I have it on good authority that I get to keep my shoelaces!

August 28, 2011 6:48 PM

I'm going to an intake (evaluation/show-and-tell) session at a psychiatric partial hospitalization program, due to severe social anxiety, ADHD and most importantly my current acute bipolar depressive episode. What kinds of questions should I be asking? How should I prepare?

The session is supposed to take around two hours. The program is a general one that helps people with all kinds of serious mental illnesses and also substance abuse problems. This intake session is supposed to be me plus a social worker and maybe a brief conversation with a psychiatrist - I was really super nervous on the phone (they won't tell me anything via email) so I didn't do well on getting the exact details.

I already plan to bring a list of my current medications, the notes I made for therapy since January, a prioritized list of the things that are making it hard for me to function, fourteen years' worth of blood tests, and contact information for my entire support team. I'll also have insurance paperwork (certification numbers, contact info, etc.)

The only questions I've been able to come up with are:
- what are the rules that they have for conduct within the program,
- how am I supposed to know if it's helping,
- will they be helping to optimize my medications,
- what will determine when I stop,
- do they know a lot about how to deal with comorbid anxiety/bipolar/ADHD/etc.,
- why should I go here instead of the other hospital in the area,
- is this really the right level of care for me, and
- are they really going to make me do group therapy when I'm terrified of strangers and groups.

I have no idea what else to prepare, and I feel like I must be missing something because my gosh this is partial hospitalization we're talking about here (they also have an evening program, so they could suggest anything from 7 hours a day, 5 days a week, to 3 hours a day 3 days a week.)

I'll also be asking my therapist about this, and I've posted on the DBSA forums as well, but I've seen other questions here about partial hospitalization and I thought MetaFilter might have more advice.

For what it's worth, the main reason I'm looking into this is that the last two years of biweekly therapy and monthly psychiatric appointments have not brought me to a level of functioning that any of us are happy with, and my medication needs are apparently a lot trickier than normal psychiatrists are equipped to deal with. I woke up at 1pm today and took a two-hour nap at 4pm and am ready for bed again at 10pm, and that's barely the tip of my iceberg. My psychiatrist suggested it at my last session with her, right before upping my antidepressant and telling me to come back in 7 to 14 days. My counselor at work agrees it's probably a good idea.

TLDR: How can I make the most out of this two-hour intake session for partial hospitalization?

Bonus question: I am very, very socially isolated, but someone I don't know well from church has reminded me that they are "there to help." What kinds of general social support are likely to be helpful, bearing in mind that for me it's a real accomplishment to have worked up the strength to tell anyone I was doing this?

posted by Fee Phi Faux Phumb I Smell t'Socks o' a Puppetman! to Health & Fitness (12 answers total)

The deal with partial hospitalization programs is that they work mainly through groups. You'll have a coping skills group, a goal-setting group, possibly a writing or dance or art group, maybe a social skills group. Folks with all different diagnoses can benefit this way: you'll have someone who has just gotten his schizophrenia under control with meds next to a woman who recently attempted suicide next to a guy who suffers severe social anxiety.

To try to allay your fears about groups a bit: it's like being in a class. A small class, with no more than eight or nine people. (Ask about group size!) And sometimes the teacher -- or in this case, therapist/facilitator -- calls on you. But a lot of the work is done between you and a piece of paper. Goal-setting, for instance, is you sitting there and thinking about what you'd like to achieve in the next few days, and how to set reasonable expectations for yourself. You might go around in a circle and everyone says that no, they didn't get to their laundry this week. And so you all start talking about what is involved in doing laundry and how to find a way to get it done. But it's meant to be a non-judgy, hopefully not-too-stressful atmosphere. Some people will actually have goals of being more talkative or putting themselves in more social situations. Sometimes, just being at the group session, sitting at a table, is an accomplishment.

