The process of returning home after an extended hospitalization can be one of upheaval and confusion for all involved.  It can be an emotionally draining experience for the patient, as well as for his family.  The person being discharged must readapt to an emotional environment in his home that may have become, over the period of his hospitalization, foreign and alienating.  His feelings may have changed towards certain situations also therapy may have revealed psychologically transforming perspectives concerning his own person.  There is also the challenge of having to deal with the difficult task of reestablishing close bonds in important relationships like children or spouses, these adjustments can all be quite taxing. 

There are also other possible factors that may be involved in creating difficulties in the process of returning home, such as; adjusting from the insular environment of the psyche ward to the constant bombardment of the big wide world again, returning to the responsibility and stress of the workplace, and the incredibly overwhelming task of once again shouldering his share of parenting duties.  The unfortunate reality is that many patients and their families are completely unprepared for the emotional backlashes that may occur after discharge.  Both parties are left dumb-founded by the other’s inability to comprehend the separate emotional journeys they have both embarked on whilst the other was absent.

This turmoil can be somewhat avoided if the patient, as well as his loved ones, have an established protocol and plan before the actual physical discharge takes place.  There are many advantages in preparing discharge plans with the patient while he is still in the protected environment of the hospital.  The patient can then be made aware of what to expect once he leaves the psyche ward and will not feel a sense of apprehension in leaving hospital care.  The hospital staff can help the patient understand and appreciate what is waiting for him on the outside. And, his loved ones will have had a chance to prepare a supportive environment for him before he is brought back into the family home. These precautions may help to prevent the patient from feeling a sense of detachment from home, family, and friends once he is returned to his home environment. 

Here Are Some Tips On Making The Transition Easier For Everyone:

Typically patients being discharged from hospital have advance warning before they are released.  The doctor will sit down with the patient and discuss a discharge plan.  It is important at this time, as a loved one to whom this person will be released into the care of, to request knowledge of these plans from the patient’s attending psychiatrist in advance of the discharge date.  It would be advantageous to both parties; the patient and loved ones, if a discharge meeting would be arranged with everyone present so that the attending psychiatrist could answer any pertinent questions.  In this meeting it is important to focus on what situation and care would be best for the patient to come home too.  Ask questions like:

Has the patient’s medications been changed during his  stay in hospital from the dosages and types he was taking before hospitalization? 

If so, inquire as to what the current medications and dosages are now upon discharge.  Establish a medication regimen with all present so there will be no future misunderstandings, especially if the patient has a past record of abruptly going off his meds.  Many times people are fooled by the common misconception that if you feel better you no longer need to take your medications.  This is an extremely dangerous mistake.  Many times this same mistake is the impetus that has caused his mental instability and hospitalization in the first place.  It is wise to establish with the patient an agreement which clearly communicates to him that part of his coming back into the family home is the condition that he stay strictly to his medication regimen.  The patient must be made aware that his compliance to this understanding is vital before he is to be released and consequently returned to the home environment. 

I have heard of families creating legally binding documents that are called “Discharge Agreements”.  These are documents that explicitly spell out expected adherence to treatments, therapy, and medications once the patient is discharged.  These documents have only been used by families who are faced with a highly disruptive and problematic loved one, who repeatedly causes chaos in the home environment and is a threat to all when not adhering to his therapeutic care.  If the agreement to which the patient has contracted too is broken the family is then granted the “Power of Attorney” in order to commit the person once again at the family’s discretion.  I would suggest that if you consider creating one of these documents you seek an attorney’s aid in its creation and make your loved one’s physician aware of its existence. 

I have never known one of these documents to be compromised so I cannot comment on the authenticity of its actual legal weight.  Seek legal council and have it recognized as a legally binding document before using one.  Sometimes just the knowledge that there is a tangible consequence to one’s behavior can keep a person on the straight and narrow.  Or, give loved ones a sense of relief and security in knowing that they are not completely helpless if the situation should worsen once this person should return home.

If the medications are in fact newly adjusted or prescribed, ask what the side effects will be and if there are any adverse reactions to look out for.  Ask if there are any things you can do to make these side effects more bearable for your loved one.  And, of course, ask what the effects of other prescription/non-prescription drugs and alcohol may have on the sufferer whilst ingesting these medications.  It is highly recommended that people suffering from serious or advanced mental illness abstain from drug and alcohol use. 

How much supervision does the attending physician believe the patient needs once in the home environment?  How much supervision does the patient need to feel secure and safe once at home? 

