Tag: mental health

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Levels of Mental Health Care

GenevieveLeave a comment

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?

Inpatient Treatment

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.

Partial Hospitalization Program (PHP)

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.

Intensive Outpatient Program (IOP)

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.

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What I Gained in Partial Hospitalization

Genevieve4 Comments

Two or three days into my partial hospitalization program, it became clear to me that my peers were seeing positive results. At check-in, those closest to leaving would report feeling “good”, or “light”- two sensations that are unfamiliar to my depressed brain. I was glad that they were feeling better, and initially, it gave me a glimmer of hope for myself.

As the days passed, that hope dimmed; I wasn’t feeling much better at all. In fact, as my last day approached, I started feeling lower and lower. My thoughts about self-harm came back in full force, and when I tried to use the skills we’d been taught to combat them, I was unsuccessful. Morning check-in was even more excruciating than usual because I had to admit that I wasn’t doing well. The people who had come before me had felt better, so what was I doing wrong?

For one thing, I wasn’t doing anything “wrong”. The psychiatrist and both therapists for the program all agreed that the root cause of my depression is chemical. This doesn’t mean that coping skills are useless. They can help keep me safe and offer healthier alternatives to my go-to, maladaptive coping mechanisms. Over time, I can retrain my brain to help me get out of negative thought patterns or habits. However, coping skills are unlikely to do much to address the causative problem.

Secondly, there is no right pace for recovery. Comparing myself to others was only making me feel worse. That said, it’s only natural that we look to others to find out what to expect when we’re in an unfamiliar situation. I wish I had been able to temper my expectations when comparing myself to others in partial hospitalization.

Just because I didn’t leave partial walking on air doesn’t mean I “failed”. I still got a lot out of the experience.

Connection

Similar to my experience of being an inpatient at a mental hospital, one of the most valuable takeaways for me was the sense of connection I had with other patients. Hearing about other people’s perspectives on a shared experience helped me gain insight into my own thoughts and behaviors. Plus, it feels good to talk to people who understand your suffering and can empathize. I definitely came away from the ten-day program feeling less alone.

A sense of my own value

The first few days of my participation in the PHP, I was there for my family. I was there because other people wanted me to be, and I was willing to commit my time to a program like that in order to ease my family’s fears. A few days ago, though, I realized that I felt more like I was there for myself. It was a subtle shift, but it feels like a big step.

Acceptance

Throughout my inpatient hospitalization and partial hospitalization, I had several moments that stopped me in my tracks. The fact that I was at that level of care for my mental illness seemed surreal, and I couldn’t wrap my mind around the situation. I think that I have a better grasp on my symptoms and what I need to do to keep them under control. I also have a sense of acceptance that once I feel better, I’ll still need to manage my illness; I won’t be able to push returning symptoms under the rug. That’s how I ended up in the hospital.

Greater understanding of my patterns and behaviors

While the skills I learned may not address the root of my depression, they certainly help me shift my behavior towards healthy responses and actions. Perhaps the biggest behavioral takeaway for me is greater awareness of how I withdraw, isolate, and avoid addressing the issue of my depression with my loved ones.

Patience

No, I didn’t leave partial hospitalization feeling like my peers who had left before me. Everyone goes at their own pace, and everyone has unique circumstances and factors involved in their symptoms. All we can do is go day by day.

My Secret Fear about Depression

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I have a secret fear that maybe this is what life is like for everyone. Maybe I’m expecting too much. Maybe other people can cope with life’s stressors better than I can. Maybe I should try harder. Maybe my depression is fake.

Spoiler alert: it’s not.

Part of what makes depression so terrible is that, by its very nature, it keeps you from getting help. It tells you you’re worthless, it makes you ashamed, and it robs you of motivation and energy. My depression tells me that I’m ungrateful and burdensome and that I should keep quiet about the things I’m struggling with. Well, y’know what? I’m sick of taking orders from The Lump.

