I’ve experienced a number of serious planned and unplanned hospitalisations and subsequent discharges. Medical, psychiatric, physical rehabilitation, you name it – I’ve been discharged from it.
NHS defines discharge planning as ‘a specific targeted discharge date and time reduces a patient’s length of stay, emergency readmissions and pressure on hospital beds.’ It should always begin from the moment you enter the facility and become a patient in the hospital. The same planning involved with inpatient treatment goes for outpatient. The fact of the matter is, if a facility or programme isn’t planning for your ultimate release and re-entry into the community, there is an enormous problem.
Whether it’s a question of lengthening your stay in the hospital or outpatient treatment programme for unethical insurance reimbursement when it’s unjustified, or just clumsy planning altogether, as a patient, you should always be enquiring into your projected length of stay in treatment.
Social workers or case planners will love to defer answering questions around the projected time a patient will spend in a given facility, or on the census of an outpatient programme but, as the patient, you really should always persist in enquiring with your treatment team about your ultimate discharge.
There are a number of reasons why being relentless around your discharge planning is important. Firstly, staying focused on your recovery always means thinking about transitioning to a lower level of care – reminding your treatment team about your pending discharge will keep them motivated to put together the best possible plan.
Also, future-oriented thinking suggests to your team you have a vested interest in your aftercare and thus, your in-patient treatment will more likely target how to handle ongoing and chronic issues which usually put people, who aren’t attentive to their own self-care and treatment post-discharge, at risk of re-hospitalisation. There are so many reasons to stay focused on future discharge and your aftercare plan.
Depending on the reason, or precipitating factor which triggered the hospitalisation, it will impact the work you need to complete before you are ready to move on to a lower level of care.
For patients admitted to a mental health treatment facility currently receiving services in an inpatient psychiatric setting, discharge planning can be very much dependent on your initial diagnosis upon admission, the number of hospitalisations under your belt, relative chronicity of your symptoms, the intensity of your symptoms, and prognosis. These and other factors are largely situational and based on your personal life circumstances or psychosocial history.
Discharge planners are given the enormous task of interpreting those factors, your current mental and medical status, among others. In general, discharge planners will begin to provide a more firm and concrete discharge day when there are fewer uncertainties and unknowns to be addressed in your projected prognosis. Aside from the known information, which is difficult enough to interpret to gain a clear indication of your rate of recovery, discharge planners will be more willing to commit to a window of time when you will be released once these indicators become more visible during the continuing course of your treatment.
For those of you with little experience of discharges from extreme unplanned circumstances, upon discharge, you may need to hit the ground running when returning to your life before hospitalisation. Doing so, depending on your mental and medical status, may be a challenge.
It is important that you are realistic about your recovery, understanding that you are on a journey, and discharge doesn’t mean cured, be open and honest with your supports about your situation, ready to ask for additional help or cheering on, and allowing yourself time to heal.
These are all critical agenda items for anyone who is facing discharge from a long or short-term hospitalisation in mental health, and many other medical inpatient treatments for various comorbidities. For the most successful discharge, remembering that you don’t need to be completely healed, just being very aware of the follow-up and aftercare plan will greatly reduce the likelihood of relapse or re-admission.
Re-entry into the community can feel strange. It can seem surreal depending on the length of your stay in the hospital. Sometimes, extremely lengthy hospitalisations can create feelings of learned helplessness which can come from being institutionalised. Relying upon others and feeling less motivated to be self-driven are some of the side effects of re-entering the community after long hospitalisations. Be prepared for a period of adjustment. Expect to feel strange, awkward, exhausted, and everything in between.
In the end, enjoy all of it. There is nothing more profound than healing and recovery from extreme perilous circumstances and returning to a more normal life again.
Max E. Guttman, LCSW is a psychotherapist and owner of Recovery Now, a mental health private practice in New York City.