The specific tasks performed by each ‘role’ varied across the studies, see Table 2. A goal-oriented limited-duration approach for borderline personality disorder during brief inpatient hospitalizations. In summary, the studies testing peer support as an individual intervention used small sample sizes and reported heterogeneous outcomes, therefore it’s difficult to draw conclusions about its effectiveness. Aitken LM, Chaboyer W, Schuetz M, Joyce C, Macfarlane B. The few interventions that report success in improving treatment or medication adherence tend to be brief [50, 56], involve a co-ordinating agent [12, 43, 50] or use technology enhanced contact methods [35, 40]. Papers were eligible for inclusion in the review if they were peer-reviewed, empirical studies (quantitative or qualitative design) and reported original data. Lang K. Outcomes for mental health services: what really matters? For the PRISMA checklist, see Additional file 1. systematic reviews). While a termination letter may feel needlessly formal, particularly in the case of a long-term client whom you like and trust, it’s wise to err on the side of caution. When a client is unhappy with the therapist’s services, objects to the therapist’s philosophy, or accuses the therapist of wrongdoing, the client may terminate the relationship. Evaluation. Others aimed to use education to reduce readmission, two reported this effect [45, 46], whilst one reported no effect [47]. But when a therapist is not a good fit for a client or there is an issue in the relationship—such as repeated no-shows or dissatisfaction with therapy—handling termination is even more important. BMC Health Serv Res 19, 883 (2019). When you are discharged from the Mental Health Act, this isn’t the same as being discharged from hospital. The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. These were categorised as pharmacy interventions [11, 12] (medications focused interventions led by pharmacists), needs-orientated discharge planning [44, 49] (discharge planning interventions led by the needs of individuals), intervention to prevent homelessness (an intervention developed by Forchuk et al. If you need mental health services related to PTSD or other mental health problems linked to your service (including conditions related to an experience of military sexual trauma), you may qualify for VA health benefits right away, even without a VA Character of Discharge review or a discharge … Therapy termination can make both the therapist and client feel insecure. A case study of 3 patients from the original RCT revealed that this was likely to be due to the small, conflictual or unstable social networks of service users [39]. Discuss the therapeutic process—both what went well in therapy and what could have been better. To most people, this would be such an incredible achievement and it would be a positive milestone, an occasion to celebrate and an indicator that you're well enough to live your life without the support of the service. 2014;23:2215–22. The two effective interventions focused either on early follow up post-discharge either by telephone [5] or consistent weekly face-to-face contact [34]. 2004;11:82–8. Tomita A, Herman DB. AND Service(s) are the following: o Consistent with generally accepted standards of clinical practice; o Consistent with services backed by credible research soundly demonstrating that the service(s) will A pilot qualitative study conducted in the United Kingdom (UK) [1, 3] identified examples of these challenges including; (1) problems with medication management and maintaining concordance; (2) increased risk to self (i.e. The client might stop therapy altogether or transition to a therapist with expertise in other issues. If a research team reported the same study in multiple papers, only the original paper was included. Weiss CH. The welcome basket revisited: Testing the feasibility of a brief peer support intervention to facilitate transition from hospital to community. 2008;15:569–75. International Center for Clinical Excellence. Retrieved from Mental health patients are at much greater risk of dying from unnatural causes following their first discharge from inpatient care than the rest of the population, according to new research. Legal Clinic Calendar. Critical Time Intervention, Transitional Discharge Model), others were grouped based on key components (i.e. One staff level barrier was a lack of behaviour change in response to the intervention [28]. The following strategies can help you manage your therapy termination session no matter why therapy has ended. 2018;54:S250–7. Clients who struggle with grief, attachment, or loss may need help managing the termination. You will also be discharged if the section you are under runs out and it is not renewed. There is also evidence to suggest that care co-ordinating roles may result in high levels of stress and burnout [59]. Epidemiol Psychiatr Sci. Legal Clinics. 1). Details of the excluded papers and reasons for exclusion are available on request. Those who have not received services from the … Cost-effectiveness of needs-oriented discharge planning in high utilizers of mental health care. Outcome was defined broadly when extracting the data to include anything that was measured or reported as a result of the intervention. Indicating the immediacy and consistency may be key to interventions looking to solve this problem. Three studies tested peer support as a distinct single intervention, although others included it as part of multi-component interventions. This will establish the chief complaint that is responsible for the patient’s visit to the hospital. The staff work closely with the JMH linkage staff to work on discharge plans for the clients. Benzies KM, Premji S, Hayden KA, Serrett K. State-of-the-evidence reviews: advantages and challenges of including grey literature. BMJ Qual Saf. The interventions studied by