I’m going to PHP group therapy, individual therapy, and I’m talking to my family and friends about my illness. I’ve even told a few acquaintances about my hospitalization. And, guess what? Everyone has responded with compassion and support. Not one person has said “You’re faking it. Just stop being sad.” The only time I ever hear that phrase is when it’s inside my own mind.

It’s time I show myself a little of the understanding and reassurance I receive from others. After all, I have a biochemical imbalance in my brain. It’s not my fault.

Mindfulness and Emotions

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.

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Explaining SPD to Health Professionals

Genevieve2 Comments

It’s become clear that I have a hard time explaining how Sensory Processing Disorder (SPD) affects me, particularly when I’m speaking to health professionals.

When I was recently hospitalized, I spoke to a ton of mental health professionals, all of whom asked me about my diagnoses. I had no trouble letting them know about my diagnosis of Major Depressive Disorder, nor did I struggle to tell them about my childhood history of OCD. Disclosing that I have Sensory Processing Disorder was something that I was oddly unprepared for. I either would minimize it by mentioning it as an afterthought, neglect to mention it at all, or not do an adequate job of explaining it if I was asked follow-up questions.

Sensory Processing Disorder is not in the DSM, and I’m never sure whether the person I’m speaking to believes in its validity. I’ve never run into anyone who gives me reason to believe they don’t, but the disorder’s lack of diagnostic acceptance puts me on edge. SPD is a neurological condition that results in differences in how the brain processes information. Does this make it a physical health condition or a mental health condition? SPD has multiple sub-disorders; is it enough to simply say “I have SPD”? How should I go about explaining my disorder without minimizing it or coming across as defensive?

Usually, when someone asks me how SPD affects me, I end up saying something like “I’m over-responsive to a lot of stimuli, so things like loud noises, bright lights, and certain textures really bother me.” While accurate, this doesn’t capture the extent to which SPD affects me. Saying loud noises bother me doesn’t illustrate that I have to spend 2-3 full minutes psyching myself up with my finger on the button before I turn on the blender. When I say that changes to my routine drain me, what I really mean is that I once had a full-blown panic attack while driving on the highway because I had to leave earlier than usual and it was drizzling.

Sensory Processing Disorder is real. It’s also hard to explain. I’ve started using a mixture of SPD terminology and real-life examples to illustrate my symptoms, and while it’s difficult, I combat my tendency to understate everything by tossing in some descriptive adjectives like “overwhelming,” “draining,” and “dysregulated”. The vast majority of health professionals just want to help, so describing your challenges as accurately as possible is really the best approach. Plus, advocating for yourself is important, something that I recently learned firsthand. But, that’s a story for another time.

How do you explain SPD to health professionals? Share your tips in the comments!

On Being Vulnerable

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.

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4 More Poems From a Mental Hospital

Genevieve2 Comments

I. Partway Up

The rising sun

seems stuck in its journey,

halted,

partway up

 

while I wake

and sleep,

wake,

and sleep.

 

Disoriented,

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

moving slowly.

 

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-

and is gone.

 

III. What’s in a Mile?

It’s 24 steps

from the desk

to the door-

to the other is 31 more.

 

The door’s always locked,

but still,

I walk,

If I can keep going, I will.

 

Again and again,

lap after lap,

linoleum lines

as my only map.

 

I lost count

for a while,

but I know

that 21 laps is a mile

 

and it’s 24 steps

from the desk

to the door,

to the other is 31 more.

 

How long will it take

if I pick up my pace

for me and my mind

to embrace?

 

IV. Comparison

My first roommate

left her toothbrush

and some clothes

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

staring up at me.

 

My second roommate

doesn’t notice

the evidence

of the first.

 

She cries in bed,

blanket pulled up over her eyes

while I tiptoe

around her.

 

When she packs up her things,

I wait for the third

hoping this time-

I’ll be the one to leave first.