The first week out of the hospital

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

I'm 27, I'm a man, I live in suburban Atlanta with two roommates, and I was discharged from my second psychiatric hospitalisation in late February. I want to write about the first seven days after I got out, because that week was harder than the hospitalisation itself, and I think nobody had warned me how it might feel.

Day zero — discharge day

The day I left, the unit felt strange. I had been there twelve days. I knew every staff member's name. I knew which of the puzzles in the day room were missing pieces. I had gotten used to the rhythm — meds at 8 a.m. and 8 p.m., meals at 8, 12, and 5, group therapy at 10 and 2.

My discharge was at 3 p.m. My mother drove me home. The car ride was 45 minutes. I had not been in a car for almost two weeks. I had not been outside, except for a small fenced patio, for almost two weeks. Highway lights felt aggressive. The radio was overwhelming. My mother turned it off without me asking. We did not talk much.

Day one

I woke up in my own bed for the first time in twelve days. The light was different. The sounds were different. There were no nurses doing rounds. I got up at 10:30 a.m. — which felt late, because in the hospital we had been up at 6:30 every morning.

I took my morning medications. I had a clear pill organiser my discharge nurse had filled for me. I had been told that the most important thing of the first week was not missing doses. I did not.

My roommates were kind and a little nervous. They had been told I was hospitalised but not the details. They did not ask. They made me coffee. I sat in the kitchen for a long time without knowing what to do with myself.

I want to be honest about how I felt. I felt fragile in a way that is hard to describe. The hospital had been a fortress — every door locked, every hour structured, every interaction supervised. My apartment was just an apartment. The structure that had been holding me together was suddenly mine to construct, and I did not have any building materials.

Day two

I had a follow-up phone call scheduled with the hospital social worker. She had been the one person who had organised everything. The call was supposed to be at 10 a.m. It happened at 11:40. I sat by the phone for an hour and forty minutes, increasingly anxious, increasingly wondering if she had forgotten me.

This was the first lesson of the week: outpatient mental healthcare is not the hospital. Things happen later. People are harder to reach. Appointments slip. SAMHSA resources had warned me about this in writing, but reading it and feeling it are different.

The social worker, when she did call, was kind. She confirmed my outpatient appointment was scheduled for the following week. She asked how I was doing. I said okay. I lied. I did not have language yet for what I was actually feeling.

Day three

I cried in the shower. I do not know why. I do not think it was a symptom. I think it was just the first moment in twelve days where I had real privacy and a reason to make sound.

My mother came over and brought groceries. She made me lunch. She did not talk about the hospital. We watched a show together. I cried again, quietly, on the couch. She held my hand.

Day four

Day four was the worst day. I want to be honest about it because if you have just been discharged, you may have a day like this and I want you to know it is normal.

I woke up convinced that the hospitalisation had been a mistake. That I was not actually sick. That the medications were unnecessary and possibly harmful. That I should taper myself off and prove to everyone that I was fine.

This is, I have learned since, an extremely common pattern post-discharge. The brain that has just been stabilised by medication and structure starts feeling well, and then attributes the wellness to something other than the medication and structure. It is sometimes called "medication insight loss".

I did not stop my medication. What I did instead was call my mother. She listened. She said, "You called the hospital social worker yesterday. Call her again. Tell her exactly what you just told me."

I called. She was, again, kind. She said, "This is one of the most common things that happens in week one. Please keep taking the medication. We can talk about it more at your appointment Monday."

I kept taking the medication.

Day five

I went outside. Not far. I walked around the block. It took me eleven minutes. I had not walked outside, freely, in over two weeks. The sky felt enormous. The traffic felt loud. A neighbour waved at me and I almost cried.

I came home and ate lunch and slept for three hours. The exhaustion of small re-entry tasks was real and it surprised me.

Day six

One of my roommates, the one I trusted most, asked me carefully how I was doing. I told him a little. Not everything. I told him I was on new medication and that the first week had been hard. He said, "Thank you for telling me. What can I do?" I asked him to just keep being normal with me. He said, "Okay. Want to play Mario Kart?" We played Mario Kart for two hours.

I cannot overstate how much that helped. I had been treating myself as a fragile object for six days. He treated me as a roommate who was going through something. There is a difference, and the difference matters.

Day seven

I had my first outpatient appointment. New psychiatrist, in an office I had never been in. I was terrified for two hours before. The appointment was 45 minutes. He read my discharge summary. He asked me how I was doing. I told him most of the truth. He did not change my medications. He scheduled a two-week follow-up. He gave me his after-hours number.

I went home and slept for the rest of the day.

What I wish I had known

• The first week is not the easiest week. The hospital had been hard, but it had also been organised. Coming out is when you have to build the structure yourself with very little energy.
• Strong emotions and crying are normal. They are not necessarily signs of relapse. Sometimes they are signs that you are finally somewhere safe enough to feel things.
• The "I'm not actually sick" thought is extremely common around day three to five. Do not act on it. Call someone.
• You will be more tired than you expect. Brains that have just been through psychosis and stabilisation need sleep. A lot of it.
• Outpatient care will feel less attentive than inpatient. This is not because anyone has stopped caring. It is just structurally different. Plan for it.
• Have your meds in a pill organiser before you leave the hospital. Do not trust yourself to manage the boxes and bottles in week one.
• Have a person. One person who will check in on you daily for the first week. Not to fix anything. Just to call.

Five months later

I am okay. I am working part-time again. I am still on the same medication. I have not been rehospitalised. The first week, looking back, was the hardest part — and it was survivable. If you are about to leave the hospital, or you just have, please know that what you are feeling is real, and that the worst of the disorientation will, mostly, fade.

For more, see discharge planning, avoiding rehospitalization, and returning to work after hospitalization.

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.