#rp:guide

The following information is broken up into varying chapters/sections. If you would like to know what to expect or skip ahead, use the following titles as a reference point. ( CTRL + F and copy and paste the desired chapter/section to be brought there; you can also use this method to search for any key words you may be looking for ).

Basic Information

What Determines Treatment

Entering the Residential Life

Important Rules

Contraband and Other Banned Items  

Key Points to Everyday Life

Staff Responsibilities

The Level System

The Points System

Another Thing to Note

Common Vocabulary

Basic Information

Before we get too deep, I think it’s important to go over the basic outline of the mental health system. Usually, the steps you take would include the following: hospitalization, residential/rehabilitation, partial hospitalization program, intensive outpatient program, and typical therapy. Let’s take some time to analyze each step so you can understand where your character/story would fit in.

Hospitalization is the highest level of care. It is the stage in which you are a danger to yourself or others. Since I’ve already done a guide to this, I won’t get too into it, but the primary difference between these two things is that residentials do not lock the doors while hospitals are full-lockdown. If you want to read more about mental hospitals for minors, please redirect yourself HERE.

Residential treatment center (RTC) is the second level of care. This can vary place to place, but it my experience, the doors are not locked and the staff is not allowed to touch you. Residential tends to allow a person more freedom while still maintaining a safe place to stay. I’ll talk more about this later since the guide is about RTCs.

Partial hospitalization programs (PHP) are the third level of care. Usually, teens and adults that are released from a residential program go to a partial hospitalization program. In most cases, this is a five-day program (Monday-Friday). You live at home, or at a sober living if you are an addict, and it will normally take place from 8:30 AM to 3:00 PM; however, mine took place from 12:30 PM to 6:45 PM, which is unusual.

Intensive outpatient programs (IOP) are the level of care that can sometimes come directly after residential or simply after PHP. If a person skips PHP and goes straight to IOP after residential, it is usually because they are going back to school or already have a job. But really, this is rare since residential to IOP is still a huge step-down. Anyways, in this stage, you go to the program about three days during the week. Some places let you pick any three days out of the week, but most will have you come in on Monday, Wednesday, and Thursday. IOP hours vary but are almost always about 4 hours long. Mine was from 3:00 PM to 6:45 PM.

Typical therapy is simply the usual one day a week. I don’t know what to call it since most people just call it therapy, but I wanted to differentiate it a tad. Anyways, this is pretty straight forward so I won’t get into it.

What Determines Treatment

As seen in my timeline above, you will usually come into a residential after coming out of the hospital. However, this isn’t always the case. Some people come in from PHP, IOP, or therapy. As long as it has been determined that you are safe enough to go straight to residential, you’re in.

Since we have an understanding of the timeline, let’s discuss what would qualify a person to end up in residential. To give you an idea, click HERE to see a screenshot of some questions from the website of my old residential. Now, this was for a dual-diagnosis program and was geared toward clients with drug use and mental illness so take it with a grain of salt. The general idea remains, though. It is for teens who need help and need to get that help away from home with 24-hour supervision, but not in a lockdown facility.

The type of people in these facilities vary. Without getting too into it, the first time I went into a residential, I was there for depression and anxiety. The second time, I was there for depression, anxiety, drug abuse, and excoriation disorder. This is just to give you a vague idea of the type of disorders you will see. Some facilities cater to specific issues like drug abuse, depression, or eating disorders. Others are there for a more broad approach and are typically referred to as dual-diagnosis programs. Trichotillomania, obsessive compulsive disorder, post-traumatic stress disorder, borderline personality disorder, oppositional defiant disorder, drug abuse, alcohol abuse, anorexia nervosa, bulimia nervosa, schizophrenia, antisocial personality disorder, Asperger's syndrome, and court ordered rehabilitation are just a short list of diagnoses I have come across in my time as a patient. It is not limited to these disorders, however, and can sometimes be something as simple as overprotective parents that over exaggerate their child’s issues.

As mentioned before, there are different places that can sometimes specialize in one specific disorder so it is important to determine whether a dual-diagnosis program would be better than, let’s say, an eating disorder residential.

Entering the Residential Life

Arrival to a residential is nothing like arriving at a hospital or being transferred. You are almost always driven by your parents. The only case I’ve seen where the parent didn’t drive their kid, was because they lived far and needed a police escort. The times that I’ve been on my way from a hospital to a residential, I’ve gotten food to eat and used my phone. It’s up to the parents to make stops and whatnot, but usually, they will not. Stopping makes it easier for a teen to not comply and try to escape, which is not what we want.