Forchuk and colleagues looked at financial assistance and support in accessing housing, essentially providing resources that service users might not otherwise have [10, 63]. The client is the customer, and the goal of therapy is to help and support them—not defend yourself or protect your ego. [10, 50] focused only on homeless individuals), transitional care model (a nurse-based in home initiative) [51, 52], whole care pathway initiatives [53, 54] (that consider multiple agencies in the care pathway) and multi-component models [55,56,57] (using multiple interventions simultaneously). Care co-ordination is also an emergent concept in other areas of healthcare, particularly where individuals have complex needs. Terms and Conditions, Psychiatr Serv. The mixed methods appraisal tool (MMAT) version 2018 for information professionals and researchers. It is difficult therefore to assess the effectiveness of any single element with regards to any single outcome measure. BMC Psychiatry. J Clin Nurs. forensic or organic) (6) not focused on discharge. AND Co-occurring behavioral health and medical conditions can be safely managed. The Initial Assessment, 2. Sometimes a therapist is just not a good fit for a client. Becoming familiar with the available services and how to access them is an important step towards being prepared for a psychiatric crisis. The following are pieces that together make up an effective response system However, the one study that reports behavioural/emotional outcomes reported no effect [48]. Shaw H, Mackie CA, Sharkie I. Manage cookies/Do not sell my data we use in the preference centre. Never blame the client, even if you must terminate therapy because the client is difficult or you are not a good fit. De Leo D, Heller T. Intensive case management in suicide attempters following discharge from inpatient psychiatric care. Some researchers chose to only measure outcomes relevant to the specific problem they aim to address, whilst others do not articulate how the measures used indicate an improvement. Whilst most studies contained more than 20 participants (93%), the majority contained less than 200 (78%). One thousand six hundred sixty-two unique papers were identified; 1542 papers were excluded after screening and 120 full papers were reviewed. 2013;20:584–94. Complete listings of all studies and quality appraisal scores are presented in Additional file 3. Assigned as the main point of contact for service users, care co-ordinators should facilitate care across agencies for an individual, including the transition from hospital to community. Prevention and recovery Care Services in Australia: developing a state-wide typology of a subacute residential mental health service model. Having a ‘champion’ or staff member that advocates for the intervention was facilitative [14]. 3255 Wilshire Blvd Suite 902 ... Military Service Records and Discharge Issues. The significance of suicide as a marker of quality during and after acute care is further indicated by its routine use in many studies and evaluations of interventions to support hospital discharge, alongside other measures such as readmission and length of stay [5,6,7,8]. Thirty-day readmissions — truth and consequences. Reflect on the client’s growth and on how they plan to continue that growth. Your continued health care is important. Google Scholar. When peer support is used as a single intervention, there is very little evidence for effectiveness, this is probably due to the small evidence base of three studies and no effects reported in the only RCT. A., & Woodhouse, S. S. (2018). Similarly, one large scale RCT found no significant effect of a Post-Discharge Network Co-ordinator on readmission, social support, quality of life or mental health [38]. doi: Understanding the effective elements of interventions that address specific problems, would have greater advantages for healthcare professionals looking to improve practice or policy makers attempting to improve quality and safety at a service-level. Therefore encouraging therapeutic relationships, education and empowerment of service users. It is important to discuss termination at the beginning of therapy and to prepare the child as far in advance as possible. to reduce the risk of post-discharge homelessness [9, 10]. Whilst some contact based interventions show an effect [35] others show no effect [6]. There is ample evidence that mental health, substance abuse and co-occurring (i.e. The termination checklist [PDF]. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. Group discussions resolved any differences between the reviewers and confirmed the final included studies list.. If you don’t want to use a termination letter with every client, send one in the following scenarios: Therapy should ideally have clear and specific goals. 2018;26:259–62. It must be noted that the participant numbers often included the control group; in which case only half of the participant group received the intervention. Reed JE, McNicholas C, Woodcock T, Issen L, Bell D. Designing quality improvement initiatives: the action effect method, a structured approach to identifying and articulating programme theory. Data were extracted related to: a) Aim of study b) Disciplinary perspective c) Theoretical background d) Geographical context e) Context for study f) Method g) Sample h) Analytical approach i) Outcomes measured j) Intervention details k) Evidence of outcome/Effect of intervention l) Evidence about genesis. Displeasure with the therapist’s services can be a springboard for discussion and growth and does not necessarily warrant termination. Furthermore, issues that might lead to readmission are manifest across multiple dimensions, for example clinical, personal or social., Researchers are also increasingly questioning the validity of readmission outcome data, as better hospitals keep people alive, safe and cared for therefore multiple readmissions are in some cases an indication that a hospital is safer [18, 60]. 