Adjusting to life after a mental health hospital stay

I spent ten weeks inpatient in a mental health hospital. In the hospital I had a sense of safety, security, and being cared for that I wouldn’t have to the same extent when going back to living on my own. The week leading up to my discharge I knew I was ready for it, but I was also terrified of what could happen once I left that safe environment.

Being in a mental health hospital for ten weeks meant I got used to an established routine. Meals and meds were taken at specific times (breakfast, lunch, dinner, supper) and activities were scheduled roughly at the same time each day (a morning walk, an activity before lunch, an activity before dinner). The rest of the time was up to me to manage. I usually get overwhelmed trying to choose what to do next, but because options are somewhat limited in a hospital this wasn’t an issue. I found this kind of routine worked really well for me and I tried to replicate it at home.

Leading up to my discharge I wrote down three routines: one for the time I’d be completely off work, one for my phased return working shorter hours, and one for when working full-time again. I tried to make these routines as similar to hospital life as possible to ensure a smooth transition. I wanted my life to still feel similar to hospital life for a while to keep that sense of familiarity so that the only difference would be the lack of staff and patients around me.

Routines

These were the routines I came up with:

Off work

(2 weeks)

*check on mood and look out for warning signs throughout the day

07.00 – shower, breakfast, meds, make bed

~ reading/journal/podcast/meditate

10.00 – walk 1-2 laps around park

11.00 – cook lunch

12.00 – lunch

~ refer to day’s to-do list or spare time activities list and choose

16.00 – cook dinner

17.00 – dinner + meds

18.00 – long walk, spend some time in nature

20.00 – refer to day’s to-do list or spare time activities list and choose a relaxing one

21.00 – supper optionally, meds, mood diary

~ quiet/relaxing activity

22.00 – get in bed

Phased return work

(6 weeks, varying hours)

*check on mood and look out for warning signs throughout the day

07.00 – shower, breakfast, meds, make bed

~ reading/journal/podcast/meditate

08.30 – walk to work

~ return from work, eat lunch

~ walk

~ cook and eat dinner, cook next day’s lunch

~ refer to day’s to-do list or spare time activities list and choose

~ optional short walk

21.00 – supper optionally, meds, mood diary

~ quiet/relaxing activity

22.00 – get in bed

Full-time work

(08.30-17.00 Mon-Fri)

*check on mood and look out for warning signs throughout the day

06.45 – shower, breakfast, meds, make bed

08.00 – walk to work

12.00 – lunch break – eat lunch, walk/read/listen to a podcast

17.00 – walk home, meds

18.00 – cook and eat dinner, cook next day’s lunch

~ walk at least one lap around park

~ refer to day’s to-do list or spare time activities list and choose

21.00 – supper optionally, meds, mood diary

~ quiet/relaxing activity

22.00 – get in bed

As you can see, I used anchor points throughout the day leaving the periods in between flexible.

I tried to stick to those anchor points as much as I could, while allowing myself to rest or take it easy in between them if I needed to.

The flexibility still had structure to it. I had two main lists to refer to: day’s to do list, and spare time activities list. I’m very methodical so I find that having lists, categories and so on really helps me.

To-do list

Day’s to-do list included fixed to-do tasks (e.g. laundry on Saturdays, cleaning on Sundays) as well as that particular day’s to-do tasks. Those particular tasks would either be set in advance (e.g. appointments that I knew were coming up) or, for the most part, 1-2 days beforehand. I found that trying to plan a whole week ahead was hard for me, so I only planned 1-2 days at a time.

The day’s to-do tasks would be listed by priority: things that absolutely need doing (I kept this to a minimum if possible to avoid being overwhelmed or exhausting myself), things that can wait until the next day, and things that don’t really have a deadline. This way I could focus on getting what needed to be done out of the way first, and anything else was a bonus.

Spare time/enjoyable activities

It was important to keep a good balance between things that need to be done and things that I enjoy doing. Because I get easily overwhelmed making choices, I wrote down a list of spare time activities to make the choosing process easier.

My spare time activities were mainly two types: activities that give me purpose (e.g. knitting things for charity), and activities I simply enjoy (e.g. playing a game).

Within these, I roughly sorted them by type. Things to do with my hands, things to do on the computer, things that get my brain working, things that distract me in a passive vs active way (e.g. watching a show vs going for a walk), etc.

Low-effort alternatives and self-care

Cooking healthy meals daily was an important part of my routine. I wrote a meal plan for the week so that I wouldn’t have to think what to cook every day. However, I knew some days I would feel too tired to do this and it would be easy for me to develop bad eating habits again. To avoid this, I set some low-effort alternatives such as salads, packs of microwave rice, porridge, fruit, and yogurts. I would allow myself to use these alternatives one day. If I felt like I had to resort to them two days in a row I knew my mood was going down.

For housekeeping, I had alternatives as well. For example, quickly cleaning bathroom surfaces with anti-bacterial wipes rather than not cleaning at all, or allowing myself to skip vacuuming for one week. I wrote down what a proper clean would be step by step to make it less overwhelming, and I set up a low-effort alternative for each area that needed cleaning.

Essentially, doing a bit is better than doing nothing. A low-effort alternative allows me to take a break when I need to while also maintaining a routine. It keeps me healthy, it keeps my living space clean, and it’s also a way to monitor my mood and energy levels. If I feel the need to use a low-effort alternative twice in a row, I know something’s off and I can address it.

