Out on License

Julie has come home, but not in the way that she came home last autumn.  This time she remains umbilically attached to the hospital; she is officially not discharged, but a day patient.  This means that three days a week Joe will shuttle her across the county to the hospital so that she can attend the program there, and they will post her back by taxi in the middle of the afternoon.  This gives me three (somewhat short) days in the office.  The rest of the time I will care for her at home.

The hospital's decision not to discharge Julie means that we are not faced with a cliff edge.  Last time discharge meant a complete change of team, and a dramatic reduction in services from wraparound care to a single weekly clinic appointment.  All through the winter we had neither therapy, nor outreach, nor crisis management; she slid by degrees further and further into depression. Looking back, it was a train crash waiting to happen - it was obvious she still had significant problems at discharge.  Now, by travelling to the hospital during the day, she will be kept active and busy, part of a group of patients and staff that she already knows well.  Being on the hospital site, she can access therapy - for example, she can continue working with the psychologist on dealing with her voices.  She will be able to study at the school there, and have the support of trained staff.  Meanwhile, the medical staff will have a chance of spotting early signs of deterioration and she can talk to them if she is worried about anything.  If it all becomes too much again, it will be much easier to find her a bed for a while.

At home we are cautiously reintroducing some of the pieces of Julie's life that we put in place over the winter, arranging them to fit snugly around the days when she will now be travelling to the hospital.  Rhiannon will come to visit; some home tuition will slowly start up again; Julie will continue to work in the charity shop once a week. Structures and routines: we can only hope that this time we will manage to fall into a sustainable rhythm.

There is no guarantee that this new plan will work any better than its predecessors; we have stood in this spot many times before, on the threshold of a new regime.  But because Julie does respond to treatment, we know that eventually we are likely to hit on something that works after a fashion. Like Robert the Bruce's spider, all we can do is try and try again, varying our approach a little each time.  This latest plan is not destined to last very long as it stands - in a few months we will start the transition to the psychosis early intervention service (a whole new set of people and services to negotiate) - but I hope we will be able to learn something from it to take forwards.