at your side: during outpatient

how to relate

Outpatient mental health treatment is a more intensive treatment option than regular individual counseling or psychiatric appointments. Typically these programs integrate several kinds of treatment options including individual therapy, group therapy, behavior modification, art therapy, music therapy, yoga and meditation, and even animal therapy. For people who need professional support and monitoring for more hours out of the day in order to stabilize their condition or maintain the early stages of recovery, outpatient treatment can be a great option.

Outpatient treatment programs get their name from the fact that clients only spend part of their days at the treatment facility. This is in contrast to inpatient treatment, wherein clients live at the facility and are monitored 24/7. Some students will leave campus for a semester or two in order to put their energy into outpatient treatment (and other restorative pursuits). Others will maintain their student status and attend outpatient treatment part of the day as well as regularly attend and complete classes.

Below, we offer some broad suggestions for things to keep in mind when a friend is completing outpatient treatment.

1. Admit you can’t relate (probably)
   Unless you have been there, you probably can’t relate. So, be honest that you probably won’t be able to understand, but you’re open to hearing as much as they’d like you to know.
2. Ask them what would be helpful
   Do they need you to listen and provide direct support? Put those great active listening skills to use! Remind them you can be their source for the news they’re missing by not being on campus as regularly. Conversely, they may want to just sit in silence and enjoy your presence without any expectations. They’re likely doing a lot of talking and processing in therapy. Don’t hesitate to ask directly whether they want to talk about the treatment process and their program, whether they want to talk about other things all together, or whether they want to sit in silence (or maybe in front of Netflix or an Xbox).
3. Keep telling them things about your life, too
   If you would have usually rushed to tell them about a problem you’re having, a great date you went on, or a class you’re taking, don’t stop doing that. The fact that your friend is a little bit disconnected from campus life doesn’t make them any less credible of an outlet or resource. In fact, it may make them even more credible on some issues.
4. Care packages
   Make sure your friend knows they’re not forgotten while they’re doing the hard work of treatment. Consider having all of their friends sign a card, get them a book they’d find inspiring, or send them a package of completely disparate things like stuffed animals, comic books, puzzle books, etc.
5. Keep showing up
   You might have to get creative about how to see and connect with your friend. Outpatient treatment is often a huge commitment – they’re doing good, hard work for hours a day and may even have homework in addition. They’ll likely be busy and exhausted. If you can, offer to do the work of traveling to them. Maybe they can only see you for very brief hang outs, even as little as 15 minutes. Perhaps you might try a Google Hangout if you can’t connect in person.

how do I keep them included?

1. Ask how they’d like to be included in the lives of their friends despite their busy schedule and/or distance from campus
   Simple as that. What kinds of things do they want updates on? What would they rather not know about? What kinds of outings might they be able to join you for? Do they want to have a movie night online? Rabbit is a great site to watch movies online AND be able to talk with up to 10 friends.
2. Keep inviting them to standard friend outings and events
   Even if they can’t come, it’s always nice to be invited and feel like people haven’t severed ties. No matter who you are or what you’re going through, it’s nice to feel like you belong and that you’re genuinely missed.
3. Keep sharing information and asking their advice
   Keep the relationship open in both directions so that they feel like they can lend friendship and support to you, too.

discussing disclosure

When your friend changes their routines or leaves campus for a while in order to accommodate outpatient treatment, they might feel the need to make a decision about who they’re going to tell and who they’d like to keep at arm’s length. Here are some tips for guiding the conversation.

1. Who else do they want to know?
   Help them develop a list of people who they’d like to tell about their struggle, what their goals are in telling them, and how they expect that person to respond. This will help both of you understand who would be safe to approach and able to provide positive benefit to your friend’s treatment and recovery process.
2. How should they share?
   Figure out the best method of telling others given the outlets they have available. Face-to-face is often best, but it isn’t always possible. Phone calls can be good, too. If they want to write it, encourage an email over a text, and remind them that communicating tone is going to be just as important as the facts.
3. Who do they not want to tell and how can you help them keep it private?
   People get to disclose their mental health struggle in their own time to the people they choose. It’s not up to anyone else to out them unless requested to do so by their friend. If there needs to be a cover story, make sure the details are consistent, and do your best not to say anything that would out them against their wishes.
4. Maintaining trust: Not outing them
   A big part of maintaining your friend’s trust around disclosure is demonstrating that you won’t out them. Try to resist doing so at all costs; even if your only answer can be, “I don’t know. Maybe you should ask them.”

when they stop going

People quit going to outpatient for a million different reasons, from not feeling comfortable with the program, to running out of covered sessions, to completing their course of needed treatment and every reason in between. Here are some tips for when they stop going.

1. If they completed the program, celebrate it!
   If they completed their outpatient treatment program, that’s cause for celebration! You’d probably do well to ask them how they would like to celebrate, but it’s a big milestone and achievement worthy of recognition.
2. Be there and ask how you can support them best
   Whether they completed the program or quit a bit early, ask how you can continue to provide support in the way they need.
3. Check in with them periodically
   This is garden variety good friend stuff. Generally, people will check in a lot and offer to help in the month after someone begins treatment for any illness, and then people adjust and kind of forget about it. Keep checking in. Keep offering to cook them food or run an errand for them while you’re out. Whatever it may be, it goes a long way.
4. If they left, ask how you can help them explore other options
   Outpatient treatment programs are not one-size-fits-all. Your friend gets to be the authority on whether a treatment program was helping. If it wasn’t, trust them, accept that fact, and move forward. Many people in distress find it hard enough to seek help the first time. But if they didn’t like their first program, it’s that much harder to muster the energy and hope necessary to try again.As a friend, do as much as you can to push them toward a fresh start. Track down a list of other providers and programs that accept your friend’s insurance or offer services on a sliding scale. Call them or check their website to find out if they’re taking new clients. Once you have a list of options, sit down with your friend, express your willingness to help, and help them call to set up a next initial meeting. You might even offer to go with them to check it out and register if you both feel comfortable with that.
5. Helping with payment
   Some treatment providers do not take insurance or are considered “out-of-network” by some insurance plans. Friends should check into this before seeking treatment. Otherwise, they may run out of money to pay for their services out-of-pocket very quickly.If your friend is covered by an insurance plan, help them find the mental health section of their policy and check to see whether preauthorization for mental health treatment is required. Some insurance companies bury preauthorization requirements in their policies as a way to create a loophole for paying for a consumer’s mental health and addiction treatment.After the passage of the Affordable Care Act (ACA), most insurance providers should have abolished lifetime limits on mental health and substance abuse treatment coverages. Yet, some people have to leave outpatient treatment because they don’t have insurance or because their insurance provider is not ACA compliant. If a friend can no longer afford treatment or has run out of covered outpatient treatment time, Mental Health America offers a guide that links to other local, state, and national resources. Another option is the Partnership for Prescription Assistance.