Questions to ask at your intake: Do they have case management services? Can they help you access whatever social services you need and be sure you're hooked up with those before leaving the program? What sort of information-sharing is done between the program and your regular doctors? Will you be able to see your regular doctors while you're in the program? (Sometimes this is not allowed.) Would your case manager or social worker at the program be able to hook you up with new docs if you don't like your current ones? How long does a typical patient stay in the program? (The one I'm familiar with, it's about a month on average. Some people stay around for as little as two weeks, others for as long as three months. Sometimes insurance can be a problem.) Further, you'll want to know how they transition patients. Many hospitals that do partial hospitalization also do something called intensive outpatient, or IOP. This is like a step down from a full-day, five-day a week commitment to a half-day, three-day a week commitment. B the time you're doing IOP, you should be able to get out and about and do stuff on your own during the time you're not at hospital school.

Congratulations on taking this step. And hugs. And if you want to talk more about this with someone who's been down that road, feel free to MeFiMail me.
posted by brina at 7:15 PM on August 28, 2011

brina did an excellent job of telling you what to expect in a partial program.

Definitely make sure at the assessment that your insurance will cover this before you agree to go in. One thing I didn't know ahead of time was that I would be required to see one of their doctors even though I wasn't changing meds or anything (and they didn't want me to see my own while I was in the program). I also should have asked how often and for what length of time I'd see the doctor. If yours is anything like mine, I saw her when I first got in (asking all the same questions that I'd answered at intake!!), then once a week after that (for about 15 minutes).

I was also terrified of groups, but you won't be the only one who is! As brina said, it's usually small groups and some of them are sort of like classes. I think after a couple of days you'll feel comfortable.

I think you have all the info you need for the assessment. For mine, it was mostly them asking me questions about my history, meds, etc. You have all that info, so you should be fine!

Best wishes!
posted by la petite marie at 7:41 PM on August 28, 2011

If you can bite the bullet and just accept the group therapy at first, you'll soon find yourself getting more concerned for the others in your group than you are for your own problems - or at least AS concerned - and you won't even realize it, but your social anxiety will be diminishing at the same time. I was truly amazed at the change in perspective the groups brought to me, even though, like you, I was terrified in the beginning.
posted by aryma at 9:06 PM on August 28, 2011

Just so you know, you're allowed to sit in group and be terrified of group. That's totally OK. There is literally no safer environment to be terrified in.
posted by DarlingBri at 9:32 PM on August 28, 2011

Thanks for your help everyone. I've been admitted to the all-day PHP program starting tomorrow. I am deeply stressed out and anxious and have no idea if this is the right thing to do and am generally unhappy, which probably means it's a good thing I'm going to be doing a ton of CBT over the next two weeks.

If anyone reading this thread has an upcoming intake session: one question to ask before you go to it is if they're going to insist you commit to the program right then. Today would have been a lot less stressful if I'd been ready for that one.
posted by Fee Phi Faux Phumb I Smell t'Socks o' a Puppetman! at 2:09 PM on August 30, 2011

I'm so glad you're going to do it! The night before is the hardest because, if you're like me, your anxiety is getting so bad just imagining how awful it's going to be! Try to watch a TV show you really like, take a bath, or something soothing tonight, then try to get a good night's sleep (easier said than done in this situation, I know!). I think you're right -- doing a concentrated program of CBT will be really good for you.

I was recently in a program for anxiety and I was scared to death (VERY anxious!). It turned out to be the best thing that I've done for myself in years. There were several people there with social anxiety so bad they couldn't go to class, couldn't talk to sales people in stores, etc. and they didn't say a word the first day. By the second, they were feeling more comfortable, and they made HUGE strides in just a few weeks...

Come back and let us know how you're doing!
posted by la petite marie at 6:37 PM on August 30, 2011

Well, I survived.

The first few hours were incredibly, incredibly, incredibly stressful, but it was all me stuff, not the environment. I think the staff members who didn't pay close attention to my file all thought I was primarily there for the social anxiety - I doubt you could tell I'm depressed, because I was folded in on myself, unable to make eye contact, the whole nine yards. Stuttered for most of the day, trembled, about killed my pen, and absent-mindedly pulled out a good chunk of my right eyebrow.

