Maintaining Treatment Gains Post-Discharge: A Recipe for Success
Author: Louann Toscano, LCSW – Young Adult Group Therapist & Resource Therapist
Completing a PHP- or IOP-level treatment stay at Compass Health Center is an effortful task. A successful discharge from our program requires a significant investment of time and energy, demands vulnerability and openness, and is the product of hard, sometimes even uncomfortable work. While in program, patients are asked to demonstrate willingness to reevaluate long-established patterns of thoughts and behaviors, share their authentic selves with people whom they have only just met, and skillfully apply an array of newly-learned techniques, both inside the group setting and out. Sound challenging? It can be, yet it can be extremely rewarding as well.
As a culmination of all the effort put into their time in program, a patient’s discharge day is a long-awaited, well-earned moment. On this final day, patients are given the opportunity to give a brief “goodbye” speech to their fellow group members still remaining at Compass. In their farewells, patients are prompted to share their personal reflections on their time at Compass, offer any words of wisdom they may have for their peers, and lastly, describe their ‘future plan.’ This plan can be as short-term or long-term focused as patients like, and they are then invited to share any goals and aspirations they hold for themselves post-discharge. Listening to these ‘future plans’ is one of the most rewarding parts of my job, and it becomes even more rewarding when I am able to play a role in making those future plans a reality.
As a split-role Group and Resource Therapist at Compass, I have the opportunity to work with young adult and adult-aged patients who participate in our specialized Resource Track. This Track is designed to support patients with transitions, strengthen their executive functioning skills, connect them to resources and services, and empower them to add structure and meaning to their daily lives. Patients paired with a Resource Therapist can work on a number of personal and professional goals, including: creating resumes, preparing for interviews, finding hobbies, discerning interests, organizing a schedule, prioritizing responsibilities, and practicing self-accountability with socialization, health, and wellness goals. As an added benefit of Resource sessions, patients also have an opportunity to identify with their Resource Therapist what is preventing them in the moment from following through on what they value most. We can then work collaboratively to brainstorm how patients can use the skills developed in the group setting to work through these barriers, and how to translate their application into their everyday lives.
While the Resource Track is something that can be very beneficial for patients as they travel through our program, a large part of a Resource Therapist’s focus is on equipping patients with a structured, meaningful life to return to once programming is over. Given that such so much of my role involves preparing clients for their discharge, I spend a lot of time learning and thinking about what patients need to be able to maintain the gains that they’ve made during programming well beyond their time at Compass. I want my patients to be as successful as possible following their discharge from program, especially knowing how much hard work they put in while here and how much achieving their ‘future plans’ matters to them. Thus, I share below several tips and techniques that patients can follow to boost the likelihood of post-discharge success and minimize the risk of returning to old patterns of unhelpful behaviors.
- Maintaining a schedule
According to the National Institutes of Health, routine and structure are essential components in maintaining mental health recovery (Mercer & Woody, 1999). Keeping to a routine can be particularly helpful for boosting positive emotions, such as confidence and competence. Patients who leave Compass equipped with a regular schedule have practice designing and following through on self-initiated plans and activities. The mastery they build by making and adhering to their commitments often leads to a sense of autonomy that can be a powerful counterpart to feelings of lethargy and purposelessness.
Discharged patients who adhere to a schedule also are less likely to experience unpleasant emotions, such as boredom and apathy. With minimized unstructured time, patients reduce their risk of feeling disinterested or unfulfilled (Mercer & Woody, 1999). As such feelings can lead to a renewed interest in returning to previously ineffective patterns of behavior, maintaining a fuller schedule post-discharge can mitigate the risk of relapsing into potentially harmful coping methods.
- Practicing self-care
In addition to filling open gaps of time with fulfilling activities and interests, it is also helpful for newly-discharged patients to schedule time for self-care activities. Conditions such as depression and anxiety can make it challenging to find the desire or motivation to meet one’s personal hygiene and comfort needs. However, making sure to uphold set sleep and wake times, planning out time for balanced exercise and nourishing meals, and maintaining personal hygiene – such as showering, face-washing, and teeth-brushing each day – has a direct, positive impact on emotional and mental functioning, and overall quality of life (Pryjmachuk et al., 2014).