The patient may feel he needs a 24hr chaperone or may believe that too much hovering will be suffocating.  It is important to establish what form of human comfort and accompaniment the sufferer needs at home before he is released.  This gives family members the time to make arrangements and schedule for these needs.

What are the physical needs of the sufferer in his home environment?  Can this person function by himself?  Can this person be expected to manage tasks such as laundry, housekeeping, looking after young children, cooking meals, and grocery shopping?  If not, is there need of a proctor?

These are critical concerns for family members since unfortunately they are most frequently on the front lines of a sufferer’s care.  They will need to make arrangements for people to deliver meals, provide childcare and the like.

Is this person still a threat to himself?  Will this person self harm?  Is he still vulnerable to suicidal tendencies? 

Sadly, we all wish we lived in a perfect world, one in which mental health sufferers who are released from a period of hospitalization would be happy and healthy.  This, many times is not the reality faced by family members and sufferers alike, it is tragically the opposite.  I have been released to my husband’s custody on a few occasions when I have self harmed or attempted suicide only days after.  The period of time during the few weeks after a sufferer has been discharged from hospital can actually be the most detrimental to his wellbeing.  His delicate emotional condition is further aggravated by the psychological vacuum left behind by the deprivation of the constant care and insulated environment provided by the hospital.

It is vitally important that family members educate themselves on the therapy plan of their loved one before discharge.  They need to be vigilant in aiding the sufferer in this process.  Things such as knowing when psycho-therapy sessions are scheduled and the locations of support groups are detrimental to the family of a sufferer’s ability to aid him to readapt back into life on the outside.  Constructive emotional and psychological support in the community is crucial for the sufferer to fill that vacuum and not feel alienated from his community as a whole.   

Get involved in your loved one’s therapy.  Roll up your sleeves and get your hands dirty.  Visit a support group in your community with him and actively partake in the discussions. You may be surprised how much you learn and the extent of the support you will receive.  Ask if you might join a few of the sufferer’s therapy sessions, listen to what he has to say.  You will discover the concerns most pressing on your loved one’s mind, how he perceives life situations and perhaps begin to comprehend how he is able to psychologically contend with it all. 

Acquaint yourself with your loved one’s practitioners; his psychiatrist, psychologist, proctor, etc.  This will enable you to keep an open line of communication with the specialists he is treated by every day.  Legally, these professionals cannot disclose any information dealing with your loved one’s therapy, but at least if they do need to discuss anything with family members they will know you are open to listen. 

And, while we are talking about communicating, make sure your loved one knows that there are no boundaries to the conversations you share with him.  In this way you will encourage him to be truthful; he will not feel like he must hide anything from you.  Be available to just talk as frequently as possible.  Establish a non-threatening avenue of communicate through which you can inquire frequently about his emotional state of mind without making him feel obligated to lie about how he feels.  Or, put him on guard or feel as if he is suddenly a hapless victim of the inquisition, for that matter.

Ask the sufferer if he feels there are dangers in his home environment that should be removed before the return? 

These dangers can be such things as alcohol still in the home, drugs he can use to overdose/abuse, or even the influence of friends that will only serve to cause the sufferer further emotional distress.  Sometimes people being released from hospital have struggled with substance abuse for most of their adolescent and adult existence.  Consequently, a hospitalization may be the only time in the sufferer’s life when he has remained sober for a sustained period of time.  The presence of these substances in the home upon his return may pose a temptation he simply cannot resist during the difficult transition from the hospital.  It is most beneficial as a caregiver to be aware of these concerns and aid your loved one by removing these obstacles in his recovery before he can be waylaid by them.   

There are “good” friends and then there are “not-so-good” friends.  If the sufferer identifies specific relationships that are detrimental to his mental health, as a family member you may consider sheltering him from these people.  Some of these people may be fellow substance abusers or unhealthy influences, if needed you may have to step in and put yourself between these characters and your loved one.  Deflect phone calls from these people or even venture so far as to request on your loved one’s behalf that they no longer make contact with him.

BUT!! There is a cautionary warning with the above advice.  Do not go a slap-happy with the elimination of your loved one’s social circle of friends and acquaintances.  These are people you may have to depend upon in caring for the sufferer.  The sufferer may feel your discretion as to whom he associates with is overwhelming and too far reaching.  It is necessary that you work in partnership with the sufferer in these decisions and tread carefully on this very delicate ground.  Your loved one is bereft of his mental health you do not want to strip away from him a social network that may potentially help him readjust to normal life.  His friends may be all he has left. 

