The Decision Your Family Has to Make Before Your Teen Even Leaves the Hospital
Your family has just gone through a crisis, and your teen had to be admitted to a mental health hospital. Everyone’s emotions are all over the place, but there is a mental health system to navigate, and even though they were just admitted, it is already time to plan for what needs to happen so that the crisis does not repeat.
A well-planned discharge is necessary for successful treatment. At times, a poor discharge plan can lead to a return to the hospital for your teen. It is best to set things on the right foot in the beginning so that things can be as smooth as possible for your family.
Discharge planning will be discussed with you by a member of your teen’s treatment team. Some mental health hospitals have a dedicated discharge planner, while others have therapists or social workers handle discharge planning.
What Comes After the Mental Health Hospital: Your Teen’s Options
When discharging from the mental health hospital, there are a few options for how treatment can continue:
- Residential Treatment Program
- Partial Hospitalization Program (PHP)
- Intensive Outpatient Program (IOP)
- Outpatient Therapy
Residential Treatment
I will briefly cover residential treatment before going in depth on PHP/IOP programs. In a residential treatment program, your teen would live away at home while attending treatment. Residential treatment is for severe cases where it is not appropriate for the patient to remain at home. This could be due to:
- Unsafe home environment
- Substance use
- Self-harm or Suicidal Thoughts
The quality of these programs vary greatly, so do your research before entrusting your child to them. Residential programs tend to last for 30-90 days.
Partial Hospitalization Program (PHP)
The PHP level of treatment is the next step down from the mental health hospital in terms of the level of monitoring, structure, and treatment. They are often used as a step-down from the mental health hospital or as an alternative to the mental health hospital if the teen does not require 24/7 monitoring.
PHP is short-term, usually lasting from 2 to 7 weeks. Treatment is highly structured and usually lasts 5-7 hours a day, five days a week. Teens in these programs typically are unable to attend school, but some programs work with schools and provide time for schoolwork as part of the program.
While every program is different, treatment is often heavily focused on coping skills to manage suicidal thoughts and self-harm. Programs vary in how much they involve parents in treatment.
Throughout the program, your teen will be regularly assessed by a psychiatrist and will attend group therapy with a therapist.
Intensive Outpatient Program (IOP)
Most of the programs that offer PHP and IOP level care in Katy, TX make the programs identical. The PHP patients have the same structure as the IOP patients, but the IOP patients attend the program less.
For IOP programs, patients typically attend a few hours of therapy a day, three days out of the week. For teens, they are often able to attend school two days out of the week, but every program handles this differently. Some programs may offer evening programming so teens can attend school while receiving treatment.
A common path for teens who discharge from the hospital is to spend 2-4 weeks attending PHP, then transitioning to IOP for another 2-3 weeks. By the end of both programs, there should be a new discharge plan in place for the continued care of your family by an outpatient therapist.
The outpatient level therapist is the specialist who is able to get to the heart of the issue now that the crisis is over and things are stable enough to do the hard work. They are kind of like a surgeon who is able to do a difficult operation now that the Emergency workers (inpatient and PHP/IOP providers) have stabilized the patient.
How to Know If Your Teen Actually Needs PHP/IOP — or If It’s Overkill
Before you begin researching programs, you must first determine whether your teen would benefit from a PHP/IOP program at all. It is easy to fall into the trap that these programs are for everybody. Some programs even advertise themselves this way, but this is not the case. Here are four things to consider when deciding whether a PHP/IOP program is right for your teen.
Will Group Therapy Actually Help Your Teen?
Because group therapy is such a big part of PHP/IOP programs in the Katy, TX area, it is important to think about how your teen would do in a group setting. Group therapy can help teens by:
- Normalizing mental health issues
- Providing community and support
- Providing new perspectives
Despite these benefits, group therapy is not for everybody. Below is a chart that reflects what makes a teen a good or bad fit for group therapy based on my experience. It may be a surprise that I listed having a strong support network as a bad fit. A teen can still benefit from group therapy if they already have a strong support network. I only want to point out that if they already have this support, they may not need a therapy group for support. They may benefit more from outpatient therapy.
| Teen characteristic | Good fit | Poor fit |
|---|---|---|
| Social style | Sociable, engages with peers | Seeks negative attention |
| Support system | Limited peer support at home | Strong existing support network |
| Behavior in groups | Follows rules, respects structure | Behavioral issues, disrupts others |
| Openness to growth | Open to feedback and change | Resistant to treatment |
| Social awareness | Reads social cues well | Low social awareness |
| Motivation | Wants to get better | Using program to avoid school or home |
Not sure where your teen falls? Talk it through with a specialist
Are my Teen’s symptoms Severe Enough for PHP/IOP Level Care?
Even though your teen is discharging from the mental health hospital, this does not mean their symptoms are severe enough to require a PHP/IOP program. Sometimes, a stay in the hospital is enough for a teen’s suicidal thoughts or self-harm to no longer require PHP/IOP level care.