Furthermore, practicing skills such as self-compassion, relaxation, meditation, and positive self talk are additional forms of self-care that similarly have a positive correlation with mood. As an antidote to self-defeating and self-critical thoughts, engaging in uplifting affirmations and allowing oneself time to feel nurtured and validated is helpful for maintaining a more even mood post-discharge.
- Cultivating a support system
While there are many skills and techniques that discharged patients can apply individually, it also is crucial for patients to have support in their post-discharge journey. By preemptively identifying go-to trusted supports, patients will already have a list of people they know they can turn to should they need help navigating any potential symptoms that may arise or recur after discharge. These supports may include friends, family members, coaches, mentors, and even professionals, such as therapists, primary care doctors, or psychiatrists.
It also can be helpful to use friends and family members as ‘accountabilibuddies.’ Identifying trusted people who are able to hold a newly discharged patient accountable on their personal goals, as well as on their skill usage, can be helpful in maintaining the gains patients made while in programming. ‘Accountabilibuddies’ also can be helpful in accompanying discharged patients while following through on certain tasks. For example, it can be much easier to find the motivation to complete a task (such as going to the gym) if a friend or family member is willing to go too.
- Following-up with mental health providers
As mentioned above, professionals can be important components of a patient’s post-discharge support system. Maintaining regular therapy appointments, engaging in outside therapy groups, and staying connected with a psychiatrist for medication management are essential components for post-discharge success. Although patients leave Compass equipped with a wealth of knowledge and skills, it is necessary to continue with outside mental health practitioners to ensure continued application of these techniques. By not maintaining this professional accountability, one’s coping skills toolbox can quickly become rusty. These practitioners also offer continuing care to help ensure that a patient’s transition out of program and back into their home/work environment is as well supported as possible (NCQA, 2012).
Additionally, professional supports are likely the first individuals that patients can turn to if their mood symptomology recurs or worsens after discharge. While cultivating personal supports (such as friends and family members) is certainly helpful, maintaining a relationship with a non-judgmental, bipartisan party can be a helpful outlet for conversations that may be challenging to have with people in one’s personal circle.
- Identifying go-to skills – and using them!
A moment of high distress is not the ideal time to try and recall all the skills learned when at Compass. Just as it is helpful to identify go-to support systems in advance of when the time arises to contact them, it is similarly helpful to identify go-to skills to use, in advance of when the time arises to apply them. Patients often find it helpful to identify upon discharge roughly 3-5 skills they most resonated with while at Compass. This way, when encountering situations in their outside lives in which applying a skill would be helpful, they already have an assortment of a few to choose from that they know how to apply and that they know tend to work well for them.
In addition to preemptively identifying a set of go-to skills, it also can be helpful to practice these skills – even at times the skills may not seem needed. By choosing to utilize the skills in moments of low distress, patients boost the likelihood of being able to effectively apply them in any future moments of higher distress that they may encounter after discharge.
At Compass, we want to equip our patients with the necessary skills to make their ‘future plans’ a reality. Following the above steps can be helpful in maintaining treatment gains throughout a treatment stay and beyond. If interested in learning more about our Resource Track, please reach out to Compass Health Center for additional information.
Mercer, D.E. & Woody, G.E. (1999). An Individual Drug Counseling Approach to Treat Cocaine Addiction. Rockville, MD: National Institutes of Health.
National Committee for Quality Assurance (NCQA) (2012). Follow-Up After Hospitalization for Schizophrenia. USA: National Committee for Quality Assurance.
Pryjmachuk, S., Elvey, R., & Kirk, S. et al. (2014). Developing a model of mental health self-care support for children and young people through an integrated evaluation of available types of provision involving systematic review, meta-analysis and case study. Health Services and Delivery Research, 2(18), pp. 1 – 38.