Does the sufferer have any dietary needs or restrictions?

I have met some patients in hospital who have been placed on strict diets and exercise programs for the sake of both their physical and emotional health.  Many people who are prescribed certain drugs, such as Olanzapine for instance, experience considerable weight gain.  I, myself, am currently taking the drug Olanzapine.  I know quite personally how it can play havoc with your weight, and as a truly unfortunate consequence, your self-esteem as well. 

When a person is feeling a sagging sense of self-esteem, with an unhealthy dose of depression thrown in, many times he becomes sedentary and unmotivated.  A person naturally gravitates towards comfort food and falls victim to the urges of snacking on junk food to make himself feel better.  I have found that some meds actually make me crave carbohydrates and sugars/sweets.  It is silly really, you find yourself caught up in a vicious cycle.  You have to take the meds to make yourself feel better emotionally, but the overwhelming side effects only seem to push you further into the dizzying abyss of low self esteem.  What’s with that?  Many people suffering this dilemma opt to stop taking their meds in order to lose the weight.  This is an unwise choice to make because then they wind up in hospital due to unstable mental health. They may be thinner, but at what price?

Okay, one moment now, I want to stop and make something very clear.  I am thankful that I have a drug like Olanzapine in my daily medication regimen.  It has helped me quite effectively in my struggles with mental illness.  At first, I resented having to take this med for a very long time because of the weight gain.  But, I have come to realize that I cannot solely blame my meds for my physical distress.  I had contributed to my heavier weight just as much as the meds.  I had become sedentary and my diet had become very unhealthy.  I had an epiphany of sorts.  The fact of the matter is there are a great many factors involved in weight gain than just the side effect of one drug. I realized that if I adjusted my diet accordingly and became more active I would be able to control my weight whilst still taking the drug. And it worked.  This is the message the doctors and nurses are trying to send to their patients in hospital who have stopped taking their meds because of certain side effects like weight gain. These patients are put on strict diets and exercise programs to encourage them to learn how to properly control weight gain and still continue to adhere to their medication regimen. 

It is crucial for the sufferer’s caregivers to understand the importance of developing these new and healthy habits.  Promoting this new perspective on his medications will aid the sufferer in avoiding the mistake of going off them again in the future.  If the patient’s caregivers are given this information before discharge they can encourage him by ridding his home of foods that are not on his list of recommended dietary requirements.  His caregivers can inquire about the patient’s new dietary plan so that they can endeavor to support him in this new lifestyle. They can go grocery shopping before the sufferer’s return home and stock the house with healthy staples and snacks. Caregivers can educate themselves on how to cook meals in a healthier way and provide good-for-you snacking solutions instead of junk food. Perhaps, even encourage the rest of the family to start eating healthy too.  Everyone will benefit. 

I can’t stress enough that the family of a sufferer should make every effort to encourage him to maintain his prescribed exercise routine once he has returned home.  If weight gain is the patient’s major sticking point with medications, daily exercise is vital in dislodging this attitude from his mind.  Look at it this way, “a rolling stone gathers no moss”; apply the same principle to weight gain.  Exercise releases certain chemicals in the brain, feel good ones like endorphins.  It can help to lift a person’s mood and alter negative attitudes towards life.  The sufferer can feel a sense of achievement and empowerment in finishing certain attainable fitness goals.  It can act as an avenue to vent negative emotions or excess nervous energy.  It promotes weight loss which in turn positively affects a person’s self-esteem.

I strongly suggest that caregivers actively participate in the sufferer’s daily exercise routine. Ask the psychiatrist during the discharge meeting what fitness activities the sufferer is currently participating in whilst in hospital.  Find out if it is possible to continue these exercises in the sufferer’s home environment. Get creative and figure out activities you can do with your loved one. Go out and walk with him.  Ask him if he wants to go swimming at the local pool.  Pools cater to adults interested in using their facilities for their daily exercise routines.  They will often set aside specified areas for people to swim laps.  A family member could inquire at the local fitness facilities in the sufferer’s area about the services they offer to the public.  When the patient returns home he can look over this information and use it to determine whether he wishes to take advantage of these services.  Some community centers offer quite reasonably priced exercise classes; you and the sufferer could attend one together. 

I am not going to swear on a stack of bibles that diet and exercise are going to be the miracle pill to preventing weight gain in all sufferers while on specific medications.  There are exceptions to every scenario.  I, myself, know how frustrating exercise can be when you want immediate results.  It takes time and hard work; two things that people suffering mental illness often feel are too emotionally expensive to “waste” on such exhausting activities as exercise. The message I am trying to spell out here is a healthy and active lifestyle can go a long way in improving a person’s mental health.  The key word here is control; a healthy lifestyle will positively contribute to the control and maintenance of a person’s weight. 

