Resource I'm starting a PHP (my thoughts & AMA)

[puella]

I'm starting a partial hospitalization program (PHP). I wanted to make this post to share my thoughts and answer questions so that anyone considering starting a PHP would have a primary source to consider. In addition to answering questions, I will update this thread daily to share what I did that day. You can click 'watch' on the thread if you want updates.

PHP patients attend for several hours a day and get access to all the resources available during full hospitalization while there. Unlike full hospitalization, which is inpatient, you retain your freedom to leave each day to be at home. In my opinion, the only reason to choose inpatient care over intensive outpatient care is if you are worried about the potential of harming yourself, relapsing, etc. on off hours. If that isn't a worry you want to protect yourself from—and you have the choice—I think the best options are different levels of outpatient care. A PHP is the most involved form of outpatient care, usually taking up a full day of time. Places with partial hospitalization programs also often have intensive outpatient programs (IOP). It seems like the only difference is that an IOP takes up fewer hours of the day; maybe there are more differences between the programs at other hospitals.

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Day 0

I haven't started the PHP yet, but I had my intake appointment earlier today (Feb 1). I got to ask many questions during the intake appointment. I am scheduled to start tomorrow (Feb 2). The program begins at 09:30(am) and lasts until 14:30 (2:30pm). I hate mornings, and the bus ride is 90 minutes, but it'll be okay. The intake coordinator told me most of the day is in group therapy. I will also see an individual therapist, I hope daily, and a psychiatrist, hopefully, multiple times a week. There is also access to family therapy. The program seems to be split by age and nothing else. I'm 21, so I fall into the 18-24 group. If I recall correctly, the other groups were 13-18 and 25+. The center looks nice, though I didn't get a tour of most areas.

Honestly, I am pessimistic. I don't think anything can "fix" me. I'm just hoping this program will give me skills to manage my depression so that I can take care of myself day to day. Being able to make myself study more and possibly get a job would also be helpful; I can't manage that right now. I am unable to find a method to CTB right now, so I need to take care of myself at least until I can. I am worried about my anxiety. Being in groups can make me feel anywhere from uneasy to panicked. I also have to eat lunch there, but I have a phobia of eating around other people. The intake coordinator seemed nice, and I hope everyone else working there will also be helpful/accommodating so that I don't get too overwhelmed.

 

[UsagiDrop]

Thank you for starting this thread, puella. I'll definitely want to keep my eye on it, and I hope that you can get the most out of this experience despite feeling pessimistic about it. Even if it doesn't "fix" you, at the very least, you'll have helped others by documenting your experience whenever you get the chance to.

I really feel you when you say that you don't believe in a cure to your condition, so to speak, and that you just want ways to cope until the end. I feel similarly, although I think that if there's a possibility that we can find a reason to live along the way, that's always a worthy cause to try. I know this whole thing can be scary, because I would be scared too, but I'm proud of you for doing this for yourself. Even if you just make your time left here easier, it's a positive! I hope that you can be accommodated for your anxiety around eating, too. When I had a job as a manager, I had an employee with a similar phobia, and I always let them eat in the back with full privacy or at different times. I hope maybe something similar can be done for you. Good luck on everything!

 

[puella]

Day 1

You get a daily Pifzer nine-item Patient Health Questionnaire (PHQ-9) as part of check-in. If you're in America, I'm sure you know it. We also do a daily check-in stating our name, pronouns, and a 1-100 mood level. The questionnaire is on paper for the therapists, and the check-in is verbal for the group. Most of the day was in group therapy. Monday and Friday, each group member sets goals for the week/weekend as another section of checking in.

We got worksheets and listened to the group therapists explain the concepts they related to. Aside from asking questions, it wasn't very interactive or personalized. The topics seem too general to be extremely helpful for any one specific person. We started a lesson on managing changes, but I was called away by a nurse for a vitals check. We also learned about the DEARMAN communication technique, but I'd already learned it with a previous therapist. I also don't struggle to communicate my boundaries or make requests, so it wasn't helpful. I'm sure the topics will be useful to many people. But I have been in weekly therapy for five years, so I hope I won't have seen everything before.

I met my psychiatrist before leaving. She asked me follow-up questions about my intake appointment answers, had me make a safety plan, and scheduled to finish our appointment on Monday. I think healthcare professionals are required to have you agree to a safety plan—basically saying you will call a professional or hotline if you feel suicidal. I just agree to agree; it isn't like they could get mad at me for lying if I do die. I have no plan to CTB anyway.

So far, I think today was positive but less helpful than most one-hour individual therapy sessions. Maybe as I continue, the frequency and quantity will make it more impactful.