When you arrive, you are faced with a basic interview. Usually, the first day is the worst. You’re tired and are suddenly thrust into this new world with about five other teens. You’re being dragged in and out of milieu to do interviews with your therapist and say goodbye to your parents. Any belongings you have are given to a staff member and they check in your things. However, bras with underwire, thongs, shoe laces, jacket/sweatshirt/sweatpants strings, sharp items, phones/computers/anything you can use to communicate, and inappropriate clothing are not allowed. Typically, for the first 24 hours of arriving, you are not allowed to make any phone calls because people usually try to persuade their parents to take them out of the residential. You also start out on level one, but I’ll get into that later. Lastly, a folder is given to you that contains the rules, levels, and treatment goals. Again, this will all be explained soon.

Also, you’ll learn who your roommate is. It’s broken up by gender and normally, there’s two boys and four girls. However, in some occasions, the roles are reversed. Of course, this is only for a co-ed house. Some are specifically for females and some are specifically for men. Please note that transgender clients tend to have to room with the gender they were assigned at birth. I’ve only known one person who was allowed to room with a male (he is a female to male), but just know that cases like these are difficult. This isn’t across the board, but typically this WILL cause tension for the other roommate. Just because you are in a treatment facility, don’t expect everyone to be tolerant and politically correct. Remember that these treatment facilities are not just for people that have depression, anxiety, or an eating disorder. These places are also for teens that have behavioral problems so physical altercations can be expected.

Important Rules

The rules are also very basic. Unfortunately, I no longer have that paper so all of this will be based on memory, common sense, and research. They normally don’t have a list of rules they pass out, but they do give you a welcome packet that briefly goes over expectations. In short, the main idea is to avoid triggering topics. This is something that is huge, especially because you never know what’s going to set someone off. There’s also a big no-touch rule. Hugs are not allowed since some people are uncomfortable with that. Blankets are usually not allowed since it’s easy to do inappropriate things with them. No relationships because they can cloud your judgment and stunt your growth. Profanity is also not allowed. Nails should be cut short to avoid self-harm and no contraband at all.

The next big thing is the kitchen. Knives and sharp objects, in general, are locked up. The staff also has to keep count of them to assure that no clients have stolen them. In my last one, literally, EVERYTHING was locked. Only the fridge was unlocked, and this brings us to the next rule! Breakfast, lunch, dinner, and the snack time in between meals are the only time you can eat. However, if you are hungry even with all of that, you are allowed to eat fruit or cheese and crackers. Those were the only things we could eat in between meals. Everything you eat or don’t eat is recorded in a binder as well.

This rule isn’t really for drug-related residentials since it’s more for the depression/eating disorder ones. After eating/meal times, the bathrooms are locked for 20-30 minutes. If you really need to use the bathroom, the staff may use their judgment to allow you to go; however, if they let you, it’s uncomfortable. You need to constantly sing or talk whilst doing your “business” so that they know that you are not purging or anything like that.

I know earlier I stated that the doors aren’t locked, but one door that is, would be the bathroom doors. This is just to ensure that clients don’t go in there and smoke or do anything eating disorder-related. This also goes into the line-of-sight rule. At all times, you must be in the line-of-sight of at least one staff members. This means you cannot go wondering off on your own. Doing so will result in consequences and can be considered an AWOL. If you AWOL and while you are in a residential under a court order, you can be arrested. One of my friends did this and he was arrested and taken away for breaking his probation.

Now, this is a part that I don’t particularly love talking about since it has some bad memories attached, but it is important. A 5-foot-rule can be implemented when a person is being inappropriate around you. It can either be requested by you or issued as a punishment for two clients. With me, I had a 5-foot-rule against all the males in the house. One of them was because we were getting too close too fast and the other was because the guy was not respecting personal boundaries. I shit you not when I tell you he whispered sexual things in my ear while rubbing his foot on my leg. Yikes. Anyways, those can be issued and if things improve, they can be revoked. It’s all up to how you and the other person act.

Your room also needs to be clean. You can’t have clothes lying around and your bed needs to be made. If it isn’t you do get taken back to your room so that you can clean it. You are also responsible for doing your laundry on your assigned laundry day. Everything gets a day. Monday through Saturday are usually reserved for each client and Sundays are house cleaning days. That’s basically when towels, sheets, and other things are washed.

