I am very pleased that we are addressing the topic Providing Essential Care and Services Following Psychiatric Hospitalization in this issue of Mental Health News. I want to thank the many people and organizations who helped make this issue possible.
According to the National Alliance on Mental Illness (NAMI), mental illnesses are medical conditions that disrupt a person’s thinking, feeling, mood, ability to relate to others, and daily functioning. Serious mental illnesses include major depression, schizophrenia, bipolar disorder, obsessive compulsive disorder (OCD), post-traumatic stress disorder (PTSD) and borderline personality disorder. In addition to medication treatment, psychosocial treatment such as cognitive behavioral therapy, interpersonal therapy, peer support groups and other community services can also be components of a treatment plan and assist with recovery. The availability of transportation, diet, exercise, sleep, friends, and meaningful paid or volunteer activities contribute to overall health, wellness and a meaningful path to recovery. The good news about mental illness is that recovery is possible. As a survivor of a prolonged and serious mental illness myself, I would like to share with you some of the things that I learned during my ten-year journey to recovery.
A Very Thin Line
One thing I realized when I first became ill with depression, was how thin the line between normal and abnormal mental wellbeing could be. It was a line I fell off of so suddenly and without warning. My first suspicion that there was something wrong was an unexplained feeling of fear, and anxiety, which I brushed off as a quirky feeling or a passing mood. When these troubling feelings persisted and began to interfere with my daily routine, I really didn’t know what to do, so I made an appointment with a psychiatrist I found in the phone book and was given some medication and told to return in several weeks. In my case, things spiraled quickly out of control in a matter of days because the medication I was given was not what I needed. This is not that uncommon in severe cases of depression which I didn’t realize I had. Had I known, my best choice should have been to get a referral to a more skilled psychiatrist that was an expert in diagnosis and psychopharmacology. As my mood worsened, I was having trouble just hanging on, so I had to be admitted to a nearby hospital’s psychiatric unit.
Making the Most of Your Hospitalization
If you are now in the hospital or are about to be admitted, there a few things I learned from the several experiences I had as an inpatient, that might help you. First of all, you must understand that treatment for mental illness is not an exact science, but rather a combination of the right medication(s), psychotherapy, and outpatient care. Although you would like your ordeal to be over in a week or two, it just doesn’t always work that way. For example, many medications your doctor prescribes may take several weeks to work, so be patient. Your job is to communicate as honestly as you can to your doctor and treatment team as to how you feel on a day-to-day basis. As your symptoms may interfere with your thinking and daily routine, it may be helpful to have a simple spiral notebook where you can keep daily notes on what medications you are on, how you are feeling, and any questions you might have. Then you can review these notes with your doctor and other members of your treatment team.
When you are admitted to the hospital, become familiar with your treatment team. The team usually includes your psychiatrist, psychologist, social worker, nurses and other unit staff. List your team members names in your notebook so you can remember who they are and what each person is helping you with, including: medications, individual, group and family therapy, medical insurance and entitlement benefits (SSI, SSD, and Medicaid for example), and discharge planning. Each day in the hospital is structured so that patients have a daily schedule of activities. Often you will have free time during the day, and if you are able, use this time to read an inspirational book or information about your illness that your doctor might recommend. It will be time better spent than sitting in front of the TV in the day room. Do the best you can every day and push yourself to participate in the daily routine on the unit even if you are so depressed you don’t feel like getting out of bed. The enemy of recovery is “ruminating” or persistently focusing on your problems over and over again in your head. Activity (moving forward) is the key, and part of the healing and recovery process. Think of it as learning how to walk for the first time all over again. Start with your left foot then your right foot, and so on. If you keep working at it, soon you will be moving right along.
A Sensible Discharge Plan
As soon as you are admitted to the hospital you and your team are theoretically working toward your eventual discharged back into the community. Find out who you will be working with to plan how you will return to the community. If you are fortunate to have the support of your family and employer, you may be returning to your home and when ready have a job to return to as well. For some, however (including myself), you are not so fortunate and have to find your own way. This can be a very scary prospect in addition to having to cope with your illness. If you do not have a family, home, or job to return to, your task is much more difficult. Proper planning in this situation is critical so that enough of a support network is set in place to help you cope with the many issues involved with life back in the community. You will need all the basics including housing and government assistance to help you pay for food, transportation and health care, and all the other basic expenses necessary to survive back in the community while working on your recovery. In most cases, you will need to continue in treatment in either a private or an outpatient clinic setting. For those needing a more structured daily outpatient treatment plan, referral to a continuing day-treatment program (CDT) is what is required. The CDT program may provide the daily structure that you need to continue working on your recovery.
Returning to Your Community with Hope and Pride
Enduring and surviving a psychiatric episode or relapse is nothing to be ashamed of. You must understand that, and I can’t stress it more. Having a psychiatric illness is a medical condition that scientific research has shown to be caused by chemical imbalances in the brain at the synaptic level.
Unfortunately, stigma towards people with mental illness is outside the realm of science yet still does exist and can really hurt. Be it from family, friends or employers, stigma is caused when the people around you do not fully understand what you are going through and why. Even people you love may say things to you like: “Why don’t you just snap out of it?” or “There’s nothing wrong with you.” Since mental illness is invisible on the surface, most people cannot comprehend that something is really wrong with you. If your arm was in a cast or you were in a wheelchair, these visible abnormalities would enable people to be more understanding than when someone’s psychological wellbeing is broken. The key here, is to expect stigma and move ahead in your recovery in spite of it. Don’t let it bring you down and do not expend any unnecessary emotional energy defending against it. You will need all your energy to get better. If there are people in your life that want to ridicule you or make you feel bad or responsible for your condition, you must tell them to stop! If that doesn’t work, try to avoid these people at all cost. I’ve been there and I can tell you that it took time for me to accept my illness and allow myself to heal. I was then able to tell understanding people about my experience which seemed to open many doors for me. It was then, that I decided for my own continued mental health that there would be no room in my life for any toxic or negative people. Telling my story to understanding people was very therapeutic for me and it increased my self-confidence. My shame disappeared and I found that most of the people I spoke with understood what I had gone through, and often shared their own personal experience with mental illness, or a similar experience that a member of their own family had gone through.
Be Proactive in Your Recovery
If you are fortunate to live in a metropolitan area, there is a good chance that there are other beneficial programs or services that you can hook up with in addition to your outpatient therapy or CDT program. If you have access to a computer, go to NAMI’s website at www.nami.org, and Mental Health America’s (formally the Mental Health Association) website at www.nmha.org. Both national associations have useful information on their sites, and you can find the location of your local community chapter, which may offer other therapeutic programs. There may also be “consumer-run” programs such as clubhouses and drop-in centers in your community where you can meet and learn from others who are also working on their recovery. Beware of poorly run CDT’s or consumer programs where you are not challenged to work on useful recovery activities every day. If everyone is either going outside to smoke every five minutes or loafing on couches napping or watching TV — find another program fast!! If you have lost your job, find a supportive employment program that can help you regain the confidence and skills you will need to find your way back to meaningful employment. If you have a choice, you deserve to be in the best programs available in your community so remember you have a right to shop around.
I wish there had been a newspaper like Mental Health News at the time of my illness twenty years ago. There wasn’t, and so I started this newspaper. It took years for me to fully recover, but during that time I discovered that there are many wonderful people in the community that care about you and are there to help—many of whom you will read about in every issue of Mental Health News.
Mental health is about all of us. Good luck in your recovery, and never give up.