Mental health treatment is an important topic in the U.S. right now.
Two and a half years of stress and disruption caused by the coronavirus pandemic and various other social and political factors have increased the need for effective, evidence-based treatment for mental health, behavioral, and/or alcohol/substance use disorders. If you or someone you love developed a mental health problem during the pandemic – or if the pandemic exacerbated a previously diagnosed disorder – you may not know which type of treatment offers the best hope of recovery.
We can help.
This article will address the two most immersive levels of mental health treatment available: psychiatric inpatient residential treatment and inpatient psychiatric hospitalization.
We’ll define both levels of care, explain the difference(s) between psychiatric inpatient residential treatment and inpatient psychiatric hospitalization, and identify the reasons a person with a serious mental health disorder might choose treatment at a psychiatric inpatient residential treatment center rather than an inpatient psychiatric hospitalization program.
Before we get into the details about these levels of care, however, we need to ensure everyone reading this article understands the scope of the problem at hand. To that end, we’ll present the latest facts and figures on mental health in the U.S. and the world, with an emphasis on the increase in mental health disorders and overall psychological distress reported since the beginning of the pandemic.
Mental Health in the U.S. and the World: Facts and Figures
We’ll start with a narrow focus: the six-month period between August 2020 and February 2021. In a report published in late 2021, the Centers for Disease Control (CDC) indicate that during that six-month, mid-pandemic period:
- The percentage of adults with symptoms of anxiety or depression increased from 36.4% to 41.5%
- The percentage of adults with unmet mental health care needs increased from 9.2% to 11.7%
- Young adults 18-29 experienced the greatest increases in symptoms of anxiety and depression
Keep in mind those statistics are for the U.S. and cover a relatively short period of time. Now let’s expand our scope and look at a large-scale meta-analysis performed in the United Kingdom (U.K.) that includes data on almost 50,000 people collected between 2006 and 2021. Note: a meta-analysis includes data from the most relevant studies on a specific topic in order to identify trends or changes over time. This meta-analysis used data from eleven separate studies on psychological distress based on measures of depression and anxiety among adults in the U.K. before and after the pandemic.
Before and After: Mental Health and the Pandemic
- One study showed an increase of 16.5%:
- Pre-pandemic: 11.5% of adults reported symptoms of anxiety or depression
- Post-pandemic: 28.0% of adults reported symptoms of anxiety or depression
- Another showed an increase of 22.6%
- Pre-pandemic: 11.4% of adults reported symptoms of anxiety or depression
- Post-pandemic: 35.0 .0% of adults reported symptoms of anxiety or depression
Now let’s look at a report from World Health Organization (WHO), which identified increases similar to those found in the U.K.:
- During the first year of the pandemic, worldwide prevalence of anxiety and depression increased 25%
- Women and young adults reported the largest increases
We’ll end with data from closer to home, extracted from the National Survey on Drug Use and Health (NSDUH), an annual, large-scale survey that includes data collected from over 70,000 people in the U.S> every year. The following statistics appear in the 2018 NSDUH and the 2020 NSDUH, and include information on substance use disorder (SUD) as well as mental health disorders.
Mental Health Disorders and Substance Use Disorder (SUD) in the United States: 2018 and 2020
- Diagnosed with mental illness:
- 2018: 47.6 million adults
- 2020: 52.9 million adults
- Diagnosed with serious mental illness:
- 2018: 11.4 million adults
- 2020: 14.2 million adults
- Among those diagnosed with mental illness:
- 2018: 9.2 million also had SUD
- 2020: 17 million also had SUD
- Among those diagnosed with serious mental illness:
- 2018: 3.1 million also had SUD
- 2020: 7 million also had SUD
This last set of numbers give us valuable information and clearly outline the scope of the mental health and addiction problem in the U.S. For the two years for which we have reliable before and after data, we can see significant increases in people with mental illness and serious mental illness. And among those, we see the number of people diagnosed with a mental illness and an SUD – called co-occurring disorders or dual diagnosis – almost doubled.
That’s why we’re writing this article. The statistics demonstrate a significant need for increased mental health support in the U.S., specifically for people with serious mental illness and a co-occurring substance use disorder.
We’ll now talk about how psychiatric inpatient residential treatment – as opposed to inpatient psychiatric hospitalization – might be an appropriate choice for someone support for a mental health disorder, a substance use disorder, or both, i.e. co-occurring disorders.
Psychiatric Inpatient Residential Treatment or Inpatient Psychiatric Hospitalization: What’s the Difference?
There are significant differences between psychiatric inpatient residential treatment and inpatient psychiatric hospitalization, but let’s start with one thing they have in common: the inpatient component. What inpatient means is that the individual in treatment lives at the treatment center or hospital and receives 24/7 medical support and monitoring.
In mental health treatment, inpatient means the same thing: the individual lives on-site and receives 24/7 support and monitoring during treatment. However, after that basic similarity, these two levels of care diverge. The relative divergences are primarily related to the overall goals of treatment and how clinicians and staff help individuals meet those goals.
Before we describe these differences, we need to add a disclaimer. This article is neither a diagnosis nor medical advice. Licensed and qualified mental health professionals such as psychiatrists and therapists are the only people who can diagnose a mental health and/or substance use disorder and refer you or a loved one for mental health treatment. This is an essential step you can’t skip. If you think you need or a loved one needs psychiatric inpatient residential treatment or inpatient psychiatric hospitalization, we recommend arranging a full biopsychosocial evaluation administered by a licensed and qualified mental health professional: that’s the first step toward recovery.