Luckily the "process" group only happened to have three people in it, so it wasn't nearly so bad to try and talk there. Still didn't really say anything very loudly, but it helped to get practice in. By lunch I was able to have a conversation with the person brave enough to decide to sit with me even after hearing me say over and over again how scared I am of people, and seeing me be all petrified and miserable.

I had a massive ADHD moment late last night and took my Vyvanse instead of Advil (yeah, I know, they're so easy to confuse with one another) at 9pm, so my sleep was... ah... not good. It helps that I've done a lot of reading - the classes were easy to follow along with even though I was super unfocused and scared. By "unfocused" I mean that I accidentally drove a good part of the way to work before realizing I wasn't going there today. Then I had to really work hard to convince myself not to go to work today. Heh.

It also helped that they let me color and doodle as much as I wanted. It took about four hours for me to go from writing out things like "just stay in your seat" and "you don't have to be nervous, but it's OK if you are" and smilies just to try and remind myself of the existence of not-being-miserable to coloring, but hey.

The staff are all very nice and the people are a lot more together than I thought they'd be. I was so sure I was going to be in the upper 50% in terms of day to day functioning, but that is so, so not the case.

Oh, and I had to go into work to set stuff up for my absence (since this was all super sudden) and my supervisor is exactly as nice about this as my EAP counselor said she'd be, many many times over the last two years. So score one for the person with the master's in social work, I guess.

(For reference: I am definitely tired now, but not at all in the stress-stress-want-to-explode kind of way I have been after leaving work, nor in the "I need to be in bed right now" way. I might even do some laundry.)
posted by Fee Phi Faux Phumb I Smell t'Socks o' a Puppetman! at 3:47 PM on August 31, 2011

I am so delighted for you that this is looking like a really good thing for you. Go laundry sock puppet!
posted by DarlingBri at 4:01 PM on August 31, 2011

So glad your boss is so supportive and that you're already feeling better about the whole thing.
posted by la petite marie at 8:46 PM on August 31, 2011

Just wanted to stop in and let you all know that I'm being promoted to the Intensive Outpatient Program (mornings) starting tomorrow. I'm not convinced I'm ready, but they seem to be, so we'll see.

It incidentally took till mid-day yesterday or so for my anxiety levels to drop low enough for my depressive symptoms to shine through. Everyone keeps commenting that I've been brave - honestly, I don't think I'd have done it if things weren't so bad. But I'm glad I did.
posted by Fee Phi Faux Phumb I Smell t'Socks o' a Puppetman! at 2:07 PM on September 7, 2011

I am really glad you are making progress! And you are brave - it's even harder to do things when they get to "so bad" so you should really congratulate yourself here.
posted by DarlingBri at 4:33 AM on September 8, 2011

Since you were all so helpful I wanted to come in once more and let you know that I discharged yesterday. More importantly in some ways, I was able to clean out my car (haven't had the motivation/energy/etc. to do that since I bought it two years ago.) I took out the trash just because it needed to be done today. Just because it was there and I could take care of it! It wasn't even smelly trash.

Looking back, I wish I had done something like this years ago (not that I even knew what this was six weeks ago.) I'm reasonably confident things will get worse again in the future but I'm also feeling a lot less helpless about it, and way less self-critical. I'm even handling discontinuation effects from Geodon well (at least, not beating myself up about feeling bad and going slow,) and normally I'm a total baby when I feel sick. We'll see if I do OK going back to work. I've honestly never done anything but hide and sleep the time away during a depressive episode before, and I've never kept a job through one before, so I don't know what the long-term effects will be. Presumably not another lost decade like the one in my twenties, though, so yay.
posted by Fee Phi Faux Phumb I Smell t'Socks o' a Puppetman! at 11:19 AM on October 6, 2011