Body checks are by far the MOST annoying thing, in my opinion. Every time you leave the house and come back, you are not allowed to do ANYTHING until you get a body check. This consists of going to the bathroom with a staff member, stripping down to your underwear, doing one or two squats, and holding out your arms while you spin in a circle. Then, they check your clothes. This is to ensure that you are not bringing any contraband into the house. This also needs to be done anytime you go back to your room since they want to make sure you’re not hiding things. It’s uncomfortable, inconvenient, and I hate it. Also, girls can only get checked by female staff members and boys can get checked by females or males, though, they prefer to match gender.

Transportation is usually in a van. It’s your stereotypical mom van and the rules are cut and dry. You usually alternate who gets to sit shotgun. This is a highly envied spot since you get ALL radio control. Now, we all know how a van is set up, right? Two front seats, usually three middle seats, and three back seats. Click HERE for a better visualization. I labeled it with numbers to help you understand this. So, basically, a boy and a girl can’t sit next to each other. That’s pretty easy to understand. Now, here’s the kicker: a male staff member cannot sit next to a female client. Yep. For example, if a female client is sitting in seat 6 and a male client is sitting in seat 8, a male staff member CANNOT sit it seat 7. Only a female staff member can. However, a male staff member could sit in the driver’s seat (1) and a female client could sit in the passenger seat (2).

Any physical altercations will result in isolation. This is basically when a client is removed from the group and a staff member sits with them in an isolated setting. In this time, the client may not speak to anyone at all. Failure to comply results in your time resetting. The standard isolation times are anywhere from 7 to 9 hours, but I have seen them go on longer than that.

Contraband and Banned Items

To expand on the contraband subject, let’s go over some things that you can expect to be banned, seized, or used at certain times. In your initial intake, your belts, shoelaces, drawstrings, and any other long strings will be taken away or cut from your clothing. This normally only lasts for a short period and you will eventually get your laces/drawstrings back within a week or so depending on your behavior. Until then, slip-on shoes or sandals are normally what you would wear.

Any sharps are banned. This includes but is not limited to knives, razors, pins, needles, and broken pencils/pens. Even normal pencils or pens are usually contained to a certain room. In my first residential, which was more focused on depression and/or self-harm, the pencils were to be checked out by a staff member. They had a log that they recorded the pencils with and they used this to keep track of them as well. Pencils were not allowed in rooms at all, though, they did give me an exception since, at the time, I was struggling with something that they believed warranted the use of pencils/pens to occupy my time. In my other residential, which was more focused on dual-diagnosis issues, they did not keep track of pens and pencils. They primarily didn’t do it because only two clients were there for suicidal and self-harm reasons.

Outside food/drink/opened containers are prohibited. It doesn’t matter if you have a face wash that was expensive. You need to buy a new bottle and make sure that it is still sealed. Otherwise, they can’t allow it in for the simple reason that they do not know if the contents match the label. Some people could be sneaking in alcohol. Since we’re on the topic of alcohol, no perfumes or hairsprays are allowed either. They are usually locked up in the staff office, along with the rest of your contraband. While they aren’t allowed out on the milieu, you are allowed to ask the staff to use both items. They just need to be supervised and locked up after. Cigarettes are also not permitted, though, I’m not certain how it is with other states. I just know that California's legal age to buy cigarettes is 21.

Room searches are conducted on a daily basis. A staff member will search your room from top to bottom for any contraband. Let me tell you that these are thorough. People do not just get away with hiding razors under pillows. That is ridiculous and simply not a hiding place that would go undetected. Please, for the love of God, do NOT have your character get away with hiding shit like that. More importantly, admins, do NOT let the players get away with that shit. You can’t hide anything in your bedroom, especially if it’s an even mildly decent facility. It’s incredibly hard to do.

If the staff suspect that a client is in possession of contraband, they have the right to do a room toss. This is different from a room search because room tosses are 10x more thorough and rude. You stand by the door while the staff literally destroy your room looking for contraband. Even if you don’t have anything and it's your roommate being accused, your stuff gets tossed. One time, the staff thought my roommate was stashing cigarettes and we watched as they tore apart our room. By the end of it, the room will look like a tornado. The shitty part? Even if they don’t find anything, you have to clean up the room. Luckily, I already knew that my roommate was innocent of the aforementioned accusation and we got along great so cleaning up wasn’t too bad. We mainly joked around and shaded the staff members.

Lastly, razors used for shaving. The rules for this vary place to place. In the last one I was in, they allowed razors under the supervision of a staff member. In the previous one, they only allowed electric razors. Of course, all of the razors, electric or not, do have to be locked up in between use.

