in-patient treatment??

Discussion in 'Braaaaiiiinnnns...' started by esotericPrognosticator, Jul 19, 2017.

  1. esotericPrognosticator

    esotericPrognosticator still really excited about kobolds tbqh

    SO I've been, like, lowkey shittily depressed for several months now despite med changes, and while it's not necessarily Existential Misery (or suicidality, or even self-harming, thank god), I am SUPER NONFUNCTIONAL, like three-therapy/medical-appointments-a-week-and-nothing-else nonfunctional, which sucks! I'm fairly sure that's the depression, but I have a nice variety pack of spoon-sapping brainweirds (anxiety, ADHD, and Autism LiteTM, the last being subdiagnosable but nonetheless characteristic; combined this tends to mean I Cannot Do The People And New Places), so possibly there are multiple culprits. I ain't a rocket scientist, folks. :P

    anyway, I've been hearing "you're not doing anything to help yourself" murmurs from the familial peanut gallery, and while that is patently untrue, I do not have many ideas in that direction. one of them, however, is residential care, not the least because I won't have to go anywhere for all my goddamn appointments. >:]

    um, but I haven't talked to many people who have been in in-patient treatment (especially voluntary commission), at least not back-and-forth-dialogue-type talking; I have read various accounts of it and experiences ranging from Really Shit to Very Beneficial. so I wanted to specifically solicit opinions on my situation and anecdata from y'all's own, please?

    edit: my therapist having blithely assumed this'd be the case and thus buttonholed my parents into it, I can at least consider centers anywhere in the U.S., so if anyone knows about American centers, I would appreciate your telling me about it! especially if you have recommendations or DO NOT WANT warnings.

    n.b.: places being Not Assholes about trans shit is a major criterion.
    n.b.II: also it'd probably some kind of Young Adult Care thing? I'm 17.
    Last edited: Jul 20, 2017
  2. Deresto

    Deresto Foolish Mortal

    Hm, have you considered a day hospital (aka partial hospitalization) ? It might be easier and more beneficial than straight up residential treatment, unless being at home is part of whats exacerbating your depression/ you don't have a home to go to. RTCs tend to have a longer waiting list as well imo. (Edit: and a minimum of 28 days to have to stay)

    Youd basically go to a hospital every week day or most week days all day and do groups, therapies of all sorts, and socialize if you want, then go home instead of staying there
    Last edited: Jul 19, 2017
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  3. Salted Earth


    If you're going in voluntarily, you can prepare beforehand by asking questions about what the conditions at the hospital are like, to see if it would be a good fit for you. Interview the hospital for the position of treating you, so to speak.
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  4. hyrax

    hyrax we'll ride 'till the planets collide

    my in-patient treatment facility had a minimum stay of 3 days, but in practice it ended up being a week for most people. (my therapist told me "pack for three days" and then i had to get my parents to bring me more clothes -_-) so definitely clarify in advance how long an average stay is for.

    as for what it was like:
    we stayed in little dorm rooms with adjoining bathrooms, two people to a room. there were a couple lounges down the hall, each with a tv. there were books (mostly self-help and romance novels; i found myself re-reading Into Thin Air because it was literally the only book that looked remotely interesting), activity books (word searches etc), and coloring pages. they kept bowls of fresh fruit at the front desk for snacking.

    every morning, they woke us up between 6 and 7 to take blood pressure; i would then immediately go back to sleep until breakfast time at 8:00. after breakfast, i would get my morning meds from the medication desk, then take a shower. after that, there were hour-long group therapy sessions, focusing on different things like CBT, DBT, trauma recovery, ED, etc. whether or not you went to therapy was up to you... but my "treatment plan" included going to therapy at least once a day, and in general you are discouraged from leaving until you're following your treatment plan. (whether they can actually keep you there depends on if you came in voluntarily and if you're a danger to yourself or others.) so i would go to therapy a couple times a day, usually. in between, it was a lot of listening to music or watching tv in a lounge, reading, socializing with other in-patients, and coloring. so much coloring. so so so much coloring. it's a good thing i enjoy coloring otherwise i would have been very bored. i also met 1-on-1 with the psychiatrist assigned to my case every other day or so. every day there was another miscellaneous activity, like gym time or yoga or art, that was entirely optional.

