I have never felt more at risk than during the first few hours, days, and weeks, after a stay in inpatient lockdown.

As an autistic person with BPD, all transitions are hard. I’m talking, lie-down-on-the-cold-pavement-and-wait-until-I-regain-the-strength-to-take-another-step–breath, hard. But the harrowing shift from inpatient to outpatient treatment is unique in its dizzying capability to make me feel even less human than the moment I went in. 

According to The National Action Alliance for Suicide Prevention (2019), “Research indicates that in the month after individuals leave inpatient psychiatric care, their suicide rate is 200 times higher than that of the general population.” 

Nobody told me this my first time inside. In fact, nobody has ever talked to me about it… at all. Perhaps we should start.

In 2019, I left inpatient after 10 days and immediately transitioned back home. I was slated to start at a day program (PHP) on the same campus two weeks later. It was the soonest they could get me in. Two days into this dreaded waiting period, I couldn’t take it anymore. I called the hospital up and said, “I think I need to go into residential. Now.” After establishing safety, the person on the other end discussed with me the reasons I didn’t transition into residential care in the first place–largely because I don’t do well in strange environments, and only enter into them when absolutely necessary. They then reminded me of my history in struggling with exactly these kinds of transitions, and that entering into yet another one would not be an effective solution to how I was feeling. 

They were right, but it didn’t help.

I spent the next two weeks staring at the ceiling and trying to erase, escape, or otherwise destroy the awful mixture of weirdness, emptiness, and utter loneliness I felt, existing in the foggy void between inside and not-quite-out. I had left the hospital, but I hadn’t really returned to my life. I was in limbo and there was nothing I could do but wait for someone to press play.

Practically speaking, leaving the hospital to go back home always begins with one question:

“Okay, but what now?” 

That question, for me, has often been met with crickets and blank stares.

Once immediate risk has been mediated–as is the purpose of hospitalization–the ball is easily dropped in establishing the continuum of care that is required in the path to wellness and recovery for patients with chronic suicidality and mental illness. At least, that’s been my experience. And I’ve found the research backs me up.

These transitions are challenging, and potentially quite dangerous. We shouldn’t be left to sort through it alone.

About the Author: Jennifer is a recent MSW graduate and licensed social worker with lived experience of borderline personality disorder. She volunteers her time with the Lived Experience Committee because through advocacy we find that representation matters, human connection saves lives, and recovery is possible.