10 Things You Should Know About... Being an outpatient

Note: this post is regarding psychiatric community services and not medical outpatient services.

   1. If you become an outpatient after being in hospital for a long period of time, then it could be a bit of a shock to the system, and that's normal and ok. For me, when I first became poorly and was admitted to psychiatric wards a number of times, it was for very short periods of time. This meant that I felt that I hadn't been in long enough to become used to the environment. Then I was admitted to a long term ward where the average length of admission was 12-18months; I was an inpatient for two and a half years. I definitely didn't miss the ward when I was discharged. It was just that there was a lot of adjustments to make in order for me to cope with the dramatic changes that I experienced. The main ones were that there wasn't someone to talk to 24/7; I couldn't just pop down to the staff office or knock on the door of another patient's bedroom door. If I needed to talk to a professional then I'd have to ring my community team and (usually) wait until someone was free to return my call. Constantly being surrounded by people also meant lots of noise. When I first moved into my own home I'd often leave the TV or music on because it would feel too quiet. The biggest change, though, was that I was now 100% responsible for my safety. In hospital, there was ALWAYS a chance that someone would either stop you from self-harming or if they hadn't then they'd at least ensure you got appropriate treatment for it. At first, I found it quite upsetting to acknowledge that I could hurt myself or even attempt suicide and no one would know. It meant that I'd either have to try incredibly hard to resist the urge to self harm, or somehow get help if I were to do something. As hard as it's been to make these changes, I've never had a moment where I've wished I was in hospital.
2. It might take a while to find the right professionals for you. Each individual has different needs and a different level of care and so, some may have many professionals and others might just see a therapist. Typically though, an outpatient will have a Community Psychiatric Nurse (CPN), a Psychiatrist, a Psychologist or therapist of some sort, and a Social Worker.  Personally, I haven't had the easiest of experiences with staff. I've gotten used to some staff and then they've left, I had an argument with my original Psychiatrist and refused to see her again, and I've been introduced to support workers that I've immediately not taken to. It is a double edged sword though, as you can either decide not to work with someone in the hope that you'll be allocated someone you'd prefer to work with but risking that you might be put on a waiting list or allocated someone you dislike more. Or, you can stay silent and try to improve the professional relationship but with the risk that it may get worse and have an impact on your mental health. It's a personal decision that's unique to each situation. Just know that you will eventually be happy with the people involved in your care; no matter how long you feel it takes. And if you're not, please don't be afraid to speak up. At the end of the day, there's no point in providing you with a service if it's not helpful; you need to be able yo take advantage of the services offered to you, in order to benefit from them.
3. Not all of the professionals on your team will communicate. And that'll be difficult to deal with and accept at first. Sometimes, the lack of communication is between themselves and other times it's even with you. I think that it's personal experience that will determine which situation bothers you the most. But thinking back on communication problems that I've experienced, I'm not sure that I could say which way bothers me the most. It's definitely frustrating when it's between the professionals; as an outpatient, you'll want consistency in your care. And it can be difficult for professionals to pass information on to one another if each of them are based at different offices and are likely to have completely different schedules. But as the outpatient, I think that when you're actually in the situation, it's difficult to just remind yourself of these factors because you feel let-down and annoyed. Sometimes the communication error might be that you've talked to one professional in detail about something important and personal for you, and if they don't tell the rest of your team then you might be asked to repeat it. You might also find that you'll make a plan or an agreement with one person and  they don't tell others then the inconsistency might result in you feeling let-down and unsupported. If such lack of communication is being detrimental to your mental health then rather than just trying to cope with those feelings, your time will be better spent on; firstly, telling the professionals how their behaviour is affecting you in the hope that the knowledge might aid them in altering their behaviour. And if they refuse to accept what they're doing or fail to change it,  you could try thinking whether there is anything that you could do to prevent it. And it's completely ok to be angry at the thought of that. To think"why should I have to do anything when it is them who aren't doing their job properly?" At the end of the day, it comes down to this: which is the worst scenario? Accepting their failings at communication? Or, putting in some effort to try and stop it from happening? Personally, some of my professionals listened when I told them what affect their failings were having on me, and for those who didn't make changes, I now pass information on myself! If I tell my CPN something that I want others to know, then I'll call them and tell them myself. Bit of effort but it's much better than all of the upsetting inconsistencies.
4. Always ensure that you have the contact details of a support service available to you out of hours. The kind of support you'd need out of office hours will depend upon which support service will work best for you. Often your community mental health team will give you a number for your local CRHT (Crisis Resolution Home Treatment team), often referred to as the crisis team, as this the automatic response. But, if you didn't want to call them or if you had and had bad experiences of working with them, then it's worth asking your professional team if they have any suggestions but personally, I think you'd be better off finding a support service yourself. There's so many helplines available these days and I've heard lots of people have very good experiences with them, but it'll be different for each person. I called a helpline once and it was horrible so I've never used them since. It is worth mentioning that if you aren't happy with one helpline then you could try another. Don't do what I did and assume they'll all be bad if one was. Your diagnosis could also affect which out of hour services would help you the most. For example, I work with Richmond Fellowship who specialise is Personality Disorders. I see two workers for sessions during the week and I have access to the service out of office hours. So it might be an idea to look into whether there's any support services who specialise in specific disorders that would be relevant for you.
