Thursday, December 08, 2016

PHP - What to Expect

I had So Many Questions on partial hospitalization programs for mental health issues.  While I did find some useful information online - example schedules, brief descriptions of different programs - I didn't find a resource to address all my questions.

I'm going to guess that programs vary in many ways.  My program is at a local, suburban hospital, so I'm happy to disclose my experience with the knowledge that it's not going to reflect everyone's experience.  But I really wanted to read a blog as I was stressing out about my first day and I couldn't find one!

My Questions (and Answers)
1. What do I wear? The intake specialist told me to be comfortable and wear layers.  She was right - the women tend to wear sweats or thinner sleepy-pants (as I like to call them) or work-out gear.  Men also wear sweats but tend toward jeans a bit more than us ladies.  Ponytails are common.  Make-up is not.

2.  May I keep stuff with me?  Yes!  I packed my bag - my favorite one that I bought myself with a bonus - with all sorts of items.  I carry it with me all day and it sits under my feet during sessions.  Nobody has asked what's in it or if I really need it.

3.  Wait - what's in the bag?  Lip gloss and moisturizer - I don't like my face to get dry.  Tylenol for headaches and Benedryl for allergies - I think those are technically supposed to be with the nurse but nobody's enforced that.  A tennis ball that I use when traveling if my muscles knot up - I'm not sure why I take it to program.  My wallet, keys, make-up wipes, extra Kleenex, my reusable water bottle I use at the gym. A snack.  And my phone.

4. How often are phones permitted?  There's a request/rule that phones are off during sessions and it's generally followed - out of respect for each other more than respect for the rule, I think.  But there are very frequent breaks where I check email, text Mom and Friend, chase Pokemon, etc.

I think my biggest worry was how respectful they'd be - if we'd be allowed to make our own decisions, have our own items around - and it's even better than I'd hoped.

5. Food?  Hospital lunches are my least favorite part.  Both the menus that we complete a day in advance and the actual trays that are delivered make it obvious that we're in an actual hospital.  Receiving actual, serious treatment.

Otherwise, the common room has coffee and tea.  We're welcome to bring our own drinks, though alcohol is not allowed given the addictions of some, obviously.  There are a few snacks - little jello cups, crackers and peanut butter.  I've been bringing a little pack with cashews, dried fruit and little cheese cubes.  I could have it anytime but had it yesterday during break.  Today I skipped it.

6. Are we locked in?  Not at all.  I sign in an out each day at the reception desk in the unit.  I've not left our space personally but people can - and do - walk upstairs to go outside and smoke.  Or take a walk.  I can go buy something from the cafeteria.  Leave early.  And the admission process make it clear I'm welcome to leave the program completely at any time.

The one Big Rule is that you have to show up or call in.  If I'm absent without notice, they'll attempt to reach me and emergency contact.  If neither of us answer, they'll ask the police to do a safety check.  The staff take that very seriously.

7. What kinds of people are there?  We're unwell to varying degrees.  Suicidal thoughts are pretty common in my group, though it's not something I've experienced.  Depression/anxiety diagnoses are the most common, by far, but anger issues, past trauma and co-existing addition disorders are also present and accounted for.

We range in age from college (so early 20s?) to seniors (70s).  About evenly split between men and women.  Different races, economic backgrounds, educational pedigrees.

Despite being ill - or perhaps because of it? - they are intensely open and without judgment.  There are some who are heartbreakingly kind and gentle.  Others who are delightfully funny.  But everyone seems focused on recovery - not just personally but for those in group with us - which is inspiring to me.

I feel very safe - both mentally and physically.

8.  What do you do?  Everyone is given a packet upon admission that holds the schedule and a bunch of worksheets.  Each day is different but the structure is constant.  Our schedule is 8:30-4:30 though I've seen online that many programs are shorter, some offering Intensive Outpatient Programs that are only half-days.

  • Arrival - complete menu, daily rating score on various items (depression, anxiety, desire to self-harm or harm others), a form on medication taken and any issues or concerns, goals for the day.
  • Goal Group - we go around the table in a smaller group to discuss yesterday's goals, how we did and what our goals are for today.  We all focus on 3 goals per day - 1 per treatment-plan category (mine are reduce depression, manage anxiety and prevent relapse).
  • Focused Therapy - again in groups (sometimes different ones), each day is different - triggers and coping strategies, reframing negative thoughts a la cognitive behavioral therapy.
  • Group Therapy - this is unstructured and, again, therapist-lead.  Yesterday, a few people spoke for longer times.  Today we went around the circle and all spoke a little.  The group offers feedback and encouragement and the therapist will suggest new goals or encourage us to focus on how to recover.
  • Lunch
  • Expressive Therapy - in the afternoon, the work is easier (which works great for my morning-person-ness).  There's an art project (yesterday we made stones with pictures pasted to them to remind us of our safe place) or music therapy or another activity or game.  It's a different group of therapists and while I was wondering if I could just skip the afternoons and head to work instead, I'm finding it useful.  Something about the distraction or the slight shift in focus enables a different perspective which can be useful.  
  • Closing

Individual work is on an as-needed basis.  There are staff psychiatrists available to address medication questions or issues.  The therapists are also available for individual discussions during breaks for in the afternoons.  A chaplain visited today and offered to pray or talk with us whenever we'd like.  And that's where tomorrow's story begins.

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