Now let’s talk about these two levels of care, starting with inpatient psychiatric hospitalization.
Inpatient Psychiatric Hospitalization
- People with mental health disorders or mental health-related behaviors that put them in imminent danger or expose friends, family members, or anyone else to immediate risk of harm
- May be necessary when:
- Symptoms, emotions, or behaviors associated with a mental health disorder place an individual at personal physical risk
- Symptoms, emotions, or behaviors associated with a mental health disorder are disruptive enough to prevent them from participating in the typical activities of daily life and functioning
- May be mandatory and involuntary when:
- An individual in crisis needs close physical and medical monitoring until the crisis passes
- Length of stay:
- 3-10 days
- Longer in some cases
There are three operative words to consider then thinking about inpatient psychiatric hospitalization: safety, stability, and crisis. A person who is aggressive or violent, actively suicidal, or engages in excessively risky behavior as a result of their mental health or substance use disorder may need inpatient psychiatric hospitalization. If an individual arrives at an emergency room during a mental health or addiction crisis, an on-call psychiatrist may order a mandatory, involuntary referral for inpatient psychiatric hospitalization for the duration of the crisis. When medical staff determines that individual is safe, stable, no longer in crisis, and no longer a threat to themselves or others, they discharge that individual to a less immersive – and typically voluntary – level of care.
We can sum that up: if you’re in active crisis and a risk to yourself or others, inpatient psychiatric hospitalization may be appropriate. If you’re not in active crisis and don’t present an immediate risk to yourself or others, then psychiatric inpatient residential treatment may be appropriate.
We’ll talk about that level of care now.
Psychiatric Inpatient Residential Treatment
- Lifestyle change
- People with mental health disorders or mental health-related symptoms and/or behaviors that are extremely severe, disruptive, and uncomfortable
- People with mental health disorders or mental health-related symptoms and/or behaviors that prevent them from meeting the obligations or participating in the typical activities of daily life.
- Typical daily activities include work, school, family life, social life, and personal hygiene
- May be necessary when:
- Symptoms, emotions, or behaviors associated with a mental health disorder prevent an individual from meeting their personal needs
- Symptoms, emotions, or behaviors associated with a mental health disorder prevent an individual from meeting family, work, or school obligations
- Psychiatric inpatient residential treatment is always voluntary
- Length of stay:
- 3-6 weeks
- Typical time-in-treatment is around one month
Although this is an oversimplification, the one operative word to think about when comparing psychiatric inpatient residential treatment to inpatient psychiatric hospitalization is time. Hospitalization is not really about therapy and recovery: it’s about getting a person past a crisis so they can then participate in the types of therapy and recovery offered in residential treatment, which we’ll talk about in more detail now.
What Happens During Psychiatric Inpatient Residential Treatment?
Upon admission and intake to a high-quality psychiatric inpatient residential treatment program, you receive a full biopsychosocial evaluation and psychiatric assessment. Based on the results of your admissions interviews and intake assessments, you then collaborate with treatment center staff on an individual treatment plan that leverages your strengths, recognizes your challenge areas, and gives you the best chance at achieving sustainable, lifelong recovery.
In a top-quality treatment center, your individualized treatment plan will include a combination of the following:
- Common therapeutic approaches include:
- Dialectic behavioral therapy (DBT)
- Cognitive behavioral therapy (CBT)
- Trauma-informed DBT and/or CBT
- Lifestyle supports, including:
- Nutrition counseling
- Stress management techniques
- Experiential therapies, including:
- Outdoor recreation
- Equine therapy (horses)
- Medication, as needed
The specific elements of your treatment plan depend on your unique treatment needs and goals. What works for one person might not work for another. What works when you initiate your plan might change as you make progress in treatment, and the plan you begin with may be different than the plan you follow upon discharge.
The length of time you spend in a psychiatric inpatient residential treatment program also depends on you and the therapeutic milestones you set with your treatment team upon admission and intake. When you and your treatment team decide you’re ready for a less immersive level of care, you create a plan, set a discharge date, and prepare your transition.
Which Option is Best for You?
The answer to that question should be the result of communication and collaboration between you, your family, and your treatment team.
If you or a family member are in mental health or addiction crisis, please dial 988, the National Mental Health Crisis Hotline.
If you’re not in crisis, but know you need – or a family member needs – immersive treatment for a mental health or substance use disorder, then you can use this article to help make your decision.
The information above shows that psychiatric inpatient residential treatment and inpatient psychiatric hospitalization are quite different. While both support the ultimate goal – recovery – one is about short-term stabilization, while the other is about long-term treatment and growth.
During psychiatric inpatient residential treatment, you have the time and space to focus on therapy and healing. You’re free from the distractions of daily life, which allows you to direct your energy toward creating new psychological, emotional, and interpersonal skills. You receive around the clock medical monitoring in case of emergency, just as you would during a hospital stay, but your days are filled with therapy, treatment, and recovery activities. Your evenings are often busy: community support meetings, recovery homework, or additional group activities and educational workshops all coordinate to help you meet your treatment goals.
If that level of immersive support and care sounds like what you need, or what a loved one needs, then you may have the answer to the question we pose in the title of this article:
When is Psychiatric Inpatient Residential Treatment the Right Choice?
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