You know that feeling when you go to the cinema, watch a film, then leave the pitch black room of the movie theatre and step out into the light? Usually, if you have been seeing a film in the day time, the sunlight outside will be such a contrast to the dimmer environment you inhabited previously, that you end up blindly staggering around in a daze wondering where you are, how to deal with the situation, and why on earth that small bucket of popcorn you purchased cost £50.
That overwhelming sudden change in environment and resulting confusion is pretty much what it is like when you leave inpatient treatment in a mental health hospital for the real world after several months (though I admit, in that situation, you are a little less concerned about the price of popcorn in cinemas than the analogical version suggests), and this is one of the reasons so many people relapse the moment they leave 24 hour care.
In hospital, you are helped to manage your mental health problem in a very specific environment which, once changed, can make someone feel like they are mentally back at square one, home in the house with the same ghosts that haunted them prior to admission. Everyone knows that going into hospital is hard, but at the same time, there are moments when leaving and going back home doesn’t feel any easier. There is a lot of support out there for people who are due to be admitted, but not a lot of help for those on the brink of freedom, and when on the brink of anything (e.g a cliff or freedom), it is vital to have a parachute, a safety net, a plan, and that is what I hope to help you lovely people with in this post. So as someone who left hospital a mere six days ago themselves (it is a very long story that I won’t bore you with here, but in summary I kicked up a right fuss about being in hospital and have been allowed home on a Community Treatment Order, a full explanation of which can be found via this link to my post about the Mental Health Act…https://bornwithoutmarbles.com/2016/07/11/demystifying-the-mental-health-act-with-penguins/) here are a few nuggets of advice for how to deal with leaving inpatient treatment after a lengthly admission:
1. Make a plan and stick to it: When you are in hospital, there are usually a lot of rules and staff who enforce them. Your days are structured, and going from this very regulated, controlled environment to total freedom where you can do as you please, can be a frightening shift in responsibility. Therefore it is vital to make a plan and rules to stick to at home so that the change is less dramatic and you still have boundaries, rather than the secure bars of safety falling down around you and allowing your mental illness to run wild. Create a basic timetable to follow (not religiously, just to give you a sense of how to structure the days you are suddenly free to spend as you choose), and implement any non-negotiable rules from the ward at home. Follow the plan of recovery that you have been working on in hospital and don’t let your days be filled up by the to-do lists scribbled on the walls of your mind by your anxieties.
2. Take it one day at a time: Before going home it is important to acknowledge that making the transition is never going to be perfect. There are new challenges to face, and with that it is likely there will be little slip ups along the way (If you watched hurdles at the Olympics this year you will know exactly what I mean. Seriously those people were professional hurdlers and they still kept falling over and sending hurdles flying all over the place). The key however is to not see every set back as permission to revert to relapse or give up the race. If you mess up one day, start afresh the next morning and don’t let a bad hour spiral into another bad year. Treat mistakes like sand castles, make them, acknowledge them, whack a shell on top, and then watch the tides of time wash them away.
3. Keep Moving forward: Whenever I leave hospital I often find myself feeling that the geographical move signals a mental move in terms of recovery. When inpatient you are constantly being pushed to move forward, but when you go home it is easy to halt all progress and remain static because your head tells you that you are “not in treatment anymore”. The truth is, wherever you are, you are in treatment and progress in recovery is possible, so to avoid getting stuck, make a list of goals or challenges for each month to keep progress going.
4. Ask for help: Bottling up thoughts and keeping how you feel a secret is a lot harder in hospital than at home because in hospital there are people constantly following you around and shining a torch in your face at night to check if you are sleeping, which, funnily enough you were until someone rudely shone a torch in your face (if you have someone doing that at home then you should probably bring it up with your landlord). Asking for help when inpatient then is not really necessary, because help is often following you around even when you don’t want it. At home however, it is easy to isolate yourself, pretend you are ok to please others, and fall down a slippery slope greased with eels and vaseline because you fear letting others know that you need a little assistance in scrambling back up aforementioned eel ridden slope. Admitting you are struggling is tough, but it is tougher to fight your battles alone. If you can call the hospital to speak to staff from the unit you were in, do that. If not, call a friend. Either way, reach out, be honest and don’t be ashamed of needing people to hold onto.
5. Use your imagination: Whenever I have been in hospital, then go home and struggle, I often find it helpful to imagine I am back in hospital. It doesn’t sound like particularly great advice to help someone in their journey to mental stability by telling them to imagine they are in a psychiatric unit (in terms of signs of insanity that one sounds pretty high up the list), but I like to remind myself of the fact that though things feel so different and so much harder at home, really the only difference is location. If you have managed to eat your meal plan/not self harm/resist compulsive behaviours within hospital walls then going home and doing the same is, in practical terms, no different. The hurdles as it were have not got higher, they are on a different track, so if you can leap them in one place you can leap them in another. Don’t let your head spiral out of control and make you believe that doing what you have been doing for months is as drastic as it feels.
6. Acknowledge that you are still unwell: One of the biggest mistakes when leaving inpatient treatment is to see yourself as “better” and able to thrust yourself back into hard core “normal life”. Just being at home will take a lot of energy and mental effort, so don’t force or pressure yourself to going straight back to a stressful job full time when you have been out of action for a while. Allow yourself to still see the journey to recovery as your full time occupation and ease yourself back into things gradually. If you have a job, maybe go back part time at first so that you still have time to look after yourself, and find your feet back home. Then when you have found your feet (and we all know how much easier life is when one is aware as to the location of all body parts), you can try full time again, but take it steady and prioritise mental health.
So there you have it! Six delightful tips to help keep you on track when making the difficult transition from hospital to home. Maybe calling them delightful is a bit of a stretch, but they are at least what I am trying to use to help me as I find myself suddenly back in reality after several months of being locked away behind a very high and unscalable green fence.
On a more personal and honest note, I know that discharging myself from inpatient treatment six days ago was probably not the best idea, and I know I did it for the wrong reasons, but hopefully it will work out OK in the end. Whether or not these tips are any good of course will be determined by how things go over the next few months of me carrying them out myself back at home.
I guess that is something we will find out together…