PHP/IOP is a big commitment, and your teen will most likely miss even more school than they did during their stay at the hospital. This commitment is justified if your teen is still experiencing severe self-harm or suicidal thoughts. However, if your teen’s suicidal thoughts are resolved or infrequent and without a plan or intent to follow through, they may be able to begin outpatient therapy instead of entering a PHP/IOP program.
Is Your Teen Mature Enough for a Group Setting?
Teens in PHP/IOP programs are battling severe mental illness. For this reason, there can be a lack of maturity amongst group members that your teen will be exposed to. I noticed that teens in the PHP/IOP program experienced
- Cussing
- Social contagion: new self-harm techniques and pressure to adopt specific identity labels
- Vape Culture: Despite strict policies, contraband can be a real issue
- Bullying
- Stories of trauma
Good programs have policies to prevent negative experiences and influences for teens in the program. However, no program is perfect. If a program puts too many teens in a group, it can be difficult for the therapist to police and protect members of the group.
Programs often have policies prohibiting patients from sharing contact information. However, these policies are easy to get around, and it is not uncommon for bullying to take place outside of the program.
Make sure that your teen is mature enough not to be negatively influenced in these ways. Also, be proactive with who your teen communicates with online or on their phone.
Is Your Teen Going to “Game the System”
During my time as a therapist working in a PHP/IOP program for teens, I inevitably had patients who liked the program a little too much. For teens in certain situations, being in the mental health system was a great option.
Teens in these programs may want to stay for various reasons:
- They get to miss school
- They make friends in the program
- They become dependent on attention from peers
- The program allows them to escape a poor home environment
Teens are smart, and they can easily game the system to stay in for a long time. They know the magic words that force a therapist to recommend moving them up to the mental health hospital. They know what symptoms are needed to keep them moving from PHP to IOP to the hospital over and over again.
Teens may do this for various reasons. For one, they may use the system to stay out of truly difficult home situations. Sometimes they do it as a cry to help; a way to tell their family that something is not right. Other times,s they have become overly dependent on the program and reflexively think they need it when they meet with a challenge.
It is important that parents take all threats of suicide or self-harm seriously, even if they suspect manipulation. If you suspect your teen may be playing the system, call an expert to help you discern. I offer free consultations and have a lot of experience working with teens and this system.
How to Evaluate a PHP/IOP Program Before You Sign Anything
If you decide your teen would benefit from a PHP/IOP program, you now have to decide which program is best for your teen. Here are three things to consider when deciding on a program
Group Size
As I mentioned before, your teen will spend the majority of their time in group therapy for teen PHP/IOP programs in Katy, TX. For this reason, the size of the group is very important. If a group is too small, it may not be able to provide a sense of community for your teen. Also, a small group can mean a very long day if your teen is spending 4-5 hours of group therapy 5 days a week, like in most teen PHP/IOP programs. That would be therapy overkill.
You also do not want the groups to be too big. A group that is too big is hard for the therapist to manage and increases the likelihood that poorly behaved patients can sabotage the entire group. Also, if a group is too large, it is difficult for any one patient to feel heard and seen.
An ideal group size would be about 12-15 patients. Before signing up for a program, ask about the size of the group that your teen would join. Make sure to get the current group size and not an average. Group sizes change throughout the year, so they tend to be small during the summer/ holidays and larger near the beginning of each school semester.
Policies
As mentioned above, there are many ways your teen can be negatively influenced in these programs. Before signing up for a program, ask about the program’s policies regarding bullying, preventing contraband, and maintaining structure.
Structure
Although all teen PHP/IOP programs in Katy, TX have a large group therapy component, they differ in their emphasis on other key aspects of a good program. A good program requires genuine participation by the teen’s family. Look for programs with a strong family therapy component with competent therapists who know how to work with a family to give the best experience possible for your teen.
Another aspect of a good program is coordination with schools. Because teens often need to miss school to be a part of these programs, it is important that the program is proactive in working with the school to help your teen not be left behind.
A good PHP/IOP program for teens would also have a mixture of skill-building (DBT or CBT) and emotional processing. Before signing up for a program, ask about what group therapy sessions focus on and how they are structured.
A good PHP/IOP program is proactively monitoring safety issues such as suicidal ideation and self-harm. Ideally, your teen will be regularly assessed by a psychiatrist and assessed daily by their therapist.
Still Not Sure? Here’s How to Get Clarity
Determining whether your teen should join a PHP/IOP program is extremely complicated. There are so many variables to take into account, and the answer will be different for everybody. If you find yourself lost in the mental health system, reach out to an expert who knows the system and how to work with teens. I would be happy to guide you to find the best plan possible. Feel free to reach out for a free 10-minute consultation to see how I can help you. I always reply within one business day.
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My name is Justin Perry, a Licensed Marriage and family Therapist. Click below to learn more about my specialty in working with suicidal teens.