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Saturday, 9 May 2015

Marvellous Medicine? What is Private Hospital Care for Depression like?My Week.

It’s the end of my week off, hospital done and back to work next week.

Tomorrow I’ll be writing another #dayinthelifeMH post, and adding it to others’ contributions, but in this post I’m reflecting on my experience of taking time out for my depression (as I knew I needed to), seeking treatment for it, and going back to normality (whatever that means – I guess work and living) afterwards.

"Okay, I need help, time to take the mask off for a while and deal with this."

My experience of hospital is of private treatment for mental health patients with a variety of conditions, and it’s private because I am incredibly fortunate to be able to work for a company which provides, as a benefit, private health insurance. I can’t talk about public healthcare for mental health as I’ve never had it (see previous post for more details). What my private mental health coverage means is I have a psychiatrist and a one-to-one therapist I see, and in-patient or day-patient treatment which I can also make use of – depending on the severity of my depression at a given point, and also a fair amount of paper work which my psychiatrist, therapist, key worker (another therapist with whom I make appropriate treatment plans) and others complete to make the case to the insurance company that I should get approval for the treatment we believe I need.

Thanks very much, I'll take all that money from you right now...I need treatment

I knew that I’d be struggling after last weekend and a variety of external matters contributing to my worsening depression, so I took the step to see my psychiatrist beforehand and ask for the paper work to be submitted requesting day care at hospital for a couple of weeks (because it’s always easier to ask for more upfront than go back and ask for more later). Luckily my case was accepted and covered by my insurer. It’s not possible for me to pay for it privately, even on what I know is a really good salary. It’s just too expensive – something like £500-700/day, which, to be honest, if I were well I’d far rather splash out on a new pair of gorgeous Louboutin shoes as a massive extravagance (and a one off, not 5 pairs in a week, although if I ever win the lottery…).

Shoes fit for any Superheroine

The fact is that I might be able to pay for just one day of care at this amount, but I just wouldn't be able to pay for more, without going into debt. Money worries have always been a contributing factor to my anxiety and depression; when teaching I couldn't afford to feed myself without using my credit card (on £17K/year with London rents and prices) and I longed for a day when I would be able to pay my bills and eat, and socialise, without getting further and further into debt. Now that time has come, I feel physically sick at the thought of going back to that place. I cannot go back there. It would certainly worsen my health – probably both physically and mentally, as I know they’re connected (and I describe below).

When Depression Debbie comes calling, she's packs a punch.

Anyway, to hospital. My experience of private day care (as opposed to inpatient care, where I would stay in hospital) is to travel to hospital from home and to attend a number of groups every day which aim to educate and support people like me going through a difficult period of mental illness, whether that be depression, anxiety, PTSD, bipolar, borderline personality disorder. I attend groups which my keyworker and I determine will best suit my needs.

Time for support group. Let's share our troubles and support one another.

The first group of the day is support group, where I and other day patients sit in a confidential environment to share how we are feeling, what issues we’re struggling with that day and what we think we will do about them. We have to go around the room to introduce ourselves and ‘check in’ with our state of mind and feelings. This is helpful since many people are ‘new’ to the group each day. This really all comes down to insurance – if you’re covered for a particular day you turn up that day but not on days when you’re not covered. In the last week I met at least twenty people I had never seen before (and a couple I already knew). We are all taking what we can get. The people I met varied every day, so there’s always something new to talk about.

Time to fight our illnesses together. Pow!

In the hospital environment, the support group is guided by a therapist – in our case the therapy manager – and this helps us to dig a bit deeper with the problems that we’re overcoming, whether our illnesses have been triggered by a family matter, work, other pressures or a mixture of all of these. I love support groups because I don’t have to take notes or apply particular therapeutic techniques, but sharing with others is a kind of release, and hearing and participating in group discussions about issues often help me to unpick some of my own personal struggles and find that I am not alone or that I have new options I had not previously recognised.

Hello Demon Difficulties. Please go away.

The other groups are harder. This week I attended a schema group, which educates us as to our core needs as “newborns”, and how our core needs (whether met, overly met or not met) lead us to ‘maladaptive’ coping strategies – i.e. things that we do to compensate for whatever our upbringing and childhood environment was like. For me there’s a lot to learn about the way that I behave now as an adult which links back to being bullied as a child and feeling isolated. It is fascinating and useful, but it is also very hard to think back to those times where I was in so much pain and had no means of understanding or coping with the situations into which I was placed. You can make friends at hospital - because you may bond with others. It's a matter of choice, though, because if you do make friends you often talk more and more about your and their struggles, making the experience more intense and potentially tougher.

Memory Lane. Tough as nails and stronger than steel. And ever growing.

Other groups look at cognitive behavioural techniques (conscious recognition and rational working through) for anxiety, depression, and other important areas like anger management and assertiveness. Practising recognising our negative feelings and the ways that we automatically respond to them, and hearing how to apply different thinking patterns to try to retrain ourselves is what we do in this group.

I can see you, negative thoughts. I'm ready to fight.