Key Points to Everyday Life

A key part of residential programs is that they are located in ordinary suburban houses. Yes, a residential could be right down the street from you. That’s the beauty of it. While a hospital focuses simply on leveling out, Residential focus on trying to get you adjusted to a somewhat regular lifestyle. A lot of chores are a part of this. They differ day to day and there’s always a chore schedule placed somewhere in the kitchen or on the wall in the living room. Doing your chores tend to be very important since failure to comply will result in a level drop or a staff member not giving you points for the day.

Life in a residential is relatively strict. You are not allowed to take naps unless you have been ordered to by a doctor or you are basically about to die. I kid you not, the staff there are tough and take no bullshit from people. They do not let you sit down on your bed to rest AT ALL. A big part of it is learning to be responsible and not sit around all day. They try to keep you busy throughout the day. The daily schedule for most of these places is relatively similar. Exercise, breakfast, school, etc. It all goes the same. I have an example of a schedule that you can find HERE.

Note that weekdays are MUCH busier than weekends. This is because weekends are when you are allowed to have visitors. Only family members are allowed to visit you. Night and morning routines are similar. You can choose to shower in the morning or the night, your choice. Usually, they do base who gets to go first on who is the highest level so just remember that. Your toiletries are kept in a small plastic box that is roughly the size of a shoebox. All of that stuff is locked up so you do need to ask/wait for a staff member to unlock it.

Staff Responsibilities

Since I was a client, I’m not an expert on what the job entitles. However, I do have a therapist who was a staff member at a residential, and because of this, I do know a few more things than the average client.

One main thing is that they need to be observant. This is fairly obvious since the clients rely on staff to maintain safety. Throughout the day, they need to take notes on the clients. There’s usually a computer system in which this happens. In most cases, they are going to write down how you appear to be feeling. This is when “check-in’s” are important because these allow clients to actually speak up for themselves and talk about how they are actually feeling. In some facilities, clients initiating the check in can result in them being leveled up. Check in’s are simply the clients telling the staff how they are doing. These are also usually done in private, so the staff has to have time to talk to the client.

The shifts for the staff are usually broken up into 3 different times. From 5AM-1PM, 1PM-9PM, and 9PM-5AM. This is a very broad idea, but it’s usually morning, afternoon, and night shift aka graveyard shift. The graveyard shift is the one that is least convenient for people because of the time it’s at. During this time, you still need to keep notes and keep track of the clients, even if they are sleeping. You can’t fall asleep, and trust me, if you do, things can go wrong really fast. Clients are sneaky so do not put it past them to wait until a staff member falls asleep. Still, the graveyard shift does have a whole new list of responsibilities. Theirs usually consists of laundry and chores instead of taking the clients to and from their daily activities. They also end up getting a lot of free time, which can sometimes be ideal for college students who work there since they can stay up and study/do homework.

Another big thing is that since this is not a lockdown facility, they are not required to chase after or follow runaway clients. Yes, they should definitely follow them, but they do not have to. They can choose to follow, or choose to call the cops immediately. Again, this may not be the same policy for all facilities, just the ones I’ve been.

Perhaps the biggest thing, though, is that you need to avoid giving full names. Some kids in there are stalkers, so staff members emphasis the importance of avoiding sharing their personal details. You also have to avoid sharing to much about yourself in general. I know a while back, a bunch of people at this one residential got fired because they were oversharing with the teens. Even if you believe that your harrowing story may be relatable, you need to be careful. Don’t stack one problem on top of the other. Just avoid getting too attached to the kids. 

The Level System

The level system directly correlates with the point system, but I’ll get into this more in the next section. For now, let’s cover the basics. There are typically 5-6 levels. Each level comes with its own perks, so leveling up is something that is a great achievement.

Level One: This is the level that all clients start out at. It is the most basic one and therefore, has the most basic rewards. The main, and most disappointing, is that you will usually be last when it comes to body checks and showers. This means you will have to wait in the hall until it is your turn, and trust me, by the end of the time, you do not want that. You also get 5 minutes of phone time each day to talk to your parents. If your parents are divorced, you get two 5 minute phone calls each. You also do not get outings with your family, just visits.

Level Two: Alright, this level barely has anything different than the first level. You get the same amount of phone time and you are still relatively low on the list of who goes first. However, this is when you do get to have outings with your family. This means you can leave the residential when your family visits, but you must be brought back immediately.

Level Three: Not gonna lie, this is also pretty similar. You get the same amount of phone time and the same rule applies to the showers and body checks. You also get to have off-site visits with your family.

