Residential treatment for depression means living at a licensed mental health program for a period of time, usually weeks rather than days, while you get daily therapy, psychiatric care and round-the-clock support from staff. It's meant for people whose depression hasn't improved enough with outpatient care, or whose symptoms make it hard to stay safe or get through daily life at home, but who don't need the locked, medical setting of a psychiatric hospital.
If you or someone you love is thinking about suicide right now, call or text 988 or go to the nearest emergency room. Residential programs are not crisis services, and many have waitlists.
How residential care differs from other options
Depression treatment comes in levels. Moving up a level adds more hours and more support.
| Level of care | What it looks like | Where you sleep |
|---|---|---|
| Outpatient therapy and psychiatry | Weekly or biweekly appointments | Home |
| Intensive outpatient (IOP) | Several hours a day, about 3 to 5 days a week | Home |
| Partial hospitalization (PHP) | Most of the day, most weekdays | Home |
| Residential treatment | Daily therapy and activities, staff on site 24/7 | At the program |
| Inpatient psychiatric hospital | Short, intensive medical stay focused on safety and stabilization | Hospital unit |
The biggest difference between residential and inpatient care is the goal. A hospital stay is usually short and focused on getting someone safe and stable during a crisis. Residential treatment is longer and more focused on building skills, adjusting treatment and preparing for life at home. Many people go to residential care after a hospital stay.
What happens in residential depression treatment
Programs differ, but most combine the same proven pieces used in outpatient care, just more of them, every day. The National Institute of Mental Health notes that depression is usually treated with psychotherapy, medication, or both, and that brain stimulation therapies are an option when those haven't worked (NIMH).
A typical program includes:
- Individual therapy several times a week, often using cognitive behavioral therapy (CBT), dialectical behavior therapy (DBT) skills, or interpersonal therapy.
- Group therapy daily, on topics like coping skills, managing negative thoughts, sleep, relationships and relapse prevention.
- Psychiatric care: a psychiatrist or psychiatric nurse practitioner reviews medications and adjusts them. Changes that would take months of outpatient visits can be made and monitored more closely.
- Medical care for sleep, nutrition and other health problems that can make depression worse.
- Treatment for co-occurring conditions, such as anxiety, trauma or PTSD, eating disorders, or alcohol and drug use.
- Family involvement through family sessions or education.
- Structure: regular meals, sleep, exercise and activities, which can be hard to keep up when you're deeply depressed.
- Discharge planning: setting up therapists, psychiatry, a step-down program and a safety plan before you leave.
Some programs also offer or coordinate brain stimulation therapies such as electroconvulsive therapy (ECT) or transcranial magnetic stimulation (TMS), which NIMH describes on its brain stimulation therapies page. Ask each program what it provides on site.
Who residential treatment helps
Residential care may be worth considering when:
- Outpatient treatment hasn't worked. You've tried therapy and one or more medications and you're still struggling.
- Depression is making daily life unmanageable. You can't work, go to school, eat, sleep or look after yourself.
- You're leaving a psychiatric hospital and need more support than weekly appointments before going home.
- Home makes recovery harder, because of conflict, isolation, or substance use in the household.
- Depression and substance use feed each other. Programs that treat both at once can help break the cycle. If someone is drinking heavily or using benzodiazepines, they may need medically supervised detox first, because withdrawal from alcohol and benzodiazepines can be dangerous.
It may not be the right first step for someone with mild to moderate depression who hasn't tried outpatient therapy or medication yet. A clinician can help you decide.
How long does it last?
There's no standard length. Stays commonly last a few weeks, and some longer-term programs run for several months. Length depends on how you're responding, the program's model and, often, what your insurance approves. Many insurers authorize a set number of days and then review progress.
What to look for in a program
Use these questions when you call:
- Is the program licensed by the state? Is it accredited by The Joint Commission or CARF?
- Who's on staff? Is there a psychiatrist, and are therapists licensed? Is a nurse on site around the clock?
- Which therapies do you use for depression, and how many hours of individual therapy a week?
- Do you treat co-occurring substance use, trauma or anxiety?
- How do you handle suicidal thoughts or a crisis during the stay?
- How is family involved?
- What does discharge planning include? Will you set up appointments before I leave?
- Are you in network with my insurance? Will you get authorization?
Be cautious of any program that promises a cure, guarantees results, or pressures you to decide on the spot.
Cost and insurance
Under the Affordable Care Act, mental health services are essential health benefits for individual and small-group plans (HealthCare.gov). Federal parity law also requires most health plans to cover mental health care on terms comparable to medical and surgical care (U.S. Department of Labor).
That said, insurers decide whether residential care is medically necessary for you. Expect to need prior authorization, and expect the plan to review your progress regularly. If your plan denies coverage, you can ask for the reason in writing, have the program's doctor request a peer-to-peer review, and file an appeal.
Medicaid coverage for residential mental health treatment varies a lot by state and by age. Medicare covers inpatient psychiatric hospital care but generally doesn't cover non-hospital residential programs, so check with the program and your plan.
Prices for paying out of pocket vary widely by program and region. Ask for the daily rate in writing, what it includes, and whether the program offers a sliding scale.
How many programs are there?
Across the 15 states currently listed on this site, we show 701 mental health programs that report offering residential care, based on SAMHSA data. Of those, 368 report treating co-occurring mental health and substance use conditions, and 538 report accepting private insurance. Listings show what programs report to SAMHSA; confirm services and availability directly.
Finding residential care near you
Search by state and use the "Residential" filter on any city page. You can start with Los Angeles, Houston, Chicago or Newark, but many people travel to a program in another city or state, especially for specialized depression care.
Getting help
If you're trying to figure out whether residential treatment is right for you or someone you love, call (844) 422-0619 to talk with an admissions counselor at TOS about levels of care and what your insurance covers.
You can also call the free, confidential SAMHSA National Helpline at 1-800-662-4357, any time. If you or someone you love might act on thoughts of suicide, call or text 988 now.