What Happens After Psychiatric Hospital Discharge: A Guide to What Comes Next

The period of time right after a psychiatric hospital discharge is a delicate time for many people. While successfully completing one program is certainly something to be proud of, the thought of “what’s next?” can invoke feelings of anxiety, fear, and uncertainty. The days and weeks after leaving the hospital are a vulnerable time, but can be successfully navigated with the right information and support. There is no formula for what the “right” discharge plan looks like, as everyone is unique. However, we hope this article can be a practical, grounding roadmap to support you in the days ahead. 

Why the Period After Psychiatric Discharge Is Important

The plan for the days following being discharged from the hospital is crucial. Without follow-up support, people can experience what’s commonly called a “care cliff,” where they go from having a high level of support to being on their own. This drastic change in level of support can lead to people being at an elevated risk of crisis or recurrence of symptoms in the weeks following discharge.

‍Research has shown that receiving outpatient care soon after discharge helps to reduce the risk of suicide for people who have just completed a stay in inpatient care, particularly for those with an underlying mental health condition. Having a robust, individualized aftercare plan empowers people to maintain the progress they have made and continue their recovery journey. 

What a Discharge Plan Typically Includes

Your discharge plan should be developed with you, not just for you, and you should have a clear understanding of all your treatment team’s recommendations. If there is anything you don’t understand or if you haven’t been provided with a plan at all, discuss your concerns with your care team or an administrator before you leave the facility. 

Follow-up appointments 

You should have an appointment with an outpatient mental health treatment provider within 7 days of discharge. This is recommended to ensure timely support and to keep your treatment as uninterrupted as possible. 

Medications 

You should be given adequate medication refills to cover you until your next appointment with an outpatient medication provider. At that appointment, they will likely need to perform a “medication reconciliation,” which means your provider ensures that any changes or adjustments to your medications made in the hospital are continued. 

Emergency contacts and crisis resources

Discharge plans should always include crisis prevention steps and resources. Identify the people,  treatment plans, and other outlets that can help to prevent a mental health crisis or your symptoms from recurring, and the resources you can utilize should your symptoms worsen. This can include trusted people in your life who have agreed to be an emergency contact, treatment providers, local crisis resources (if available), and the 988 suicide and crisis hotline. 

Levels of Care to Consider After a Psychiatric Hospital Stay

It’s important to understand the step-down continuum of care to know which options are available and why a particular type of program is recommended.

There is a spectrum of care levels to ensure that people receive the right care in the least restrictive environment possible. Stepping down from a higher level of care, such as an inpatient hospital stay, to a less intensive level of care, like the ones covered here, is a sign that you’ve made progress.

Partial hospitalization programs (PHP)

Partial hospitalization programs offer the intensity of support found in inpatient programs, but participants live at home while attending the program. This is a great option for people who need a high level of support and medical monitoring but are safe and stable enough to live in the community while attending treatment.

These programs offer group therapy, medication management services, care management, and peer support. They tend to involve 5-6 hours of clinical programming per day and occur 4-7 days per week.

Intensive outpatient programs (IOP)

Intensive outpatient programs are the next step down in the care continuum. Many, though not all, offer the same services as PHP but require fewer hours of programming per day and fewer days of attendance per week.

Some programs offer medication management services or medical monitoring, but these aren’t required for this level of care. IOPs usually consist mostly of group therapy, but some programs also offer individual and family therapy as well. They tend to consist of 3-4 hours of clinical programming per day and occur 3-5 days per week.

Virtual crisis stabilization

Crisis stabilization programs, such as the program offered by Willow Health, are a flexible, accessible bridge for those who need urgent support before beginning a PHP or IOP. These programs offer therapy, medication management services, care management, and peer support. Some people may not be ready to begin a PHP or IOP, or it could take some time for a spot to open up or for insurance approval. Crisis programs help meet people where they’re at and get them the support they need when they need it. 

Outpatient therapy and medication management

Traditional outpatient care is less structured and typically doesn’t involve the formal programming found in IOPs or PHPs. People may participate in weekly therapy, which can be individual, group, family, or couples. This can also include medication management services, which can range from once a month to every three months, or more frequently if medications are being adjusted. People may also participate in peer support groups or coaching. 

