Starting college after my first hospitalization

This is a composite story, drawn from common experiences shared in the schizophrenia community. It does not depict a real individual.

I was supposed to start at a state university in upstate New York the same week I turned eighteen. Instead, I spent that week in a psychiatric inpatient unit two hours from my parents' house. The voices had started in May. I had hidden them from my family until the night I called the police on myself, convinced that the people on TV were tracking my location through the window.

I was discharged in early September, started a coordinated specialty care program a week later, and arrived on campus at the end of October — three weeks into the semester, with three classes I had managed to register for from the hospital. The story of those four years is the closest thing I have to a guide for any young person trying to start college after a first episode of psychosis.

The decision to go at all

My parents and my treatment team were split. My mother thought I should defer for a year. My father thought I should go on time. My psychiatrist thought I should go but with a reduced course load. My therapist thought it depended on whether I was willing to use the supports the campus offered. We went with my psychiatrist's plan — start late, two classes the first semester, see how it went.

If you are in this position now, the most useful frame I can offer: going to college and graduating from college are not the same decision. Plenty of people start, take a leave, come back, and finish over five or six years. The pressure to graduate in four is mostly cultural. Your job is not to follow the cultural script. Your job is to stay well enough to keep moving.

Disability services — the most important office on campus

The first appointment I made on campus was not with my advisor. It was with the Office of Disability Services. I had been told to do this by the social worker at the coordinated specialty care program, and it was the single most important administrative decision I made.

Through disability services I got, at various points across four years:

• Extra time on exams (50% additional)
• Permission to take exams in a quiet room separate from the main lecture hall
• The ability to take incompletes when I was hospitalised mid-semester (twice)
• Notetaking support in two of my larger lecture courses
• Permission to return to the dorm if I was experiencing acute symptoms during a class
• A reduced-credit-load arrangement that still kept me classified as full-time for insurance purposes

None of this happened automatically. Each accommodation required documentation from my psychiatrist and a meeting with the disability services counsellor. The Americans with Disabilities Act requires colleges to provide reasonable accommodations for students with documented disabilities, including serious mental illness. See also our guide on school accommodations.

Living arrangements

I did not live in a typical freshman dorm. The disability services office helped me get a single room (instead of a roommate) on a quieter floor in a smaller residence hall. This was the right call. The energy of a typical freshman dorm — late-night noise, spontaneous social pressure, inconsistent sleep — would have undone me.

By sophomore year I lived in a four-person apartment with one friend I had told about my diagnosis and two others I had not. By junior year I lived in a one-bedroom off-campus. The progression of housing roughly mirrored the progression of my stability.

Telling people — or not

Disclosure on campus is its own complicated subject. I told one close friend in the first semester. By graduation I had told maybe six people. I never told a professor; I always went through disability services, who handled accommodation requests with my professors so I did not have to disclose directly.

The friends I told mostly handled it well. One did not. He stopped inviting me to things, in a way that was unmistakable but never named. That hurt more than I expected. The friends who handled it well did so without making a project out of me — they treated it as one fact among many about who I was.

The care I kept up with

I kept the coordinated specialty care team I had started with at home, even though they were two hours away. I went home every other weekend for the first year for in-person appointments and did the rest by telehealth. By sophomore year I had transferred to a campus-affiliated psychiatrist who took my insurance, and the home team had handed off care formally.

What I never did was take a "vacation" from medication. The temptation was real, especially when I was feeling stable and my friends were drinking and staying up all night. But I had read about the duration of untreated psychosis and I knew that another episode would set me back further than any social benefit was worth. I took my medication every night for four years.

The two times it got bad

I was hospitalised twice during college — once at the end of sophomore year (final exam stress, not enough sleep, a medication refill that fell through) and once during the first semester of senior year (a difficult breakup, the start of a new academic project, a creeping return of voices). Both times I called my psychiatrist before things became dangerous. Both times I missed about two weeks of school. Both times I used the incomplete process disability services had set up and finished the missed work over the following month.

Neither hospitalisation ended my college career. They were detours, and they cost me an extra semester at the end. I graduated in four and a half years instead of four. From the outside, my transcript looks normal.

What I wish someone had told me

1. Sleep is a treatment. Pulling all-nighters in college is not heroic when you have schizophrenia — it is genuinely dangerous.
2. Alcohol and cannabis worsen outcomes. Read up on cannabis and psychosis if you have not.
3. The disability services office is your friend. They have seen more students like you than you think.
4. You do not have to be the most social person on campus to have a meaningful college experience.
5. The professors who matter will not care about a late-add or an incomplete. The ones who give you a hard time tell you everything you need to know about whether to take their next class.
6. Find one person on campus who knows the full story. Loneliness is a relapse risk.
7. Therapy is part of your schedule, not an extracurricular. Block it on your calendar like a class.

I graduated with a B.A. in environmental science. I am 26 now and I work as a research assistant at a state agency. The four and a half years it took me felt longer than they look on paper. They were also the years that taught me how to live with the brain I have. That, more than the diploma, is what I took away.

This article is for educational purposes only and is not medical advice, diagnosis, or treatment. Always consult a qualified mental health professional. If you or someone you know is in crisis, call or text 988 in the US, or your local emergency number.