    in general: i went in very scared and depressed and suicidal, and came out feeling well-rested and with more spoons than i'd had in a year. getting put on new medication helped, as did the intensive therapy... but a lot of it was just being in an environment where it was socially acceptable to be depressed at people. when someone asked you "how are you?" there was no pressure to lie and say "good", usually my response was along the lines of "well i mean, i'm HERE so not... great..." and it was honestly really refreshing.
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  5. esotericPrognosticator

    esotericPrognosticator still really excited about kobolds tbqh

    I've talked to a couple professionals about day care, and none of them have good things to say about programs in my area, so I'm probably not going to one. also I think driving back and forth would be SUPER exhausting, and while I do have a home which I don't want to Escape or anything, I think maybe a different environment with different pressures would be beneficial, so. (also, I'm not going to be hospitalized, technically; I'm looking for longish-term care, not quick stabilization.) thanks for the suggestion, though!

    yeah, I talked to my doctor and my therapist today, and they really stressed this part of the process. (especially my therapist, and she should know; she worked in residential care for a number of years, though she specialized in EDs.) basically she said that, like, it's an industry, and there are a lot of places where Making Money or moving people out fast are the primary concern, so there are a lot of shitty ones. also she said it overlaps some with, like, the Bad Kid Rehabilitation stuff, where they like stick you out in the desert and make you run five miles a day until your behavioral problems are Gone. apparently I'm unusual in that, while I am voluntarily going, a lot of teenagers don't really want to go. their parents volunteered them, or at the very least insisted until the kid gave in. but I was the one with the idea, in this case.

    anyway, we'll be looking around a lot, and hopefully, since it's not Urgent, I'll be able to pick a place I really like. I just hope my dad doesn't drag his feet through the process hoping that it will Go Away. :/ anyway, thanks for the advice, I hadn't really known that and it let me bring it up instead of waiting for the suggestion! :)

    my doctor mentioned that several of her patients had stayed at a center for an entire year, and my parents were all >:OOO about that. I think I'd be ready to settle in for a couple months if that's what it would take (or longer, if I'm still not well enough). and my mom discussed what might happen with me if I missed this school year ('cause if I were out till, like, October, my school wouldn't let me finish the year, as it is Rigorous), so they won't yank me out if it's "taking too long," I think.

    I had read about the other stuff you mentioned in Brainbent elsewhere, and that's kinda what I thought the Beneficial things would be? (although I'm not suicidal, so I don't think I'll run into the Safety Precautions you might've. well, if they believe me right away, anyway, people have been all >:? at the idea that I can be seriously depressed and NOT suicidal.) but this is new to me, and it definitely sounds like something that I would benefit from, too, so thanks a lot. (although... could you really not get any other books? I'd be bored out of my mind if I couldn't get a steady supply of new books, tbh.)

    (also, as per the edit I made to the initial post, I probably can go to places pretty far away from me, and I think you live in the U.S.? and your place sounds real nice, and as I'm Stockpiling Possibilities, I'd like to know its name if you're comfortable divulging it. you can PM it or something if you don't want it in this thread. :) thank you!)
    Last edited: Jul 20, 2017
  6. hyrax

    hyrax we'll ride 'till the planets collide

    there were visiting hours a couple days a week, so my parents brought me a stack of books! i think you could also receive mail at the hospital i went to, but i was only there for 9 days and wasn't that far from home.

