psychologist, or psychiatrist once or twice a week and regular appointments with a dietician for eating disorders.

Intensive outpatient treatment is a structured program that includes individual therapy, group therapy, and education. Sessions are typically three to four hours long and run two to five days weekly.

Intensive outpatient treatment is usually offered when a person needs more support and structure than standard outpatient treatment. It is also a valuable option for people who have just ended a period of hospitalisation or when leaving residential care.

Partial hospitalisation – the person attends an outpatient treatment centre during the day for five days a week but sleeps at home. Most meals are taken at the treatment centre. This is especially critical for eating disorders as part of a food education and recovery program. This level of care is suitable for medically and psychiatrically stable people who can’t function in normal educational or vocational settings and need daily assessment.

Residential treatment is 24/7 care in a non-hospital setting. Treatment includes multidisciplinary care, nutritional support, medication management, and individual and group therapy. Residential care is ideal for young people who are medically stable but need time away from home and school, college, or university to make progress in recovery.

Medicalised hospitalisation is emergency care for people who are medically unstable and require 24-hour monitoring of vital signs. The person may require intravenous fluids and tube feeding. Sometimes, the person may be admitted to a psychiatric ward or mental hospital against their will for compulsory treatment.

Countries have different regulations for hospitalisation against a person’s will. For example, in the USA, a person can be committed against their will if they meet specific criteria, which may differ from State to State. In the UK, a doctor can decide to admit a person to a hospital for compulsory treatment under the Mental Health Act.

What does treatment look like?

Treating eating disorders is complex. Individuals have different needs, and treatment should reflect this through a precise and personalised program of therapies and supporting activities. 

Talking therapies are essential. Opportunities to explore feelings that underpin eating disorders may include individual therapy, group therapy, and family therapy. Families need to understand that eating disorders aren’t just about food. There is often anxiety, depression, trauma, perfectionism, and an element of control.

The most common type of talking therapy for eating disorders is Cognitive Behaviour Therapy (CBT-E). CBT-E is a scientifically proven method of treatment where the therapist and the young person work out together what is keeping the eating disorder going and how to manage and ask for help. In addition, the therapist supports the young person in exploring how they feel about themselves and their bodies and the rules they may have developed around food and eating. Family involvement is usually an essential part of CBT-E for young people.

Dialectical Behaviour Therapy (DBT) is a therapy method initially developed for people with borderline personality disorder (BPD) but has shown to be helpful for people with eating disorders. This approach helps people develop new coping and relationship skills, which include mindfulness, distress tolerance, interpersonal effectiveness, and emotional regulation.

In addition, essential to any comprehensive eating disorder program is wrap-around support and education and the chance to enjoy new experiences and have fun. At The Wave, for example, a typical day would include journaling, arts, dance, study time, self-care breaks, reading and relaxing, and individual and group therapy. Notably, The Wave’s expert dieticians work with our young people to make food challenges more manageable and provide support and guidance on weight management. For example, we empower young people to practice safely writing lists, shopping and preparing meals together.

Is residential care at The Wave a good fit for my child?

The Wave is one of the few International Programs dedicated to mental health care for children, teenagers, young adults, and their families.

The Wave has developed a team of exceptional professionals who are talented, dedicated, experienced, and lovely, empathetic people. Our team of experts is renowned for treating young patients with care and sensitivity, so you can feel assured that your child or young person is in a safe space and in the safest possible hands.

Please get in touch with us for further information and to discuss your child’s needs. All enquiries are treated with the utmost confidentiality and respect.

Fiona - The Wave Clinic

Fiona Yassin is the founder and clinical director at The Wave Clinic. She is a U.K. and International registered Psychotherapist and Accredited Clinical Supervisor (U.K. and UNCG).

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