What is the exact time and date scheduled for the sufferer’s release?

A caregiver should inquire about this information ahead of the discharge date.  In this way, people in the family can arrange to take time off from work, if needed, so that the sufferer does not have to return to an empty home. 

Does the sufferer have transportation to his home on this date?

This is very important information to ascertain.  You don’t want your freshly discharged loved one to be forced to take public transit home, or a taxi, for that matter.  What kind of message do you think this sends to the sufferer? Besides, you want to make sure he makes it home safely and soundly.  And, that he is properly settled in to the surroundings of home. 

What is the time frame/duration of the sufferer’s leave of absence or medical leave from work? Or what are the terms of his disability compensation or welfare?

This is vital information to be aware of since these factors directly impact the means by which the sufferer will provide for himself and his family during the recuperation period at home.  It will also determine a time frame in which all parties must work together to aid in getting the sufferer back on his feet. If the psychiatrist believes more time is needed for recuperation than the patient can make arrangements with the aid of hospital staff, such as social workers provided by the institution.  The patient can take advantage of the services provided within the hospital to iron out details, instead of alone at home with nobody to guide him through the complexities of government programs/workplace benefits. 

Final Note:

Before caregivers attend a discharge meeting of any kind it is important to sit down and consider what questions need and should be asked.  You may have ones that are not mentioned above, ones specifically related to your loved one’s needs.  Take the time to plan out the way you wish a meeting of this nature to progress, but don’t be put off if everything does not go the way you feel it should have.  Remember this is a meeting for everyone concerned and your loved one may have issues you could not possibly anticipate.  Make the most of this opportunity of access to the sufferer’s attending physician and caregivers.  Learn as much as you can about your loved one’s condition upon discharge and his specific needs/concerns, even fears.  Your diligence will pay off for you in the long run and may even preserve your family’s stability in the weeks to come after discharge.

Additional Tips:

Do not arrange a huge family gathering to welcome home the sufferer from hospital.  Walking into a hugely demanding social setting, such as a party, only commands from the sufferer that he must expend emotional energy he may not be prepared to use up at that moment.  Just working up the courage and emotional fortitude to return home is enough to ask of a sufferer upon his discharge, expecting him to jump in cold to a demanding social situation is just too much to request. Jubilant and happy people cheering as the sufferer walks in the door will force him into a situation where he may believe he has to act “happy” for the sake of all involved.  He will feel hard pressed to visit and socialize when he is completely emotionally spent.  Allow the sufferer to slowly work his way back into social situations, ones in which he will feel secure and in control.  Let it come naturally; don’t force him into emotional/social interactions that may be beyond his emotional capacity to cope.

This does not mean that family and friends should not visit the sufferer.  Not in the least!  Visitors are a must. Just pace the socializing in accordance with the sufferer’s energy levels and ability to cope with people.  Remember that the sufferer has been living in an insular environment for an extended period of time; he has not been exposed to copious amounts of social activity.  It may be overwhelming at times.  Empty his social calendar; allow him to decide upon his own social engagements.  Try to gently, and with a healthy dose of sensitivity, encourage him to be socially active and not reclusive. 

Tell friends and loved ones to be respectful of the sufferer’s condition.  Don’t push or prod him.  Don’t nag him or give him unnecessary advice about a condition you may have no comprehension of or empathy for.  Don’t press him about distressful information.

Some Things You Should Encourage Family NOT To Say:

“You look so thin, you should eat something” And then force him to eat a meal that is not on his recommended dietary plan.

“Why aren’t you happy?  You should be happy.  You just got out of the hospital.”

“What is your problem, can’t you just get over it already?”

“Why don’t you want to talk right now?  You didn’t seem to have a problem talking in the hospital.”

“Those people in the hospital don’t know anything.  You’re home now, we will take care of you the way we always have.”

You get the idea.

Don’t make the sufferer come home to an empty house.  Arrange for a loved one or friend to stay with the sufferer the first day he returns home to help him unpack and get settled in.  Let him know that he is not alone in his emotional journey of readjustment in the weeks to come.  They say it takes a village to raise a child, well, I firmly believe it takes a community to heal a broken soul.  We should not lay the burden of recovery solely upon the sufferer.  That is just plain cruel.  No one can be expected to grow or heal in isolation. 