 

[puella]

Day 2 & 3

I was really tired Monday, so I forgot to post. I feel like I have no time to myself. Once I got home yesterday, I just went directly to bed. I have to wake up so early for the bus anyways.

I'm writing this during lunch. It's also hard to find a space totally alone here. I cannot eat in front of people; I have a phobia. And it's been inconvenient.

Being here feels like going to school. I don't wanna wake up for it, I'm bored and socially anxious all day, and then my day feels over by the time I get home. I'm really hoping this isn't just a waste of time.

 

[carac]

Have you tried making any friends there? Having a shared experience can draw people together and you need some support. Also you should ask a private space where you can eat or be alone for some time.

 

[spring vainglory]

i think if mornings aren't a part of your natural rhythm the early schedule is going to take a toll on you. ive been through trying to keep up an early schedule as a night owl and it was agonizing. that could be why you're so tired and feel like you have no time, thats exactly how i felt. all my time was spent sleeping to make up for how consistently tired i was.
i hope you can find some way to feel better during this process :(

 

[puella]

Have you tried making any friends there? Having a shared experience can draw people together and you need some support. Also you should ask a private space where you can eat or be alone for some time.

I'm extremely introverted, it's hard for me to talk without being spoken to. But a few people have been extremely friendly and started conversations with me that I was able to hold.

I asked, and they've been trying. It's just difficult cause there are only main rooms open to groups and offices with staff always in them.

i think if mornings aren't a part of your natural rhythm the early schedule is going to take a toll on you. ive been through trying to keep up an early schedule as a night owl and it was agonizing. that could be why you're so tired and feel like you have no time, thats exactly how i felt. all my time was spent sleeping to make up for how consistently tired i was.
i hope you can find some way to feel better during this process :(

Thank you. I hope that eventually my body will adjust. I'm feeling a little better today.

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Day 4

Morning routine went a little more smoothly than normal. I can set my alarm for 6 and still make the bus, as long as I get out of bed actually at 6.

My psychiatrist sent for me to get a blood test, I'll try to get that done tomorrow. She was also talking about antidepressants. I'm a little scared because one of the side effects of the specific medication she wants to try first is an increased appetite. She said it's a good thing, since I haven't been eating enough and don't usually feel hungry until my head hurts. But I honestly like being thin. I'll see how different I feel after trying before making judgments though.

We had art therapy today, and it was awesome! I was having fun just water coloring circles on my page. I actually felt a lot less socially anxious when I had that to focus on. I wish it was more often than once a week.

 

[puella]

Day 5

Posting this late again. I felt horrible on Friday, and left the classroom at the end of the day to cry. We were doing practice breathing exercises in group; taking deep breaths in and out can be a trigger for my emotional outbursts. My therapist saw me sit in the hallway and cover my face, so we went to her office to talk. I felt a little better after that.

I also got a blood draw for my psychiatrist. I have a serve vitamin D deficiency (13ng/mL). That might be contributing to my depression.

I had a really bad panic attack on Friday evening. My phone died on the bus, and everything was so loud without headphones/music. I got lost on my way home, and the cars are so loud here too. Everything is just so busy and crowded. I don't remember much after that, but afterwards I was home in my bed and I was in a call with my girlfriend. She said I called her sobbing and that I didn't calm down enough to say anything—that made sense—for about an hour. I was really exhausted the day after, but I'm feeling okay now.

 

[kawaiiphantom]

Day 5

Posting this late again. I felt horrible on Friday, and left the classroom at the end of the day to cry. We were doing practice breathing exercises in group; taking deep breaths in and out can be a trigger for my emotional outbursts. My therapist saw me sit in the hallway and cover my face, so we went to her office to talk. I felt a little better after that.

I also got a blood draw for my psychiatrist. I have a serve vitamin D deficiency (13ng/mL). That might be contributing to my depression.

I had a really bad panic attack on Friday evening. My phone died on the bus, and everything was so loud without headphones/music. I got lost on my way home, and the cars are so loud here too. Everything is just so busy and crowded. I don't remember much after that, but afterwards I was home in my bed and I was in a call with my girlfriend. She said I called her sobbing and that I didn't calm down enough to say anything—that made sense—for about an hour. I was really exhausted the day after, but I'm feeling okay now.

Thank you for giving updates I know how debilitating and frustrating it can be to have panic attacks. They take so much out of you, I struggle with them a lot too. i had to drop out of art school last year because I was having them everyday in class. It's especially hard when the world is too noisy, I can definitely relate. I have to wear earplugs a lot. I just want you to know I'm very proud of you for making it this far. You got this!! :> the steps you've taken to try to improve your mental health is amazing. I'm cheering you on!!!