Inpatient vs. Outpatient

I used to look out the window, wishing I was anyone but me.
Yet somewhere in the reflection, I found my own life to lead.

There seems to have been a bit of a delay in my writing of this blog post.  I don't really know why exactly.  Generally, I have to be in a particular mood to blog and I suppose, for whatever reason, that hasn't happened over the past few weeks.  Nonetheless, I'm here now and the purpose of this post is to weigh up the benefits of inpatient and outpatient treatment for mental health problems.  

My motivations behind this topic come from the fact that around this time two years ago I was in the midst of my one and what I hope to be my only inpatient admission, so the experience is fairly fresh in my mind at the moment.  It was a pretty short stint of just 3 weeks but it was a very influential time in my life and I hope my insights will still be useful.  I have previously written about my inpatient experiences in the following blog posts:

~My Inpatient Experience - Part One

~My Inpatient Experience - Part Two

So here are a few of my thoughts on inpatient vs. outpatient...

 I hope it might be useful for you to weigh up your treatment options or it just might be interesting to learn more about what different types of mental health treatment entail.

Outpatient allows you to receive treatment for your mental health condition while still being an active part of the community.

For me, this is the clincher!  With outpatient treatment, you will go to your usual appointments at your treatment centre with the people who are responsible for your care but the rest of the time, you are left to go about your usual business.  You can go to work if you are able, you can study, you can meet up with friends and family who might form part of your support system and generally get on with the tasks of everyday living.  It means that you have the opportunity to build other aspects of your life while working on your recovery.  It can actually be really important in your recovery to have other things going on in your life that prove to you that there is much more to you than just your mental illness.  At the end of the day, you are going to have to live the rest of your life in the community, so in my mind, it is the most ideal setting for your treatment and recovery to take place.

Inpatient can take you out of an environment that may be detrimental to your mental health and limit distractions to recovery.

It is for this reason that inpatient can be a bit of a life saver, literally.

It can be easy to find yourself in a bit of a rut and a vicious cycle with your mental health when in your home environment.  You may be surrounded by things that represent previous negative experiences, which can make it more difficult to move on.  It may also be that you have people in your life who are having a negative impact on you.
I found in the past, I used to use a lot of avoidance to cope with my mental health on a day to day basis - I used work and exercise as a distraction to cover up what was going on inside.
If you struggle in this way, inpatient can be useful in taking away these kind of distractions and leaving you no choice but to face your mental health problems.  It even takes away some of the tasks of everyday living, such as cooking and cleaning, allowing you to focus instead on yourself and your recovery.  I found this very alien and very difficult to accept but I suppose it is just all part of it.
I admit, I found it all very daunting at the time but at the same time necessary, you can't go on hiding forever.

Your mental and physical health can be constantly monitored in an inpatient setting.  
It can be crucial to keeping you stable and safe.
Following on from my last point, inpatient can be really useful if you need more intensive support and regular monitoring.  There are staff in the hospital who are medically trained and able to keep a check on your physical stats as well as your mental health.  Your physical health can be strongly affected by your mental health, exceptionally so in illnesses such as eating disorders.  Inpatient care can be crucial to your physical survival.
In the same way, your mental health can be regularly monitored within an inpatient setting, ensuring your safety.  Depending on the level of risk you pose, you are observed by staff at regular intervals and this means that if issues arise or your state of mind changes dramatically, it can be dealt with straightaway.  I was put on 24/7 constant observation for more or less the first week of my stay.  This meant that someone was sat watching me the whole time and couldn't be anymore than a couple of metres away from me (and yes that included when I went to the toilet).  As much as that experience felt so alien, overwhelming and still haunts me now, I realise that at the time, that was what I needed to ensure my safety as I was such a risk to myself.

Outpatient gives you more freedom, flexibility and choice.

In outpatient treatment, you don't have to follow such a rigid timetable or routine.  You are largely free to build your life around your appointments and manage things in the way you feel is most helpful to you.  Sometimes having more freedom can feel scary because you are having to rely on yourself to make good and healthy choices a lot of the time but it also means you can shape out your recovery the way you want it and that can feel quite empowering.

Inpatient treatment is very intensive and can be overwhelming.

