hospitalization – Love, Your Brain
In light of my recent posts, I thought it might be useful to elaborate on the levels of mental health care you can find in a hospital setting (at least in the US). What are the differences between them, and what can you expect from each?
Entering a hospital as an inpatient for mental health care can be incredibly nerve-wracking. If you don’t know what to expect, the experience is overwhelming. The important thing to remember is that the system is designed to keep you and the other patients safe.
In an inpatient setting, you sleep at the hospital and spend your days on the unit. You might have a roommate; they’re probably just as overwhelmed as you are. The staff will likely elaborate on the expectations for patients, but you may be expected to spend the majority of your time in a common area, interacting with other patients and staff. Your nurses and doctors will want to see that you’re participating in group therapy, willingly spending time outside of your room, and eating meals with the unit. You’ll meet with your doctor and a social worker, and have a chance to discuss your treatment goals and any concerns you have. Different hospitals have different timeframes for this; you could meet with your doctor as often as every day, although it may happen less frequently.
Before you’re discharged, the staff will probably want to be sure that you have a support system, safety plan, and aftercare set up. Continuing mental health care might look like a partial hospitalization program, intensive outpatient program, or outpatient therapy with your own mental health counselor.
The next level down from inpatient care is a partial hospitalization program. In a PHP, patients typically attend therapy for most of the day, sleep at home, then return for the next day of programming. For example, the PHP I did was from 9 am to 3 pm, Monday through Friday for ten days.
Programming usually focuses on teaching skills and information you can use to manage your illness. The PHP I was in took content mainly from DBT, although we also touched on ACT and CBT. You’ll meet with a psychiatrist and your case manager, who is usually one of the therapists who leads group discussions and teaches content. Your case manager will probably set up a treatment plan with you, and meet with you periodically to check in on your progress.
Many people come to a PHP through inpatient hospitalization. After spending time isolated from your normal, day-to-day life, it can be overwhelming to be tossed back into it. A PHP can serve as a helpful step-down to ease you back into your routine. Other people come straight from their outpatient treatment. They may not need the level of mental health care you get with inpatient treatment, but the support of a PHP can give them the structure they need to stay safe.
In the same way that a PHP offers a transition from inpatient back into your normal life, an IOP does the same. It’s the next level down from a PHP, but is still, well, intensive. An IOP is similar to a PHP in the content that’s taught, but you meet less frequently and for a shorter amount of time each session, but for a longer overall duration. Many IOPs meet three times per week for three hours. The program might run for as many as eight weeks. The IOP at the hospital where I did my partial hospitalization had a more independent treatment; you didn’t get to meet with a psychiatrist or a case manager. That meant you would need to have outside medication management set up for your time in the IOP.
Many people go straight from inpatient treatment to an IOP, although others may need the structure of a PHP. Some people continue on from partial hospitalization to intensive outpatient, but sometimes that’s not feasible with work or family obligations. I decided not to do an IOP, but rather to return to my regular schedule and leave IOP as an option should I need more intensive mental health care down the road. It’s all very individual, and which program you choose depends on your specific needs and constraints.
May 5, 2019 March 31, 2021 Genevieve2 Comments	
If you’ve been keeping up with my posts lately, you know that I’ve been having a rough time of things. I’m waiting for my new medication to kick in and doing my best to implement skills I’m learning in partial hospitalization. Whether it’s the meds, the skills, or just the ebb and flow of emotion, I’m finding myself…feeling….feelings. Wild, right?! The numbness is retreating and being replaced with actual emotions. Which, is good. I think. I’m no longer feeling crushing sadness through a thick haze of nothingness; I’m feeling crushing sadness in a pure, unadulterated manner. But, that’s okay- because it passes. I’m trying to work on my mindfulness skills. The sadness checks in, I sit with it and do my best not to catastrophize that it will stay forever, then my dog does something funny and amusement bumps the sadness out of the way.
Later, I’m outside, enjoying the sunshine when sadness saunters up again and says “Hey. Really sucks that you missed out on all of this pleasantness when you were in bed for days on end, doesn’t it?” Yeah. Yeah, it does. Thanks for that reminder, brain. So then I’m sad about being sad. I’m meta sad. Immediately, worry and despair pop in to let me know that a moment of enjoyment doesn’t fix everything and that I still have a long way to go. Oops, now I’m crying, and maybe I’ve ruined the moment entirely. Quick, focus on the sunshine! Focus. On the. Dandelions!