For example, if I text a friend and don’t receive a text back, the lonely and isolated, bullied child in me might apply an automatic response, linked to our old ‘fight or flight’ mechanism. I don’t receive a reply = I’m somehow in danger of getting hurt here; = My friend doesn’t like me anymore; = I’ve done something wrong… and so I start to become anxious because of these worries and start becoming  depressed as I wrack my brain for potential incidents in the past where my behaviour might have caused the person to dislike me. (The first – worry – leads to a build-up in anxiety, as the physical symptoms like a racing heart, feeling sick, feeling dizzy may strike in addition to the ‘cognitions’ or thoughts that I described above leading to the feelings – shame, guilt, fear, etc. The second – rumination – leads to increased depression and may include some of the physical symptoms above, but also add sluggishness, a feeling that one is hopeless, a failure (more shame, more guilt, anger at self and others, fear of never getting better.)

In this case, 'A' is very much for 'Anxiety'

When I read the above and tell you that attending these groups leaves me feeling exhausted, I hope that you are not surprised. It’s quite hard for me (and I think it’s hard for others) to acknowledge in the first place that I need help of this level. Unfortunately the part where I get help is far from easy, as I look to past events and their effect on my feelings and depression, and I have to recognise them and confront them in order to start working through those feelings and events to feel better.

I went through this on Tuesday, Wednesday and Thursday, always attending the support group first thing, and following this with other groups. By the end of each day I am drained and sad, probably sadder than I was when I arrived, because it is hard to go through things from the past. However, the alternative – not to go through those things – not to challenge my past and my negative thinking – not to address the deep depression that is overwhelming me – is not to live. And since I choose to live, I choose to get help, even though it’s hard and afterwards I curl up in my bed under the duvet, with pillows all around me, and I tune out with Netflix or my Kindle, or with a radio programme, and perhaps go to sleep for a while.

Support group. Where we share and sometimes laugh together. 
It's good to know I'm not alone.

I took Friday as my last day before returning to work. I didn't go to hospital because I wanted some time to do more tuning out and re-acquaint myself with the land of the living, thinking a bit about work, doing some food shopping, posting some parcels, paying bills and so on. I also spent a good deal of time cleaning (which is surprisingly therapeutic as a physical activity that allows me tune out) and resting in bed with a book. It's also just good not to think about myself in such a focused way - not to work on myself anymore. It's a relief to stop that and necessary in order to dip into a week of treatment and then return to work immediately. For me, Friday was the opportunity to start back into life and lead into the weekend with rest, and with those sad, terrible thoughts not exactly put away, but left for a while to get some air and be revisited in a smaller way at a later date.

And time for sleep while that works away...

I now feel like I’m ready to work again, and I feel rested, and heard. On Tuesday I felt hopeless; on Wednesday more so; on Thursday tired by the whole thing, and on Friday relieved to be away from all that difficulty, but able to recognise its value. I could see the sun and smile quietly at it. I could walk and appreciate the wind (and drizzle!) on my face and be in the world without anger or self-hatred. It’s a step forward. I will keep stepping forward. 

Time to step forward.  And put my head band and shield back on. Obviously.


  1. Very interesting post. I'm glad you were able to recognise the need for and take the time out to get good quality treatment.
    Do you mind me asking who your health insurer is? My insurer (like yours, provided by my employer) has so far refused to pay for day hospital treatment, despite the recommendation of my psychiatrist (whom it funds). Six months on from the last report, we're just about to submit a further recommendation, but I'm not holding out much hope that they will accept it.
    Each policy comes with its own Ts and Cs of course, but the principal arguments seem to be that they won't fund anything involving group therapy where 1:1 therapy has already been provided (they seem to suggest group therapy is only ever a forerunner to 1:1, not complementary), even though my psychiatrist's recommendation is for the treatment to include intensive 1:1 as well as group therapy.

    1. Thank you for your comment. I find it quite hard to recognise the right time to seek help, and I do tend (and have something of a reputation at large) for pushing myself to get through things. It's only now that I have to be a bit more realistic.
      My health insurer (and I'm in the UK, as you probably realise) is BUPA - but BUPA does provide different coverage (I believe) according to the nature of your policy. If you don't have it through your employer but privately, I'm not sure what the coverage would be - or again, if there are different options.
      Group therapy can sometimes be more intensive than non-group therapy - in my opinion - especially since group therapy often consists of a variety of groups accumulated throughout a day of care, which is certainly far more intensive than a single 1-1 session. Since generally one only sees one's therapist for 1-1 once per week I would argue that group therapy is a useful and important complement. Obviously I'm not an expert - I only have my own experience to go on - but I believe it's beneficial and certainly not less important than 1-1 by any means.
      Good luck to you and take care. I know I'm lucky to have support, and that I wouldn't have it at all unless I had private insurance as my condition isn't considered severe enough I believe. Happy to answer more questions if you would like more information - as far as I'm able to. All the best. x

    2. Thanks Jessica. I'm in the UK too, but my insurer is Cigna. Unfortunately they've now concluded that my condition is chronic, which means they won't provide any further treatment for it (my employer's policy covers only acute conditions). It's all very disappointing, although I realise that having had eighteen months of private treatment I'm much more fortunate than if I'd had to rely on the NHS.
      Good luck to you too.

  2. Hate to hear you were not feeling well. But, I am glad you notice your symptoms in time. Take care and sending my prayers your way.

    1. Thanks Donna I really appreciate it. Noticing symptoms is still quite hit and miss but I managed it this time, which was fortunate. Sending love to you and hope that you are okay over in your part of the world. Happy (US and apparently rest-of-the-world than UK and Canada) Mother's Day. xxx