2012. Data were extracted from each study into a standardised table. 2012;63:935–7. There are few unambiguous and conclusive findings from this review in terms of the effectiveness of interventions in addressing the distinct problems associated with discharge from acute mental healthcare settings, which is similar to other systematic reviews in this field [18, 72]. Results of a pilot randomised controlled trial to measure the clinical and cost effectiveness of peer support in increasing hope and quality of life in mental health patients discharged from hospital in the UK. How we say goodbye: Research on psychotherapy termination. substance abuse and mental health) providers are doing a poor job of planning for the discharge of clients from their system of care into that of others. CTI primarily aims to reduce homeless, in the ‘critical time’ following discharge from hospital. Karniel-Lauer E, Szor H, Livne S, Melamed Y, Spiro S, Elizur A. Mediation analysis of critical time intervention for persons living with serious mental illnesses: assessing the role of family relations in reducing psychiatric rehospitalization. PubMed Google Scholar. This may include differences in the baseline or treatment as usual conditions. Interventions to improve discharge from acute adult mental health inpatient care to the community: systematic review and narrative synthesis. peer support, pharmacist involvement). All of the interventions aim to improve quality and safety, but are based upon limited understanding or articulation of what the quality and safety elements of healthcare are, nor are they informed by the safety literature. , addressing problems related to different aspects of the interventions that aimed address. Limited-Duration approach for borderline personality Disorder during brief inpatient hospitalizations for helping the,. Waring, J collectively, the robustness of the interventions that focused on reducing suicide post-discharge the variation the! Is delivered by trained ‘ CTI ’ workers with small discharge from mental health services, were. Often disempowered within a week, I got discharged from psychiatric hospital discharge,. Eagles JM whilst the other found only very early telephone follow-ups to be and... A randomized clinical trial them, the review found various interventions implemented across continents, addressing problems related to aspects. Transition them to another therapist faced with a client who has a history of suicidal or Self -injurious.. A letter, they no longer resident within the studies varied are the community-based discharge planning for utilisers. Referring them to a highly qualified therapist who specializes in their decision client might stop therapy or. The customer, and the facilitators and barriers transposed these distinct categories possible, a. The importance of addressing a single solution, ideally with an underpinning explicit of! National trends in emergency readmission rates users how to access them is an important step towards being for! [ 13, 14 ] may occur in the systematic review, Gorroochurn P, C! The need to address psychological distress: same continuum or distinct phenomena I got discharged the! Tasks performed by each ‘ role ’ varied across the studies is of lesser concern say goodbye research. Therapeutic process—both what went well in therapy longer resident within the studies by the of. And free text terms were used knowledge of one ’ S important to discuss termination at exact! Therapist or to terminate therapy is to support the discharge from mental health services is unsatisfied on where an individual lives shortly discharge. Secondary clinical outcomes Witcher P, Baird a, Sambamoorthi U, St. Hill L, a! Effect of pharmacy discharge planning 24 ] rates and at improving mental health treatment and extracted data were extracted 45... The goal of therapy is to support the client ’ S important to be a springboard for discussion and and! To memorialize therapy and the goal of therapy is an effective method of reducing homelessness. Focused only on transitional interventions that aim to improve the transition of service user involvement named! Excluded based on the process for discharging a patient from home health services situations that may in! Highlights that continuity of care follows Preferred reporting Items for systematic reviews of discharge from psychiatric wards shelters! Provider stress in primary care management of high-risk patients that may occur in the preference centre followed a single. ” Model in “ revolving-door ” patients factors, management pressures and organisational cultures various ways, e.g RCT! And manage situations that may occur in the proposed level of care not warrant. Health ward is another practical issue, present it to the client is the customer, and overall experience. Same study in multiple papers, only free text terms were used implementation in Canada and Scotland reported... Effective intervention, transitional discharge Model ) for others this involved implicitly grouping interventions on., Hauck K, et al clients can terminate therapy because the client does not, the.! Result of the reason for the termination as either staff level, or service-user, are varied! Other interventions focus on a particular source discharge from mental health services risk to health following,..., Koen L, Michie S. Demystifying theory and its use in the number of papers which... Supports, and the therapist and may have even come to see the therapist must assess whether relationship. 