Level Four: Level four is actually not that bad! You get to have a 5-minute phone call with your parents as well as a 5-minute phone call with an approved friend. Your friends must be approved by a therapist.

Level Five: At this level, you are allowed 10 minutes per day to parents/guardians and a 10-minute call to a friend. In the facility I was at, this was pretty much the highest level you could get since most people didn’t stay long enough to reach the next one.

Level Six: At this level, you are allowed 20 minutes of phone times which can be split up as you want it. This is the highest level and if you reach this, it means that you are trusted by the staff. You are the leader, and therefore, need to act like one. It is super hard to reach this level, and often times you need to petition in order to reach it. A petition is when you speak to the milieu and the staff, usually during treatment team meetings. You describe to them how you have changed and why you deserve to get to level six and they decide.

In short term facilities (4-6 week programs), there is no waiting period. You can level up each week. In longer ones (anything beyond 6 weeks programs) there may be waiting periods between levels. In my facility, you could move from 1 to 2 and 2 to 3 each week. However, moving from 3 to 4 and so on, you usually need to wait a week or two before you can move up. I hope that made sense. You can also be level dropped for bad or innappropriate behavior. 

The Points System

The points system is the main part of residential that slips my mind, and this is simply because it is so different in each facility. The main the that stays the same, though, is that each level represents a number of points you get each day. If you are on level one, you get one point each day. If you are level three, you get three. If you are level six, you get six. You can also earn extra points for doing extra work. For example, I had a pretty unique connection with the chef at my last facility and because of this, I enjoyed being in the kitchen. We made an arrangement that I could earn points by helping him clean the oven and organize things when I had free time. You can also earn points by displaying good behavior or, sometimes, making bets with staff. It isn’t too professional, but some cool staff would make bets with me during basketball season. It was always something small, like earning one point if I could correctly guess who would win the upcoming game. 

In the place I was at, they didn’t take away points, but they would withhold them from you. If you displayed bad or inappropriate behavior, they could simply tell you that you didn’t earn any points for the day. 

Now, let’s get into what the points are actually used for. Each level brings in a new list of things that you can buy with points. Here is a short list of simple things you could buy with points for each level:

Level One: Nothing. 

Level Two: For 10 points - cup of soda (you normally only get juice or water), for 15 points - an extra snack (candy).

Level Three: For 50 points - haircut, for 25 points - time to shave your legs (monitored), for 25 points - time to apply makeup. 

Level Four: For 100 points - bubble bath (monitored and done in a bathing suit), for 150 points $10 to spend on Amazon (not a gift card, has to be approved by a therapist). 

Level Five: For 250 points - Dinner with a staff member of your choice to a restaurant of your choice, For 275 points - $25 to spend on Amazon (not a gift card, has to be approved by a therapist). 

Level Six: For 1,000 points - Mini-golfing, for 500 points - $50 to spend on Amazon (not a gift card, has to be approved by a therapist).

Now, I know the prices seem high, but that’s the whole point. You pay a lot of points for something, but the high number of points means you worked your ass off for it. When I was in my last residential, I was there for a little over 90 days and by the end of it, I had about 1,500 points. That’s a lot, okay, and you don’t just magically get there. Plus, by the time you do get that many points, they don’t even matter. Between you and me, they never mattered to me. In the end, I only spent about 250 points just so I can go out to eat with my favorite staff and look at pictures of her daughter. It was fun and I did it at the end of my treatment, so I knew I deserved it. 

Another Thing to Note

While this isn’t something that is a law, most people do not return to the same facility more than once. Yes, it does happen, but clearly, the first time didn’t work and often times insurance companies or the therapists will try to avoid placing someone in the same facility twice. Just keep this in mind and don’t have your character returning to the same residential over and over again. 

Common Vocabulary

AWOL: Also known as “absent without leave.” This is basically when you leave the premises of the hospital/treatment facility.

Contraband: Items that are not approved, but are in the possession of a client. Examples of this include cigarettes, knives, drugs, inappropriate clothing, perfume, etc.

Milieu: A person’s social environment or the peers around them when they are out in shared spaces such as community rooms.

PET Team:  Psychiatric Emergency Teams (PET) are mobile response teams based in and operated by psychiatric hospitals approved by the Department of Mental Health to initiate applications for 5150 and 5585 evaluations.

Treatment Team Meetings: There are two different treatment team meetings. The first one is when the staff and the therapists get together and discuss how are you doing. The second is when you are with the milieu, the clients, and one or two staff members. There, you discuss treatment goals and what you can approve upon.

If you have any questions/comments/concerns, please feel free to ask!