Educate yourself on his illness so you know what to expect of a person in recovery and how to respond to the emotional needs that might arise from situations he might discover himself in.  Make sure family and friends are made aware of how important it is for them to make time for the sufferer in the next few weeks. 

Shelter the sufferer from the full impact of distressing world events such as; school shootings, the outbreak of war, mass massacres, and all the usual culprits you find on the nightly news.  Sometimes learning about these events can be the catalyst that sends an emotionally vulnerable person even deeper into despair. 

Don’t allow pushy employers or co-workers to disrupt a sufferer’s rehabilitation at home by phoning or bringing over work matters and demanding his attention. 

Let the sufferer come home to a tidy house.  Extreme cleaning may make the home over sterilized so don’t go overboard.  Tidy rooms, clean bathrooms, empty garbage, wipe out the kitchen sink, do the laundry; small things such as these household tasks are easy for loved ones to do and will greatly bolster a sufferer’s spirits if done for him before he returns.  If the sufferer is a pack rat and has a lot of things strewn around, respect that.  Dust around the clutter. 

Sit down and have a good open conversation with the children whose parent is returning home from hospital.  Make sure you thoroughly and honestly explain their mom/dad’s illness in uncomplicated terms.  It is best to describe an illness such as mental instability in simple and educated terms.  Do not under estimate a child’s ability to comprehend illness.  Allow them to ask questions and voice their concerns.  Be mindful that the children might have fears about what their parent will be like when he returns home.  Talk in encouraging tones, use positive language.  Children can decipher what your own feelings and fears are from your body language and the words you choose to use. 

Make a game plan with the children about what they should do if mom/dad behaves a certain way or if they are frightened by unnatural reactions to their interactions with said parent.  The children might be terrified that they will cause the ill parent to get sicker by what they do or say (or don’t do or say, for that matter).  The child might develop guilt that he is the sole reason the parent is ill in the first place. There are even some children who will take on the enormous responsibility of ensuring the parent stays well.

It is crucial as caregivers to be ever vigilant in your efforts not to allow the children to take sole responsibility for a parent’s care or develop any of these misguided beliefs.  Make sure the children know that there is a whole network of concerned individuals involved in their mom/dad’s care.  Open communication with the children will ensure they are well prepared for mom/dad’s return and make it easier for everyone to reunite in a healthy manner. 

Do not keep the children of a mentally ill person from having contact with him.  It is vital the children and parent have a relationship, even if it is chaperoned or limited. 

Help the sufferer keep track of dates, times, and locations of important appointments.  Sit down and plan out the family schedule for the month, mark therapy and necessary appointments in red ink.  Make sure the sufferer does not have to be plagued with the concerns of making it to and from these appointments by prearranging transport, bus tickets and schedules. 

Get the pharmacy to blister pack the sufferer’s medications.  It is a wonderful way for him to remember how many of what medications and when to take them.  And, you can discretely keep track of whether he is following his medication regimen.  You don’t have to count out the pills, just monitor whether the blister packs have been opened and at the appropriate times.  Store the blister packs in a common area with lots of family traffic so that you can be sure that the sufferer is not secretly flushing the medications down the toilet.  It is harder to discard pills if you are out in the open, having to constantly interact with other people, while you have to swallow them.   

Do not place large demands or expectations on this person right away.  Don’t try to work out relationship matters in the weeks following a discharge.  You may end up sending him right back to the psyche ward.  Give him light household duties and non-threatening family responsibilities.  Let him work his way up to the hard stuff. 

Try not to be bitterly disappointed if the person you bring home is not happy and healthy.  It is a long and arduous process to achieve mental stability, especially after a psychological meltdown.  The hospital is not a place where people are made better, rather it is a place where they are stabilized to the point that they can try to get better. 

If you and the sufferer attend a religious institution, encourage him to go to a few services and remain in contact with the congregation.  If it is too difficult for the sufferer to attend large gatherings of people ask if it would be possible for the clergy to visit him in the family home.  Sometimes it is easier for a sufferer to worship with a small cell group in a more casual setting, or in a smaller more intimate service, than an overwhelming congregational setting.    

Take some time out of your day and slip over to the grocery store.  Make sure the sufferer’s kitchen is sufficiently stocked with fresh staples and healthy foods before he comes home. 

Make the home environment as comforting, welcoming, cheery, and de-stressing as possible for the sufferer to come home too.

Good luck to you all.  Love each other and cherish every moment you have together.