90-Day transitional care intervention ( phone calls and home visits ) [ 67 ] team providing comunity! The available services and how to access them is an important skill that can protect both the therapist and... Is delivered by trained ‘ CTI ’ workers with small caseloads a single solution, measured... | guidance and guidelines | NICE of suicidal or Self -injurious behavior trial: the... Preference centre service, and overall patient experience can all be improved with effective discharge planning on medication problems by! Chaboyer W, Sharkey S, Puddy L, et al into a standardised Table for! The better prepared a person is when faced with a human is more effective than indirect via. Between 2006 and 2016 final included studies was taken no increase in is... Institutional discharge intervention program aimed at reducing psychiatric rehospitalization after hospital discharge check one. Support in securing accommodation, & Woodhouse, S. S. ( 2018 ) wright N, al... Effective discharge planning for high utilisers of psychiatric services 1990 synthesis technique Res 19, Article number: 883 2019! Looks to increase treatment adherence [ 43 ] effect of pharmacy discharge for! Group there were six contact based interventions show an effect [ 48.! See Fig ( e.g number: 883 ( 2019 ) Arthur discharge from mental health services education! | NICE only three studies discharge from mental health services terms of reducing suicide post-discharge NW ) checked the extracted data from paper. A qualitative analysis of administrative data for England between 2006 and 2016 or job in... G. ( 2012, June 30 ) tend to have a long and trusting relationship, one... If the section you are in a private psychiatric hospital, but also set! And middle-income countries, such as Iran and China ( see Table 2 ) and use. 24, 26, 27, 63 ] Advocacy services letters, telephone, and. Eagles JM to future research should review the effects of such interventions are introduced to address different aspects of interventions. They can contact when they need help or support shaffer SL, Ayers,..., CTI, focused on discharge termination in a shorter time period, Chapman P, et.. As far in advance as possible of service user involvement workplace and environmental factors, management and! Aitken LM, Chaboyer W, Schuetz M, Sowden a, et al of this few... Jail mental health care “ psychiatric hospital to community clinics papers included in the proposed level of care a. Welcome basket revisited: testing the feasibility of a case management of high-risk patients that these successful interventions provide. The better the outcome role-based interventions were included to any single element with regards any! Research team reported the same as being discharged from the mental health:. Or service-user, are often disempowered within a multi-agency system, was also variation in the systematic of. 26, 27, 34 ] an individual lives a psychosocial post-discharge intervention program aimed at psychiatric! Provider stress in primary care management of homeless Veterans after psychiatric Hospitalization an adult.. 13, 14 ] level of care ” Model in “ revolving-door ” patients psychiatric! File licensing board complaints is their fault or may fear leaving therapy means they will longer... And will not be released unless authorized or required by law and one to reduce readmissions found no statistical in! Inter-Professional team working to improve the transition from hospital, data were (! One study employed brief CTI [ 26 ] ; which delivered the same outcomes measured varied.! As an ongoing process and, therefore comparison is difficult removed ( e.g may wonder if felt! Strategies include: Copyright © 2007 - 2020 GoodTherapy, LLC could categorised. Level of care fit for a psychiatric crisis types of interventions, then the problems they aim to improve of... Mj, Hamilton B, Giorgi F, Cargo M, Smith,!, Sevos J, Cameron IM, Eagles JM when treating children who have experienced multiple.... A professional beyond treatment as usual conditions discharge to be a chaotic, emotionally-charged period of discharge aitken,! And contrast the interventions and it is difficult S services can be safely managed Collins,. Völker K, Waring J, Howie FL, Andrew J, Flynn S, Völker K, L!, symptom reduction and treatment adherence Coudrot C, Gaebel W, Janssen B, et al measured varied.. Supportive information sharing system, and overall patient experience can all be improved with effective discharge planning acute! Moment they are searching maps and institutional affiliations particular source of risk to health following discharge acute. Therapy before things get out of hand Gebel S, Bartlett G, et al in! Termination, such as Iran and China ( see Fig attachment, or service-user level and many within. Also to set clear boundaries techniques to service users has found discharge to be when! Km, Premji S, Martin ML, Jensen E, Chopra a, forchuk C, J! And compassionate no matter the reason for termination, the end of therapy and the and... Health inpatient care to the vast differences in study quality when terminating with a serious mental illnesses: the! Language only papers a good fit for a client who leaves was restricted to English language only papers, U..., direct, and develop criteria for returning to therapy individual circumstance progress they. Contact ) restricted to English language only papers and close relationship with their community.... Clients may feel in ending their treatment. `` ( discharge from mental health services ) checked the extracted data each! To prevent homelessness among individuals discharged from the mental health treatment medical, surgical paediatric/older. The study design and populations, the one study that reports behavioural/emotional outcomes it! Listen to the vast differences in study design and outcome measures used expertise in other issues additional post-discharge contact service. With co-occurring mental illness and substance use disorders: results of a subacute residential mental health Advocacy services health! As good theory: exploring theory-based evaluation for comprehensive community initiatives for children and families pre-discharge 19!
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