EXPLORE THE IMPACTS
Multiple Behavioral Health Hospitalizations
Multiple behavioral health hospitalizations can be both a response to and a source of stress for individuals with complex emotional and neurodevelopmental needs. Repeated transitions, even short-term ones like hospital stays, can overwhelm the brain and body, making regulation difficult without guided support. Understanding how stress impacts behavior, immune function, and emotional well-being is key for caregivers and professionals. By prioritizing felt safety, connection, and structured support, it is possible to reduce the need for repeated hospitalizations and help individuals build stability, resilience, and a sense of control in their daily lives.
Brain
Transitions in places to live (even short-lived ones like hospitalizations) are a stress on the limbic system.
It is also important to remember that when this person “up regulates” (engages in an activity, thought, or interaction that gives them energy) they will not “down regulate” without assistance. This is because there is a lack of coordination between the cortex and limbic regions, which is needed to accomplish down regulation without a physically calming activity. It will be important for caregivers and team members to co-regulate with the person not just ‘enforce calming practices.’
Body
The stress of repeated transitions (which is what multiple hospitalizations are) has been linked to a lower immune response. Human beings experiencing constant upheaval can have a lower cortisol response due to cortisol depletion, which results in less protection from disease.
Multiple hospitalizations are also often found in people who cannot down regulate without assistance. This means that when they engage in an activity that gives them energy, if they, or those around them, do not know they need a calming activity to help them down regulate, they can often continue to escalate until something outside of them like hospitalization is needed to help them calm. This is often found in brains that have autism, toxic levels of stress, and trauma (especially early or chronic trauma).
Behavioral Patterns
While this is a stressor for those undergoing this frequent need for stabilization in a more structured environment, an additional stressor can come from staff at the facility labeling the person a “frequent flyer,” which is often accompanied by a dismissal of their emotional pain. This is not helpful, compassionate nor appropriate. It is helpful to know that social or emotional pain uses the same nerve fibers and registers in the same part of the brain as physical pain. Unfortunately, with social pain, there is no physical injury so there are no internal painkillers (endorphins) released as there is with physical pain. (Please see SPOT in the Bullying Section for more info).
Supports
Instead of labeling someone a “frequent flier,” and using it as a reason to dismiss their pain and search for safety. It will be more helpful to explore how we work with the people and place where they are living to find ways to create the felt safety, connection & structure.
Think: FAR - Felt Safety, Attachment, Regulation: which can only come from a well developed limbic system in the context of safe predictable environments. The person will need felt-safety, consistency and structure from the hospital and in their home, so they do not need to keep returning to the hospital to have these three most basic needs met. It may also help the FAR part of the limbic system develop. It is helpful to remember that the drive for FAR is located subcortically, so what we do to meet it may appear irrational.
Helping people identify what would help them feel safe at home by exploring what helps them feel safe in the hospital is a crucial place to start.
Having the person write their own Safety Scripts is a powerful way to identify what helps them feel safe.
Reflect, Honor, & Connect would be helpful, so they can feel heard since they and their pain are so often dismissed.
Look at all three components of FAR and see how you can bolster them:
For example, what helps them feel safe and how do we get more of those things in their life?
What helps them feel attached AKA connected with and accepted by safe others, and how do we build that in their life? Exploring their interests and identifying where others in their community are engaging in those things is an important part of this work.
What gives them structure (which results in regulation) and lets them know with whom they will be connecting and when, especially with their “preferred” staff or people. It’s important to know that “preferred” means, “they help me feel safe.” Find out more about the “preferred people” to identify what they are doing to help them feel safe. Have the “preferred people introduce and engage in activities with the person in need and any new person being brought into their life.
Having transitional objects that remind them of their safe others or their experiences with safe others is also important to help the person not have to return to the hospital for connection.
What else helps with regulation?
Anything rhythmical is regulating, deep pressure, yoga, dance, and sports.
When an activity is “up regulating,” which means it gives you energy, the person will need something “down regulating” to help them calm after that activity.
Activity that requires slower movements and concentration can be down regulating. Calming music, nature sounds, going for a Walk and Talk are all ways to engage concentration and movement, which are needed for a down regulating activity.