How to Support Yourself in the Days After Discharge

It’s normal for the days after discharge to be filled with highs and lows. Many people feel a sense of disorientation upon returning home, as well as exhaustion and fatigue. It can be challenging to return to a familiar environment with a new outlook on things, and when the people in your life don’t fully understand what you’ve been through. 

Here are some practical things you can do to support yourself after a hospital discharge: 

• Prioritize taking care of your body by getting enough sleep, eating a healthy diet, and incorporating a movement practice (such as walking or yoga). 
• Take medications as prescribed, and avoid using drugs or alcohol. 
• Identify any life stressors that could be a barrier to your recovery, and develop a plan to address them; ask for support if needed. 
• Utilize stress management techniques such as meditation, deep breathing, creating art, listening to music, exercise, or whatever works for you. 
• Keep all your appointments with your mental and physical health providers. 
• Consider finding a support group or peer recovery program. 
• Know and keep a lookout for warning signs of symptom recurrence, such as changes in mood, sleep, or appetite, or a loss of interest in things you care about. 

What to Do If You're Struggling After Discharge

The transition back into daily life after discharge can be very difficult for many, and if that is true for you, you aren’t alone. If your aftercare plan includes steps to take if you’re struggling, follow those recommendations from your providers. You may also benefit from a crisis stabilization program, which we also cover in this section. 

When to reach out for additional support

If you are having difficulty navigating life after discharge, ensure you reach out for support. Not only is it “okay” to reach out before things turn into a crisis, but it’s actually highly recommended. Reaching out for support sooner rather than later shows you are being proactive about your recovery and can avoid things getting worse. 

Here are some signs that you may need to reach out for more support:

• Trouble taking care of yourself and doing daily life activities, such as cooking and hygiene. 
• Changes in mood, thoughts, behaviors, sleep, or appetite.
• Thoughts of death, suicide, harming others, or seeing or hearing things that aren’t there.

How Willow Health can help bridge the gap

At Willow Health, we know that the time after discharge can be challenging, and that to successfully transition, people need meaningful support. That’s why our crisis program exists. We work with people who need support, but don’t need to go back to the hospital, or can’t immediately access a program like an IOP or PHP. We coordinate with other care providers to ensure everyone is on the same page and that our patients get the right types of care that they need when they need it. 

Frequently Asked Questions About Life After Psychiatric Hospitalization

How long does it take to feel stable after a psychiatric hospital stay?

Everyone’s recovery is unique, and so is the amount of time it takes to gain a sense of stability after being discharged from the hospital. Many people feel better within a few weeks, but in some cases it takes a bit longer. Whenever the amount of time, just know there are no right or wrong ways to recover. If you’re continuing to follow your treatment plan and communicating with your providers about your progress, you are likely doing better than you think. Give yourself grace for being human and credit for all the hard work you’ve put into your recovery.

What if I don't have a follow-up appointment scheduled?

Everyone who discharges from a psychiatric hospital stay should have follow-up appointments scheduled, so if you do not, please advocate for yourself and contact someone on your care team or the administration at your hospital program. You can also schedule appointments yourself if you know your community resources or have existing relationships with outpatient providers, such as therapists or psychiatric medication providers. 

Is it normal to feel worse right after discharge?

Yes, the first few days can feel quite disorientating. People are also returning to the same environment they left, which may not be the most supportive. If this is true for you, ensure you are communicating with your ongoing treatment team about your concerns. You may feel better in a few days, but if not, reach out for support.

Can I go back to work or school right away?

When someone is ready to return to work or school is a highly individual decision. Discuss the timing of your return with your treatment team to discuss your options.

What should I do if I feel like I need to go back to the hospital?

If you aren’t in crisis, contact your ongoing treatment team or us here at Willow Health to discuss your options. If you are in crisis, please call 988 or go to your nearest emergency room.

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Sources 

Follow-Up Timing After Discharge and Suicide Risk Among Patients Hospitalized With Psychiatric Illness | Psychiatry and Behavioral Health | JAMA Network Open 

Leaving the hospital - your discharge plan: MedlinePlus Medical Encyclopedia 

Treatment engagement of individuals experiencing mental illness: review and update - Dixon - 2016 - World Psychiatry