This goes back to the idea that in inpatient, there is nowhere to hide.  From the moment you get up, to the moment you go to sleep, your whole day is focused upon your recovery.  Your timetable will vary depending on what hospital you are placed in and what kind of treatment you are receiving but generally there is a programme to follow which involves a full day of different group therapy sessions.  I went from having never attended a group therapy session in my life to being thrown into a full programme of group therapies and while it was so beneficial to me and I learnt so many important lessons, it was quite a shock and very overwhelming at times.  You also have to follow a set routine with set meal times, medication times etc.  The set meal times were something that I really struggled with - suffering with an eating disorder, it was part of my care plan that I had to eat in the dinning room at every meal time where I was supervised by staff.  For me, this became a huge ordeal.  At home I would manage my anxieties around food by eating in private, knowing the exact content of what was in my food and having various other unhealthy rituals around food.  It was this secretive, unhealthy cycle of behaviours that kept me trapped in my eating disorder and in inpatient, I was stripped of them.  Where as previously you may have 'got away with' skipping meals without anyone knowing, in inpatient, you are made to face up to every single meal and you are surrounded by people who care enough to ensure that you do eat.  Usually I would only have just recovered from the ordeal of one meal and then would have to face the next one.  I wasn't even following a specific eating disorders programme, I can only imagine just how intensive it must be on a specialised eating disorders ward.

There were times when I was in inpatient when I completely broke down because everywhere I turned there were reminders of mental health - posters, signs etc.  It was as though there was no escape.  Then I would feel rather stupid when others would point out to me, 'Well, you are in a mental hospital, what do you expect!?'

I don't wish this to sound so negative but I think it is definitely something to be aware of - inpatient is very intensive, far more intensive than I certainly thought it would be.  Sometimes in order to get better, you have to face exactly how bad the problem is first and that is never easy!

Outpatient generally means you are closer to the support of your friends and family.

Again, this can depend a lot on which hospital you are placed in but in any case, hospitals will only have limited visiting hours.  You may not have as much access to the support of your friends and family when in inpatient treatment, which can be invaluable to your recovery.  Due to the demand for beds within the mental health services under the NHS, it is unfortunately quite common now to be placed outside your local NHS trust - this can sometimes mean being hundreds of miles away from your family and friends.  When I was put into inpatient, this was the situation I faced - there were no NHS beds available within my local trust, or indeed throughout the whole country, as I needed a bed in a crisis situation, I was placed temporarily in a private hospital.  The hospital I was placed in was a two hour drive away from where I lived and while that didn't actually bother me too much at the time (probably says more about my state of mind), I imagine other people could find that really difficult.  In many ways, I actually considered myself quite lucky because as chance and cock up might have it, I ended up in a private hospital and the care I received during that time was second to none.  

The reality is that sometimes the specialist help you may need won't necessarily be on your doorstep.

Inpatient allows you to meet others in a similar position to yourself - you can learn from each other.

Before I went into hospital, I had been extremely secretive about my mental health difficulties but all of a sudden, I was put into an environment where I was surrounded by people who were going through similar hard times.  There is comfort to be found in the fact that you are not alone.  You can learn a lot from the experiences of others.  I can be very socially anxious and I found meeting so many new people a real challenge, however, despite the short amount of time I was there, I still remember and always think of the people I got to know a little and who actually formed a crucial part of my inpatient experience.  This is not to say that you cannot come into contact with others with mental health problems through outpatient treatment - group programmes can be useful in this way but when you are living on the same ward as other patients, there is definitely a sense that you are in the experience together to some extent.

Inpatient can also mean being surrounded by people who are sick.

On the flip side, while it can be helpful to be around others who are also suffering from similar difficulties to yourself, it can also be quite difficult at times and arguably detrimental to your recovery in some circumstances.  As much as you may be in the same boat, being around others with severe mental health problems can mean witnessing some distressing things.  In just the three weeks I was in inpatient care, I witnessed some severe incidents of self harm, the police searching the ward and finding a weapon, physical fights between patients, violence towards staff, patients having to be  restrained by staff on countless occasions.  

Seeing these kind of things can feel quite traumatic, especially when you are struggling a lot yourself.  As I have spoken about in previous posts, I had quite a mixed inpatient experience in that I had quite a positive experience on the first ward I was placed on - it was well managed and I was given input that was helpful to me; the second ward I was placed in, I found completely horrific.  

