Then

I first entered into mental health care as a freshman in high school. This care was divided between visits every few weeks with a therapist and a psychiatric nurse practitioner. My focus with my therapist was managing my anxiety, which was what initially caused me to seek care. However, “fit” and trust are important with a therapist, and I believe that I lacked both with the therapist even though I did not realize this at the time. Throughout the time that I saw that therapist, my anxiety only seemed to grow worse, as did my ability to cope with it. About two and a half years into seeing that therapist, I began to develop mood swings. The mood swings were more severe than just a tough day, and as time passed, they only grew harder to manage. I didn’t know how to tell my nurse practitioner what was wrong and I didn’t have a therapist anymore. My therapist quit answering my mom’s texts and calls, and even the calls of my nurse practitioner. With increasing mood instability and decreased support, I found myself struggling. I slipped into maladaptive habits and isolation.

When I finally told my nurse practitioner what was happening, she asked that I start an antipsychotic medication alongside the medication I was already taking. However, by that time, my maladaptive coping mechanisms had grown more pronounced, as had my mood swings. As much as I struggled to admit it to myself, I was quickly heading down a dangerous and destructive path. I found myself starting my summer in the adolescent unit of a psychiatric hospital per my nurse practitioner’s suggestion.

My First Hospitalization 

My first hospitalization allowed me to recharge. While in the care of that hospital, my medications were adjusted and I was stabilized to an extent. I met interesting people, learned card games, and was given some psychoeducation and therapeutic tactics to improve my coping skills. While my experience was largely good, I still saw and heard things there that have stuck with me to this day. After only a few days of inpatient care, I was released back into the world with the hope of a better life. And to an extent, my life did improve.

The Introduction of My School Counselor

After my release, I worked to improve my habits and potentially prevent another hospitalization. I was able to find a new therapist and begin to truly work on my anxiety and discuss my other struggles. With my nurse practitioner, I was being prescribed new medications in search of the right one. Soon after returning to school the next year (my senior year), I began to visit with my high school’s counselor.

Having someone who knew my situation and was accessible to me during school hours was critical.

My counselor was also helpful in guiding me to solidify some calming, healthy coping mechanisms, such as coloring and guided imagery. However, as time passed, I began to struggle again. While what I had understood to be mania was under control, my depression was not. In October, I was sent home from school due to suicidal ideation, and I found myself once again in inpatient care.

My Second Hospitalization 

During this visit, I was assigned to a new psychiatrist, who provided a new perspective. After describing my symptoms to my new psychiatric team, my medications were changed once more. This time for the better. Not only were important changes made to my medications during this hospitalization, but I was able to rediscover some of the hope that I had lost during my depression.

A New Nurse Practitioner 

After my hospitalization, it became apparent that changes must be made if I wanted to improve my quality of life and prevent another hospitalization. While helpful for the past few years, my nurse practitioner appeared to be having difficulty treating me now. In a joint decision with my parents, I decided to start seeing a new nurse practitioner, which was a hard decision for me.

However, I have found that sometimes it is important to prioritize what is best for me, not just what is comfortable.

Not only was this decision hard, but it was ultimately life-changing. My new nurse practitioner seemed to have much more expertise surrounding what had just been diagnosed as bipolar disorder.

My Third Hospitalization 

Life improved. I was on better medication, receiving helpful therapy, and had greater support. However, within a few months, it all grew to be too much. This was my senior year, and between APs, extracurriculars, and stress about college acceptances, I felt as though I was drowning. Once again, I slipped into a depression and found myself hospitalized. This hospitalization had its ups and downs, just as the others did. Following it, I made more important changes to reduce my stress, especially from school. I cut back on my hours in extracurriculars, changed my school schedule a bit, and waited to enter an intensive outpatient program (IOP).

The IOP

Shortly before my third admittance to inpatient care, my mom and I, with the assistance of my school counselor, found an IOP for me to try. It was mainly DBT-based and met three times a week for about two-and-a-half hours each time. We all recognized it would be a difficult time commitment to my already busy schedule, but we believed the pros far outweighed the cons. About two and a half months after I was added to the waitlist, I was admitted into the program. The IOP I attended was arguably one of the best things I have ever done for my mental health. It provided a distraction from my thoughts, provided me with therapists and peers I could discuss my struggles with as well as listen to, and it provided me with multiple modules of psychoeducation that have helped me so much since. I have carried concepts like the TIPP (temperature, intense exercise, paced breathing, and progressive muscle relaxation) skill and the distract skill into my everyday life.

I believe that following my hospitalizations, IOP was a perfect choice of care.

It provided me with the more intense therapeutic care I needed, but it did not have maintenance of meds.

I finished my IOP shortly after I graduated from high school, which proved to be another trying time. While the IOP had been incredibly helpful, it was also difficult to transition away from. I went from meeting with my peers and a therapist three times a week, to not seeing them again. There was a “transition” option offered, but my family often travels in the summer, so I ruled it out as a possibility. Along with the loss of my IOP in my life, I also struggled with leaving my high school and school counselor. My counselor had provided consistent support and guidance throughout my senior year. I am grateful high school ended a few weeks before my IOP so that I could transition away from both slightly better, but the loss of both within about a month of each other was still extremely difficult for me to cope with.

A New Therapist 

That summer brought a lot of other difficulties. Despite my drastic improvement in my coping skills due to my IOP, I still fell hard back into self-harm, one of the maladaptive coping mechanisms I had struggled with before. While I was still grappling with the transition away from high school and the IOP, college’s quick approach is what I ultimately believe was the impetus for the return of self-harm. After struggling for a few months, something became increasingly apparent to me.

While extremely talented, my therapist was no longer the right fit for me.

Just as the decision to switch nurse practitioners was difficult, so too was this decision. I began seeing another therapist. I had met this therapist during my IOP, so this therapist’s methods were familiar to me and had been beneficial in the past. Shortly after starting to see this new therapist, I found myself hospitalized again at no fault to the therapist. I had spread myself thin in college, and I was struggling with depression because of it.

My Fourth Hospitalization

This hospitalization was different, though. This was my first time in one of the adult units at that hospital, which was far less lively than the adolescent unit. My medications were left the same this visit, and my time inpatient was used primarily as a rest for me. It was just what I needed. Another variable had changed though upon my discharge. I was no longer in high school. My high school was very aware of my mental health struggles and very understanding of it all. As it turns out, my university was too. Before my admittance, I emailed my professors to let them know that I would be gone due to medical reasons. As soon as I was discharged, I uploaded my hospital paperwork to my university in order to get an official notification sent to my professors. I then arranged my catching-up with all of my professors individually.

My Fifth Hospitalization

Life continued on, but it was not going well. Even my hospitalization couldn’t stop my self-harm. Things culminated at the beginning of the new year. For over a year, my “true” mood swings had been undetectable. But they returned. Ten days into the new year, I found myself yet again in inpatient care, under different and arguably worse conditions. I was in the most mental anguish I had ever been in.

I was put onto a new medication, which I still cite as my following success.

After discharge and within a few weeks, I was starting to feel the best I had in years.

Now

Following that hospitalization, my life improved, and it has continued to. Though admittedly, that hospitalization was just earlier this year. These past few years have taught me so much. They’ve taught me that taking care of my mental health is unbelievably important even if I didn’t have a diagnosis. There are many ways in which I can go about doing this. I’ve talked to therapists, a school counselor, and nurse practitioners, been through an IOP, and been inpatient. I could never say any of these levels of care were better than the others, but rather they were just more or less important at different points in my life. For me, it has been important to find what level of care best suits me at the point in life I’m in, even if this means going outside of my comfort zone.