In the hospital I allowed myself quiet alone time, I would take a quick nap if I was too tired, I would talk to staff if I needed to, and I made a conscious effort to apply the coping skills I was learning. Basically, I was taking care of myself, I was listening to my brain and my body, and I was allowing myself to be helped. It was important for me to continue this at home. I kept a routine but I also made an effort not to be too hard on myself if I needed a rest of if I needed to reach out for help at any point. I reminded myself I had a really bad mental illness episode and I was still recovering from it outside the hospital, just like I would still be recovering after a broken leg and would not expect myself to be running right away.

Mood tracking

As for the mood diary at the end of the day, I just quickly rate my lowest and highest mood of the day as well as any relevant comments (for context when looking back through it). I made a spreadsheet for this (template here) and I have a shortcut to the file in my phone to easily update every night. If not, I just write it on paper and add it later.

Tracking my mood allows me to see any trends if it’s consistently going lower or higher. It also gives me reassurance; if I have a bad day I can look back and see it’s one bad day after many neutral/good ones. I can look at the past and see that a couple bad days don’t necessarily mean things are going down if I keep an eye on it.

It also developed my self-awareness, as I would have to reflect about the day when it was time to log my mood at night. Because of the comments I wrote, I could also identify whether there were any activities/habits/events that affected my mood.

Warning signs and coping skills

In the hospital, staff checked on us every hour. This meant if I displayed any warning signs I wasn’t aware of in that moment, they’d notice that and we’d do something about it. On my own, while having professional support, I wouldn’t have anyone to notice a warning sign right away or to knock on my door every hour. I made it a point to check in with myself regularly throughout the day, referring to the list of warning signs I developed at the hospital so that I could address them if necessary. I reminded myself the responsibility to stay well and safe was entirely on me now, that I had to reach out to the services myself when I needed them and not just passively wait for the weekly call from my community nurse.

Before moving on to the next task in the day I would ask myself: what am I thinking? how am I feeling? and how am I acting? If anything was a bit off, I would act accordingly.

I had a printed list of warning signs (how things are when I’m well, how things are when things start to get bad, how things are when I’m reaching or I’ve reached a crisis point) as well as a list of coping skills. I would act on a warning sign as soon as I saw it, no matter how small, before it had the chance to get any worse.

I divided the coping skills by situation: to calm down, to ground myself, to distract myself, to get myself going when I feel lethargic. This made it easier to find the right option when I needed one.

I also kept a list of services to access if I needed to (my community nurse’s number, mental health hub number, crisis number, crisis café and their opening time).

Medication and sharps

My GP prescribed me only a week’s worth of meds at a time. I bought a pill case so as soon as I got my meds from the pharmacy, I would sort them for the week (seven little cases each with three compartments). To these I added the multivitamins I take (because I know I probably don’t always get enough from my diet) as well as magnesium and fish oil (might help with migraines). Having my medication set like this means that if I were to impulsively decide to overdose, I would have to open 21 separate compartments and fish out the actual dangerous pills, since I wouldn’t want to be swallowing handfuls of massive supplement pills. Having to do that would hopefully give me the time to cool down and rethink. And if I decided to just take everything I had, I would either have the time to think since swallowing pills that size would slow me down a lot, and knowing myself I would probably vomit them soon after starting.

In terms of sharps, I gave all my shaving blades and a boxcutter to a friend to keep until I felt safe. I still had kitchen knives (my own because I needed to cook, and my housemate’s because I wasn’t going to ask him to lock them away) but my logic was that if I was resorting to a knive, either to self-harm or with suicidal intention, two things would happen: I would have a few more seconds to think since I’d have to go to the kitchen, and more importantly, I would remember I don’t have any other blades because I gave them to a friend to stay safe, and they weren’t taken from me, I gave them myself, because I want to stay safe, and that would likely get me to step back and rethink.

In summary

In summary, these are my personal tips for adjusting to life after a hospital stay:

  • Establish a routine that’s as similar as possible to the hospital routine. Don’t try to structure your day in a drastically different way in the beginning.
  • Mimic the staff support from the hospital. Check in with yourself regularly. Keep an eye out for warning signs. Be proactive about reaching out for help and use any service available to you as much as you need to.
  • Find the balance between strictness and flexibility that works best for you.
  • Prioritise your to-do lists so that you know what to start with and what can be left if needed.
  • Find a good balance between obligations and hobbies. Too much of either won’t be good.
  • Find low-effort alternatives for things like cooking and cleaning. Doing a bit of something is better than not doing it at all.
  • If lists and categorising things help you, make lots of lists.
  • Track your mood. Whether it’s on paper, an app, or any other system. It will give you a lot of insight.
  • Keep a written list of warning signs, coping skills, and services you can access. It’s difficult to think of these things off the top of your head in the moment.
  • Take whatever measures you need to stay safe in terms of keeping medication with you, sharps, and anything else you might be at risk of using to hurt yourself.
  • Listen to your brain and your body. Try to be kind to yourself and be aware of your needs.

Once you’ve adjusted back to life outside the hospital, you’ll naturally find the routine that works best for you through trial and error.

2 thoughts on “Adjusting to life after a mental health hospital stay

  1. Thank you for creating the template! I’m going to copy it and try it out… if I don’t get frustrated with Googgle Spreadsheets first! I love me some Excel, but I know not everyone has it.

    Like

    1. notjustbipolar

      You’re welcome, hope you find it useful! I definitely prefer Excel to Google Spreadsheets for most things, but I like the convenience of using it easily from any device

      Like

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