What is a residential treatment home?
In Oregon, a Residential Treatment Home (RTH) is a licensed program that provides mental health services and support around the clock for up to five adults in an ordinary residential house. RTHs are licensed and inspected by the Oregon Health Authority (OHA) under Oregon Administrative Rules chapter 309, division 35, the same rules that govern larger residential treatment facilities.
The idea is simple: many adults living with serious mental illness do best in a real home, with trained staff nearby, rather than in a hospital or on their own without support. An RTH offers help with daily living, medications, skills, and community life, while residents keep their rights, their privacy, and as much independence as is safe.
How it compares to other settings
Oregon offers a range of settings for adults with mental health needs, from the most intensive to the most independent. The right one depends on the level of support a person needs today.
| Setting | Size | Best suited to |
|---|---|---|
| Psychiatric hospital or Oregon State Hospital | Varies | Acute symptoms that require hospital-level treatment and supervision |
| Secure Residential Treatment Facility (SRTF) | Varies | People who need 24-hour treatment in a locked setting to stay safe |
| Residential Treatment Facility (RTF) | 6 to 16 adults | 24-hour support in a larger, community-based residence |
| Residential Treatment Home (RTH) | Up to 5 adults | 24-hour support in a small, home-like setting |
| Mental health adult foster home | Up to 5 adults | Family-style living with a provider, for people who need less clinical support |
| Supported housing or independent living | Individual | People ready to live on their own with outpatient services and check-ins |
Many people move through more than one of these settings over time. A residential treatment home is often a step down from a hospital or a larger facility, or a step up in support for someone who has struggled living alone.
Who a residential treatment home can help
RTHs generally serve adults 18 and older who live with a serious mental illness, such as schizophrenia, schizoaffective disorder, bipolar disorder, or major depression, and who:
- Are medically stable enough to live in a community setting
- Need daily support and supervision to live safely and work toward goals
- Are leaving a hospital and not yet ready to live independently
- Would benefit from structure, routine, and help coordinating care
A residential treatment home is usually not the right setting for someone who needs hospital-level medical care, medically supervised detox, or a locked environment. A good provider will tell you honestly when another setting fits better.
How referrals work in the Portland area
Most admissions to residential mental health programs in Oregon are coordinated through a person's care team rather than arranged directly by families. In the Portland metro, that usually involves:
- Your county's community mental health program (CMHP). Multnomah, Washington, and Clackamas counties each run programs that help coordinate residential placements.
- Your coordinated care organization (CCO), if you are covered by the Oregon Health Plan.
- A hospital social worker or discharge planner, if your loved one is currently hospitalized.
- A case manager or outpatient provider already involved in care.
Families can, and often should, reach out to homes directly to ask questions and get on waitlists. The formal referral is then completed together with the care team.
How care is paid for
Funding for residential mental health care in Oregon often combines several sources. These may include the Oregon Health Plan (Medicaid) through a CCO, county funds, and private pay. Room and board may be handled separately from treatment services. Because every situation is different, ask each home and your care team for a clear, written explanation of costs before anything is signed.
What to look for in a home
- A current license. Ask to see it, and confirm it with the Oregon Health Authority.
- Staffing you can understand. Who is in the home overnight? How are staff trained? Who leads the program?
- Respect for resident rights. Residents should have privacy, access to the community, and a clear way to raise concerns.
- Real care coordination. The home should work closely with prescribers, therapists, and case managers.
- A plan for what comes next. Good programs plan transitions toward more independence from the start.
- A place you would want to live. Clean, calm, comfortable, and close to the people and places that matter.
If you need help right now
If you or someone you love is in crisis, call or text 988 to reach the Suicide & Crisis Lifeline, or call 911 in an emergency. Your county also operates a 24-hour crisis line. Other helpful Oregon resources include:
- 988 Suicide & Crisis Lifeline
- NAMI Oregon, with education and support for families
- 211info, for local services across Oregon
- Oregon Health Authority, Residential Treatment Facilities licensing
About this guide. This guide is general information prepared by Belmont Residence, not legal or medical advice. Rules and programs change, so confirm details with the Oregon Health Authority, your county, or your care team. Belmont Residence is preparing to open in spring 2027 and is not yet accepting residents.