The first 72 hours after a hospital stay

The days immediately after leaving a psychiatric ward are, consistently and across many countries' data, the highest-risk period in the whole field.

Almost nobody is told this. You are discharged with a follow-up appointment in a fortnight, a bag of medication, and the assumption that the dangerous part is over — when in fact you have just moved from a place where someone checked on you every hour to a flat where nobody will notice for three days.

This is what to put in place, ideally before you leave.

Why this period is different

Two things collide.

The first is the drop in structure. Wards are dull, but they are relentlessly scaffolded — meals arrive, someone notices if you do not get up, there is always another person in the room. Home is quiet in a way that is very hard to describe until you are in it at 4pm on the first day.

The second is that improvement is not the same as safety. People are discharged when they are better than they were, which frequently means they now have more energy and capacity than they did at their worst — while the underlying reasons have not resolved. Feeling somewhat better is not the reassurance it appears to be, and clinicians know this even when nobody explains it to the person leaving.

Before you leave: five things to ask for

Ask for these explicitly. They are normal requests and staff will not think you are being difficult.

1. A named person and a number that works out of hours

   Not the ward's daytime number. Who do you ring at 2am on Sunday? Write the answer down and put it in your phone before you leave the building.

2. A follow-up within a week, not a fortnight

   Guidelines in several countries now say within 72 hours precisely because of the risk. If you are offered three weeks, say that you have read the follow-up should be sooner and ask what is available.

3. Clarity about the medication

   What it is, what it does, what the first fortnight feels like, and what to do if you miss a dose. Ask specifically whether it will make you drowsy or agitated in the first two weeks — some do, and being blindsided by that at home is horrible.

4. A safety plan you actually wrote

   Not a form someone filled in about you. If nobody offered one, write your own — it takes twenty minutes and it is the single most useful document you will leave with. Make one here

5. Someone told, other than you

   A partner, a parent, a friend, a neighbour. Someone who knows you are coming home and roughly when. This is the one people skip and it is the one that matters most.

The first 72 hours

Do not be alone for the first night if you can avoid it. Someone on the sofa, you on someone else's sofa, a relative staying over. If that is impossible, arrange for someone to ring you at a specific time.

Set up three fixed points a day. Not a schedule — three things at roughly known times. A phone call at 11, a walk at 3, a programme at 8. The specific content matters far less than the fact that the day has some shape.

Eat and sleep on a clock, not on appetite. Both will be strange for a week. Waiting until you feel like eating is how three days pass without food, and being hungry makes everything worse in a way that is invisible from the inside.

Do not audit your life yet. The job, the relationship, the money, the mess in the flat, what everyone thinks. All of it will still be there in a fortnight and you cannot assess any of it honestly this week.

Expect the crash. Around day two or three there is very often a drop — a flat, frightening "nothing has actually changed" feeling. It is extremely common, it is not evidence that the admission failed, and it usually lifts. Knowing it is coming takes most of its force away.

For the person picking them up

You matter more this week than any professional will.

• Turn up, and keep turning up. The visits thin out fast after the first few days, which is exactly when they start to count.
• Do not interrogate. "How are you doing?" three times an hour is exhausting to be on the receiving end of. Being in the same room is enough.
• Be concrete. "I'll come at six on Tuesday" beats "let me know if you need anything", which quietly hands the work back to the person least able to do it.
• Ask directly if you are worried. "Are you thinking about suicide?" does not plant the idea — that belief is widespread and wrong — and being asked plainly by someone unafraid of the answer is usually a relief.

More on supporting someone →

If the follow-up does not happen

Appointments get lost. Referrals fall between teams. This is common and it is not your failure to fix quietly.

Ring the number you wrote down. If that goes nowhere, ring your GP and say the words "I was discharged from hospital on [date] and I have not been contacted." That sentence tends to move things, because everyone in the system knows what this period is.