On the second ward, I felt as though the patients I was surrounded by were far more acutely unwell than I was and highly medicated.  As much as I valued them and felt sympathy for them, I found it very distressing to be around them.  I suppose sometimes you just hanker after a really 'normal' conversation with someone about the weather or what rubbish was on the telly last night!

Inevitably, you are going to be influenced by your environment and the people around you.  

There is a chance that you may pick up some destructive behaviours that you see other people displaying.  I think this can especially be a problem with eating disorders, which can have quite a competitive element to them.  We are all human beings and all fighting our own battles and our own issues - that can sometimes mean that the things we may say or do could trigger others.  

It is of course still our responsibility as to how we respond to that trigger but I think the point I want to make is that there are both positives and negatives to being around others who are also suffering from mental health problems.

It's easier than you think to become institutionalised.

This probably seems a bit over dramatic but based on my own experiences, I think there is definitely some truth in it.  Although I was only in inpatient care for 3 weeks, during that time I had not been allowed any leave on either ward, so had been stuck in that same environment for all that time.  

I hadn't crossed a road, I hadn't been out in public, I hadn't been to a shop, I hadn't bought anything myself, I hadn't done so many usual every day tasks that are taken for granted.  

It is not exactly like returning from a holiday.

I am definitely someone who finds comfort in routine but I think anyone would certainly get used to it if they were following the same structured routine every day.  It can therefore be quite difficult to settle back into life outside of inpatient.  I can only imagine just how difficult it must be if you have had a longer inpatient stay.  I think the issue can also arise that inpatient can become quite a safe and almost comfortable place, home might be a very different and more unpredictable environment for you and so it can be difficult to make the transition.  

That being said, I think that if you are well supported in making that transition and your discharge is managed well, it can be successful.

Inpatient - you often don't have a choice in the matter.

While writing all this, I thought to myself whether there is actually much point in weighing up the pros and cons of inpatient and outpatient treatment as most of the time it is not as though you have much choice in the matter, generally you are just given the treatment that is most appropriate at the time.  Often people are placed in inpatient care under section and that is definitely not something they have a choice about.  As much as it may sound quite unbelievable, there was quite a lot of discrepancy over whether I was placed in hospital under section!  However, the ultimate reason I placed in hospital was because of the risk I posed to myself in spite of being under outpatient care.  I was told that if I was to attempt to leave the hospital, I would be sectioned so in a sense, I had no choice but to stay and I have to say, the experience of being stripped of so many of your rights is such a surreal one.  That being said, when stripped of so many choices, sometimes I think the only choice you have is to make the best of what you have.  It is also important to express your opinions and preferences regarding your treatment where possible and push for the help you feel you need - it is your recovery after all and it is vital to take ownership over it.

The main issue is about whether the help and support you receive is beneficial to you, regardless of the setting.

I think this is what it comes down to - if the quality of the support you are receiving is good and helpful to you, it doesn't really matter what setting it is in.

In an ideal situation, I think it is best to receive outpatient treatment for mental health problems as it allows you to manage your condition while living in the community.  However, sometimes inpatient is necessary to ensure your safety or provide you with more intensive support.
Whatever the setting, my main piece of advice would be to make the most of whatever help is passed your way - commit to it and try to use it to improve your wellbeing because as much as it may not seem that way right now, your life really is worth it!

To end, here are a few pictures of where I chose to spend my two year 'anniversary' to the day that I was put into inpatient in a crisis situation - Beachy Head!
You might think me brave or even really stupid.  You may think it inappropriate but it was such an amazing experience and I'm so glad I did it.  Two years ago, I had planned to end my life at Beachy Head but two very special, caring people stopped me. For a long time I hated them for stopping me but time has passed, things have changed a lot for me in that time and while I find life very challenging, I couldn't be more grateful to be here.  I finally made it to Beachy Head but in a totally different mindset, my only thoughts was just about how amazing the view was and it was truly spectacular.
I found peace with myself up there.

My reason for sharing all this is purely to send out a message that there is life after inpatient treatment, you can find peace with yourself and become a stronger person in the process.

 

Love and strength,

The One Day Seeker.