When do you consider referring to residential mental health facilities for patients in your adolescent psychiatry clinic?

In general, I do my best to avoid placements in residential facilities. I rarely find that they provide effective treatment. So, I refer to residential facilities when the teen is either a danger to themselves or others and when they are chronically gravely disabled.

I think the data supports that good in-home treatment is more effective.

I have to begin my response by noting that both the number and quality of residential facilities for adolescents - particularly, but not exclusively, those from low-income families - appear to have declined considerably in the 30+ years I’ve been working with this population. This must, of course, factor into any such decision. It is really our responsibility to vet any contained environment to which we send youth and to advocate for better funding and oversight for such facilities.

That said, my most common recommendation for residential treatment is made as a step down for the youth who requires hospitalization for severe instability where hospitalization alone or with day treatment is insufficient to enable safe functioning at home. Thes...