All too often, our psychiatric inpatient facilities function in a disconnected fashion from the community based system. However, psychiatric hospitalization is not a destination point, but a stop along the road to recovery and an integral part of the behavioral healthcare continuum. In this healthcare environment, new clinical coordinated care management practices are emerging, along with financial drivers to more fully integrate the hospital with the community. Sound discharge planning is essential for a safe and accountable transitions of care.
Discharge planning begins at intake and involves many key stakeholders in the individual’s life, their circle of support and accountability. This includes doctors, therapists, family members and others closely involved in the patient’s care, including the individual him or herself. Alongside identifying the patient’s outpatient needs and creating basic goals, the planning team should address a number of components such as a case management strategy, living arrangements, financial help, medication and – above all – safety.
Discharge planning should address the individual’s personal safety as well as the public safety in the environment that the individual is being discharged to.
An iconic example
Some states have set out to design plans that address potential safety concerns through outpatient treatment. For instance, in New York City, in 1999, a woman named Kendra Webdale was pushed to her death in front of an oncoming train by a man with diagnosed schizophrenia who had been off medication. The resulting state legislation, Kendra’s Law, allows court-ordered assisted outpatient treatment in specified cases for individuals with mental illness who are unlikely to live safely without supervision, whether due to medication non-compliance or other complications in their treatment history.
One of Kendra’s Laws defining provisions is its medication grant program. The law recognizes the need for individuals with mental health troubles to continue to treat their conditions with proper medication as they are transitioning out of psychiatric facilities back into the community.
Kendra’s Law was an immediate focus of study for numerous researchers during its first ten years. According to the Treatment Advocacy Center, a national nonprofit organization striving for more effective treatment of severe mental illness, studies covering Kendra’s Law have discovered various key benefits.
The law has helped reduced homelessness in the mentally ill by 74 percent, suicide attempts by 55 percent and substance abuse by 48 percent. It has also reduced physical harm by the mentally ill to others by 47 percent and brought property destruction down by 43 percent. Kendra’s Law has reduced hospitalization among the mentally ill by 77 percent, arrests by 83 percent and incarceration by 87 percent, all of which save the state money.
Just as importantly as percentages, the law has resulted in beneficial structural changes to mental health service delivery, noted the Treatment Advocacy Center. Thanks to the law, there is improved accountability among medical professionals working with patients, individuals have better access to outpatient services, and coordination of those services has improved. Furthermore, observed the news source, new emphasis has been placed on discharge planning.
The Treatment Advocacy Center also features a long list of Kendra’s Laws supporters, citing former New York State governors, the State Association of Chiefs of Police and the New York chapter of the National Alliance on Mental Illness. One of the primary reasons these individuals and groups band behind Kendra’s Law is clear: It prioritizes safety as a part of the discharge planning process.
What discharge planners need to know
The process of discharge planning is complicated, and in many ways that individual’s safety in the community is a result of organization and discharge management. Beyond baseline information about the individual, such as financial status, legal issues, the state of the individual’s home and support systems, the discharge planning team needs to address major issues, such as history or risk of medication non-compliance.
Managing the complexity of discharge planning and safety requires communication. Outlining a means of communication between care providers and emphasizing collaboration in case management are essential steps the team must take. In many cases, discharge planning software or electronic behavioral health records ready for health information exchange can help facilitate communication and monitoring, giving mental health care providers an up-to-date and more comprehensive view of their clients.
With the right support network and proper discharge planning, individuals have a greater chance of reintegrating into a community safely.