Partial Hospitalization: the first day
The first day of an intensive outpatient depression treatment program.
You may notice that the title of this series has changed from "IOP" to "Partial Hospitalization".
It turns out that "almost killing yourself" is considered a six-hour-a-day problem, so I was sorted into the Partial Hospitalization Program (PHP) instead of the IOP. (It's only "Partial" because I get to spend evenings and weekends at home.) To be clear - every PHP is different, and everyone's experiences of a given PHP are different, so I can only speak for myself.
I also need to address the immense privileges that have let me take part in this program to begin with. I attend a university where (at least so far) it's relatively easy to take mental health leave, and which lets me keep my university-sponsored insurance in the process.
The program costs $570 / day, which the insurance reduces to $57 / day. Ubering to and from the treatment center (an hour drive each way) costs about $100 / day. I'm fortunate enough to have savings to cover some of the cost, and even more fortunate to have parents with enough money to pay the rest.
So with those caveats, let's get started.
After a full two-and-a-half weeks of playing a one-sided game of phone tag with the intake specialists, I finally arrive on a Thursday morning at 10 am and am immediately struck with the mental health version of impostor syndrome:
You're fine You're just exaggerating your symptoms You're taking a spot away from someone who really needs it
I meet briefly with the intake specialist, finding myself slightly embarrassed to have forgotten my insurance card, before seeing a nurse who does a general mental/physical health checkup. I now weigh 216 pounds, up from my typical weight of 190 and my October weight of 170. She asks if I've been eating normally. I say yes and mention that I'm on Abilify. She nods and makes a note and the interview continues smoothly until we reach the questions about suicidal ideation.
Do you ever have thoughts of killing yourself?
Have you ever made a plan to kill yourself?
Have you ever acted on these thoughts?
o we have to do the usual questions: am I currently in danger? do I have a safety plan? who will I reach out to if it gets worse? etc. etc. etc.
I'll answer this same set of questions a total of four times in the first two days I'm here.
I've missed the first group session by this point, so it's time for mindfulness. I'm still not certain what mindfulness is, other than that it involves running your fingers through a little labyrinth and seeing how the labyrinth is a metaphor for your life. ("There are lots of options, but not all of them are good!" "Sometimes I hit a dead end and don't know what to do" "I don't like labyrinths" and so on.) I honestly find this part a little bit condescending, but I'm willing to accept that there are people who like this sort of thing and I'm just not one of them.
Then we have lunch. It's fun, but a little awkward not knowing anybody.
After lunch is "individual time." Since I'm new, I get to meet with my therapist first and answer the usual questions about why I'm here and yes I'm suicidal but I'm currently safe and etc. etc. etc. We fill out a very official-looking Safety Plan I have to sign.
She shows me a stack of worksheets in my binder to fill out that ask questions like "what is a normal day in your life like? how about an ideal day?" They seem silly and frustrating to me at first: Obviously my ideal is not to be depressed anymore. But the more I work through them the more I see the point.
See, the program has a behavioral focus, meaning the working paradigm is at least approximately that by giving people tools to change their behavior across a variety of situations, the feelings will follow. By asking about my normal/ideal days, I think that my therapist was trying to isolate which specific areas in my life could use work. At the end, we've identified three main goals: control suicidal ideation, focus long enough to return to pleasure reading, and repair a certain broken relationship.
And, you know, that's only three things. So for the first time in a long time, getting better feels within reach.
The day ends with a group skills session: this one being TIPP skills, which refer to a collection of ways to control one's emotions under extreme circumstances (the person in charge described it as "when you're at a ten"). TIPP stands for:
T - Temperature: Apparently there's a reflex called the mammalian diving reflex that sets off if your face is cold for at least thirty seconds and can help to regulate your emotions! Examples of things you can do here are cold showers and (my favorite) holding frozen oranges against your face.
I - Intense Physical Activity: Pretty self-explanatory. My go-to here is pushups.
P - Paced breathing: Four seconds in, six seconds out. Repeat until calm.
P - Paired Muscle Relaxation: relax groups of muscles individually, paired with the above paced breathing. I find my mind goes crazy instead of relaxing whenever I try this, so find a skill that works for you!
We run around practicing the skills and I feel a little bit silly but it's also fun. I think getting myself out of my comfort zone is part of the goal - I have to remind myself I'll never see these people after the next few weeks.
And that's the first day.
The second day opens with some time for games. My favorite is called Quiplash, and amounts to essentially Apples to Apples or Cards Against Humanity, with the twist that you get to pick what you write in the blank instead of choosing from a preset list of cards.
There's a lot of gallows humor.
My personal favorite answer responded to The worst part of being immortal is _____ with living.
And it really feels like the people here "get" me. And it feels like I'm a part of something for people like me. And I only have three things to work on. And then I'll be better.
I think I'm going to be happy here.