    PM'd you the hospital info :)
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  7. esotericPrognosticator

    esotericPrognosticator still really excited about kobolds tbqh

    now for some updates on my situation, separate because I didn't want to make a M E G A P O S T:

    as I said, I visited both my psychiatrist and my therapist earlier today. my doctor's kind of at a dead end with my meds again, like she'd have to start adding new ones and seeing if they work, and maybe starting Antidepressant Roulette again, god forbid. (this is how I refer to the extensive and random process of finding a functional antidepressant, which for me lasted like... six months? 'cause like. basically your doctor is chucking different kinds of antidepressant at you until they find one that works, and mine didn't guess so well initially. I think I went through, like... fuck, four or five main ones? including Prozac, since it's a classic, but what it did to me was make me so nauseous I couldn't eat regularly. fun times.) I mean, she does have this new theory, but it would require major changes to meds.
    the theory being that I have basically... cyclical depression? depression II? the term she uses is "mood lability." anyway, I go from better to worse every few months and have done for... shit, comin' up on three years now?... even without appreciable changes in situation or medication. (and it doesn't track to seasons, so it isn't SAD; I had a really good winter this year.) I had chalked this up to, y'know, medications getting less effective over time, like my Hell Brain was developing a tolerance, but apparently that doesn't happen with antidepressants? also when I'm more depressed (maybe when I'm less depressed, too, but it's harder to tell) I have Bad Days followed by Okay Days, sometimes directly. the longest the acute Badness has lasted is like a week? and I thought that was normal, 'cause, y'know, bad and good days are a Thing people have, but apparently not for depression??

    plus I just discovered my mom is diagnosed with bipolar II (although she's been on a med that really works for, like, a decade plus), and I had no idea?? 'cause she had only said she was depressed before, not hypomanic. it sounds like she didn't have Bad Hypomania, like the sucky-feeling kind or the kind where you make Regrettable Decisions, and I was like "??? doesn't it have to be a problem to count?" but anyway. so that runs in my family, apparently, and now I'm Questioning whether I've ever been hypomanic? I really don't think so, at least not according to the DSM-5's description, but, like, that shit isn't infallible. so if anyone has personal experience with hypomania, I'd love to hear what that was like.
    so mostly we talked about my idea that I should go in-patient, which she agreed with and encouraged and so forth. but it was weird how much she insisted I wouldn't be part of the selection process? she gave my parents the info of a dude who consults about that kind of thing, and I was like, "will I be talking a lot with him," which, like. while I really don't like Making My Own Appointments, because phone, I figured I'm the one who's getting treated, so I should tell him what I'm looking for/if I like something? but she was like, "NO HE WILL BE TALKING ONLY TO YOUR PARENTS" and I was sitting there like "??" 'cause like, yeah they're my legal guardians and make all my medical decisions, and yeah I'm on their medical insurance, and yeah they'll be paying, but up till now I've had a say in all my mental health shit, like I would make the decision, possibly with their input, and they'd sign off on it. and like? what the fuck?? they don't know more than I do about what kind of treatment would be best??? why are they 100% in charge??? it's my fucking depression???? +1 stupidity that I would have way more authority if this was happening a year from now, since I'll be 18 then. and of course my dad wheeled out the "you're too young to make legit decisions" (not too young being?? 25ish, 'cause that's when he read the brain's fully mature) argument, closely followed by "you're too depressed to make legit decisions." both of which have been used previously to tell me how I obviously can't know that I'm trans and shouldn't transition!!! anyway I was like, "dude. I made a fucking decision while depressed, that's impressive in and of itself," but yeah.

    my therapist was, in my opinion, more reasonable about it, and she told my parents a lot about how to research by themselves and how she would look into it too. but at that point I learned that my dad isn't sure whether I should even fucking GO. he has this negative mental image that probably involves straitjackets and Bedlam and was insisting that since my previous doctor had expressed distaste for, like, ER psychiatry treatment (which, like. is super sucky. we all know this), EVERYTHING SORT OF RELATED TO THAT MUST BE TERRIBLE. he's insisting we (read: he) do comprehensive comparative "matrix" research, like we would do for colleges (??), before we decide anything, and I'm like, "dude. they don't make a U.S. News and World Report Top 100 In-patient Centers list." also he seems convinced that he can Do It Himself by setting up a yoga regimen for me or whatever, because I'm just not Trying Enough, and like. the DIY thing is cute when it's like plumbing and shit, Dad! but you are not a trained therapist!!! anyway.

    so yeah, hopefully the Adults in Charge will do some research in the next couple days and I'll actually be able to look at some shit! :P
    Last edited: Jul 20, 2017
  8. Salted Earth


    It's worth talking to your therapist about your concerns of being locked out of the process; addressing those feelings is important, so that you can go into treatment feeling empowered, which is a really valuable mindset to be in treatment-wise. Yeah, you're a minor, but you're also 17, so keeping you in the loop even if you're not the one making all the decisions alone is going to help you learn how to make those decisions on your own in the relatively near future when you're an adult.