5. If you think you need to be given extra support in addition to any therapy or appointments you have, don't be afraid to ask for it. It isn't something you should hide. Being an outpatient typically means that you are well enough to be supported in the community, and with that, is the hope that you're well enough to recognise when you're mental health is deteriorating and ask for help. All mental health professionals would rather that service users were in the community, and so providing you with additional support would help avoid the situation escalating and you needing to be admitted to hospital. If you are reluctant to ask for more help, then a motivation could be the thought that if
 you don't, you might end up in hospital. And professionals won't judge you; if anything, they'll probably thank you for being honest. Personally, I've found that just sitting down and talking about it, professionals appreciate it more. As if saying things are hard is better than doing something to show you're struggling. I would say that obviously talking is the best way to go about but if you really can't then I kind of feel like, what you do isn't as important as the fact you're doing it to get help.
6. It is not a sign of failure if you feel that you might benefit from an admission to hospital. I think
that admitting this to a professional is perhaps more difficult when you have been in hospital previously. If you've had a positive experience when you've been an inpatient in the past, then this will probably encourage you to voice your concerns. But it is important that you don't rely on a hospitalisation to maintain your safety. At some point, you have to take responsibility in keeping yourself safe. However, I have personally had many bad experiences during hospital admissions; varying from feeling judged and unsupported by staff, generally feeling ill-treat, experiencing lots of restraints and sedations, witnessing other inpatients self-harming, and feeling homesick. These have affected me in that I'm extremely reluctant to go into hospital and wary of voicing things that might cause others to worry and consider admitting me. Hence why most of my psychiatric hospital admissions have been compulsory, in that I have been sectioned and taken there against my will. However, the stage that I'm in with my recovery journey, does mean that I can recognise when my mental health is deteriorating, which will mean that I can ask professionals for help before I'm at the stage where an admission is required. I hope that, ultimately, no one wants to be in hospital so  it's important to determine your early warning signs, which you can do with your community team.
Note: there is a previous post in this series that is focused on being an inpatient and making the most of your admission: http://imnotdisordered.blogspot.co.uk/2016/01/10-things-you-should-know-about-being.html
7. If you're on medication (whether it be medical or psychiatric), you must continue taking it unless instructed otherwise. Admittedly, I found this hard when I first came out of hospital because on , the only staff would call for you when your medication was due. In the community, as an outpatient, I have to remember when to take my pills; although it was made easier when the pharmacy began making up a dosette box. This where you have each day of the week and then four compartments for specific times during those days. Sometimes it's all about getting into the habit of taking them when they're due, and if you don't already have one, then you should ask for a dosette box to make it easier for you. I also have PRN medication, which means pills to take/use when needed e.g. I have a mild sedative incase I feel agitated and restless, or even just if I feel that sleeping is the only way to maintain my safety. And I really enjoy being in control of my medication; firstly, because it means I can fit it into my day as in hospital you had to take your meds at a particular time meaning that you couldn't have a lie-in! Secondly, I enjoy that I no longer have to practically beg for PRN medication;
in hospital, you had to explain every little thing to be given the pills,  and even then, you wouldsometimes be refused if the staff felt that you could manage without it or that you needed to try out it other coping strategies before resorting to medication. Even in the community
PRN is the last resort for me. Finally, do not abuse your medication now that you're in control of it, because your team will most likely make changes to avoid this being repeated. I once took too much of my anti-psychotic medication (on purpose) and ended up having to go to my local pharmacy twice a day to take my medication under supervision.
8. Try your hardest to attend all of your outpatient appointments. It's a good idea to have your diary etc with you when you do go to an appointment so that you can ensure that the next appointment date will fit into your schedule. Don't be afraid to ask for specific dates and times, there's no point in them giving you an appointment slot that doesn't suit you. If you see a number of professionals then it might be wise to avoid having all of the appointments lumped together. Some people will prefer this,
thinking that they want to get them all out of the way. Although, I found it difficult and overwhelming to sit through an intense therapy session with a Psychologist and then have to see a Psychiatrist the next day to have to make difficult decisions about your medication or care in general.
9. Enjoy your freedom! Whether you've been in hospital or not, whether you've been sectioned or not. You know how much could be taken away from you if you needed to be hospitalised. I'm not suggesting that you stress over the worry of this, just that you live like it could happen tomorrow.
10. I know that a lot of people might see this as being pessimistic, but I'd advise other outpatients to ensure that they complete an advanced directive. This is a kind of care plan in the event that you become too poorly to recognise what is good for you, and so you write it with your team and sign it when you're doing well and have the capacity to think ahead. It's especially focused on maintaining your safety should you become unable to maintain it yourself or should you stop co-operating with your treatment etc. Personally, a  part of my advanced directive, advises A&E staff that should I attend after attempting suicide and am refusing treatment that will save my life, then they shouldn't waste time on having me assessed by various professionals, and should just assume that I don't have capacity and to treat me against my will. I would go so far as to say that my advanced directive has saved my life.
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