Forcing yourself to be mindful is kind of the opposite of mindfulness. Clearly, I have some work to do, which is why this weekend I’m trying to embrace the “non-judgmental” part of mindfulness. Emotions are healthy, and although I’m still feeling more negative ones than I’d like to, it’s ok that they’re there. When I start to feel sad about the past or anxious about the future, the best way to not get trapped in it is to just notice it and then redirect my thoughts. The weather is beautiful, I’m fortunate in more ways than I can count, and it’s ok to take time to heal.
May 2, 2019 GenevieveLeave a comment	
They thanked me for my vulnerability, but it spilled out by accident, like beads of condensed sadness crammed into a too-small vessel. A wave comes, and while I sit among this circle of strangers, I cry. Nine sad faces avert their eyes. Is this circle a liferaft or a sinkhole?
In the distance, we see life as it should be- a mental ecosystem in balance. For six hours each day, we hover on the edges of the ring, tossing insecurities, worries, and vulnerabilities into the middle. We wait to see if they sink, but often, they float back to us. At three P.M., we depart; a snippet of normal routine, just long enough for our symptoms to impair us under the cover of darkness, then it’s back to the circle again. Soon, each of us will leave and swim to shore, but for now, we are lost at sea. All we can do is embrace our vulnerability and let it carry us towards one another.
Last week, I was discharged from an 11 day stay in a psychiatric hospital. This week, I spent six hours every day in a partial hospitalization program. Since being admitted almost three weeks ago, I’ve received more messages of concern and support than I know how to process, and that’s a little bit scary.
A part of me is resistant to receiving so much love because it means that all of these people know about a part of my life that contains a good deal of shame. My instinct is to politely accept the well-wishes and then quietly close the door and never discuss it again. Unfortunately, being independent to a fault can get you in trouble. It can make you more likely to wait too long to ask for help, at which point, the situation has snowballed out of control and it’s a crisis. So, reach out to your loved ones. Ask for help and offer help. Being vulnerable is how we connect.
4 More Poems From a Mental Hospital
I. Partway Up
seems stuck in its journey,
while I wake
the only way to track the time
is by the shuffling
of nurses’ footsteps.
Tomorrow, I will rise
and, like the sun,
get stuck-
partway up.
II. Looking Out
Cafeteria skylights-
wide squares of sun
move slowly over patients
I crane my head back
and watch a cloud
far, far above this place
dance from one window to the other
cotton candy arms spread wide
in a perfect arabesque
that soon diffuses-
III. What’s in a Mile?
It’s 24 steps
to the door-
to the other is 31 more.
The door’s always locked,
If I can keep going, I will.
linoleum lines
as my only map.
that 21 laps is a mile
and it’s 24 steps
if I pick up my pace
left her toothbrush
when she gained her freedom.
They put the clothes in a bag,
and then it was just the toothbrush,
small, etched heart on the back
My second roommate
She cries in bed,
blanket pulled up over her eyes
while I tiptoe
When she packs up her things,
I wait for the third
hoping this time-
I’ll be the one to leave first.
April 25, 2019 November 2, 2019 GenevieveLeave a comment	
I. Constants
turning inward-
small spheres of loneliness.
-in our minds
-in our pain
-in our patient IDs
when the treatment
than the illness?
except that constant-
II. Foggy
Should I ask for the nail clippers?
Small signs of time passing-
longer nails, body hair,
and that monthly reminder of womanhood.
Everything else blurs together-
groups, meals, and the patients
before I can come back to myself.
Twice a day, the question
“are you thinking about wanting to be dead?”
Each time I reply,
I’m less sure of my answer.
III. Scrutinized
The nurses walk by every 15 minutes
and flip through their clipboards,
monitoring their charges
with small, inked notes.
Some of us deal with it
cocooning ourselves
inside our skulls.
Others direct it outward,
venting to anyone who will listen
to regain control.
Ever present: the choice to perform-
or be authentic.
Which will get me out
and which will get me better?
They say it’s not a punishment, being here-
and it’s not-
but my sputtering brain,
fighting to maintain pathology,