    Also, since you're looking at longish-term care, let me talk about the place I was in for roughly about a year when I was a teenager. Caveat: I've had a bad experience with hospitals, so this isn't exactly coming at it from the perspective you have, but it seems like useful info since staying in hospital long-term is a less common experience than staying for a month or so.

    I spent the weeks there, and went back home on the weekends. This type of very regular home visiting isn't as common in acute care, where you'll get home leave when you're getting better to try and reacclimatise you to normal life, but may be more common in long-term facilities. (I only went to the one, so I can't generalise. All my other experience is with acute units.) It's worth asking your therapist about if you want to specifically avoid/engage with places which will send you home often.

    Daytime was spent doing activities, being pulled out for psychiatric visits (which happened every few days), and medical tests if necessary. There was an art therapist who would take the kids out to do art or music therapy, especially in the afternoons. It was a co-ed dorm style unit, with girls sleeping upstairs and boys sleeping downstairs - I don't know how mine handled transgender issues, because I was in the between-period of 'well I'm probably not a boy' and 'well I'm probably still not a girl' at the time, but I'd guess they'd vary from place to place pretty heavily.

    We had graduating permissions to roam the grounds, based on our behaviour; kids who were new or had exhibited self-destructive behaviour had to stay near the nurse's station, but kids who they could reasonably trust not to do anything stupid could roam the grounds pretty far out. This was partially because this was definitely not an acute ward - people who were actually a serious threat to themselves got sent to acute units because the place I was in wasn't equipped to deal with them. That seems like something which would apply pretty broadly to non-acute units. Also, the place I was in brought kids who had high enough permission levels shopping one night a week. They got a lot of people doing exposure therapy that way.

    There was a pretty spacious lounge area across from the nurse's station, with a game system and another TV for watching movies and an oldish computer. It wasn't connected to the internet - public mental health places here (in Australia) in general don't allow people to connect to the internet, though private places do. It's worth asking your therapist whether you will be allowed to use internet devices in the place you're going to, especially if you want to stay there a while. I know not being connected to my online friends made me pretty miserable at times.

    There were other activities which the hospital tried to get kids involved with, I think, but I don't remember them nearly as well as art therapy. I guarantee you there was an occupational therapist trying to get people active, though. That's, like, a staple.

    Like all hospitals, the nurses did night checks, which can interrupt your sleep if you're a light sleeper. Everyone got woken up in the morning by way too cheerful nurses, too. In general, you're not encouraged to leave your room after lights out, and you'll have to explain what you're doing up and about, though nurses are generally pretty understanding.

    Breakfast, lunch, and dinner were all communal and happened at specific times. I was vegan at the time, and the vegan options were kind of atrocious during dinner and breakfast, but at lunch they usually had fresh vegetables out to make wraps with so I ate a lot of those. In general, they should be able to provide for your dietary needs, though the choices might be a bit myopic.

    Because it wasn't an acute ward, I was allowed to have headphones to connect to my MP3 player. It's worth asking whether that will also hold true in the wards you want to go to, because at least the acute wards generally don't like you having cords and things like that.

    Culturally, a lot of people were pretty eager to show their metaphorical scars and talk about why they were there, because that's what we all had in common. There was a lot of worst-moment trading, and sympathising with similar hurts. Because it wasn't a normal environment, people organised themselves based on other things; I got to be friends with someone just because we both wore the same type of clothing. It's a lot different in adult wards, where people are pretty content to just live and let live under good circumstances.
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