Timely Psychiatric Hospital Discharge Planning Supports Patient-Centered Care
Mental Health Awareness Month
May is Mental Health Awareness Month and Myers and Stauffer marks this observance with a blog post authored by Catherine Sreckovich (director, Atlanta) Julia Kotchevar (director, HCBS and Behavioral health, Atlanta – remoted in Carson City), both from the Consulting engagement team. See what they had to say about the importance of timely discharge from the psychiatric hospital and how it actually helps those with serious mental illness.
Inpatient psychiatric care is often seen as a protective measure to help a person undergoing an acute mental health crisis to stabilize and receive appropriate care. In the United States, about 88 percent of psychiatric hospital admissions are involuntary, meaning that the person admitted is done so by court order, rather than through their own choice.[1] Stability and safety are the primary goals of such admissions, and while important, they should not override the long-term stability and growth of the individual. In fact, research into the long-term impact of inpatient care has found that patients have a higher rate of suicide and self-harm upon discharge.[2] These adverse outcomes are highly correlated with length of stay in an inpatient setting. Further research indicates that a single long stay is more likely to have adverse effects than several short stays.[3]
Despite these challenges, few argue that their inpatient psychiatric care isn’t appropriate or necessary in some circumstances. However, inpatient stays in a hospital setting are highly structured and often revolve around strict adherence to rules and requirements that apply to all residents, regardless of the individual needs of each person. In a way, people admitted to a hospital essentially pause their life for the entire time of their admission. While in the hospital, the person has decreased choice over their life, decreased body autonomy, and frequently may experience or witness a traumatic event.[4] Decreased choice and autonomy are steep prices to pay for structure and long-term stability and may not suit the individual needs of each person. Such structure and reduced choice also do not mirror life or prepare the person for overcoming challenges of living in a less-structured environment outside the hospital.
Recent studies of quality measures and patient-centered care in psychiatric hospitals resulted in findings that can be used both in the operation of the hospital and in planning for discharge.[1] Currently, hospitals are governed largely by admissions criteria that are reliant upon clinical judgment. Rather than relying solely on clinical judgment, however, hospitals should focus on care that is patient centered. Patient-centered care focuses on the individual through assessment, treatment, and planning for each individual person. Such care can foster greater respect for autonomy and choice and leads to discharge planning that is customized and appropriate for each individual. By focusing on measurement of goals and progress, individuals can be stabilized and then quickly discharged to a system of supports to maintain that stability in the community where they can resume their lives with the support they need. Appropriate and prompt discharge also frees up resources and inpatient beds and typically results in cost savings to the health care system.
Myers and Stauffer has experience both in the management of state mental health and Medicaid programs, as well as extensive experience helping states develop systems that include institutional and community-based systems of care. If you would like more information about how Myers and Stauffer can support your state’s behavioral health system initiatives, please contact one of our contributors listed below.
| Catherine Sreckovich, MBA Director PH 404.524.0775 csreckovich@mslc.com |
Julia Kotchevar, MA Director, HCBS and Behavioral Health PH 512.340.7425 jkotchevar@mslc.com |
[2],[4] Jina-Pettersen N. Fear, Neglect, Coercion, and Dehumanization: Is Inpatient Psychiatric Trauma Contributing to a Public Health Crisis? Journal of Patient Experience. 2022;9. doi:10.1177/23743735221079138
[3] Smith P, Nicaise P, Giacco D, Bird VJ, Bauer M, Ruggeri M, Welbel M, Pfennig A, Lasalvia A, Moskalewicz J, Priebe S, Lorant V. Use of psychiatric hospitals and social integration of patients with psychiatric disorders: a prospective cohort study in five European countries. Soc Psychiatry Psychiatr Epidemiol. 2020 Nov;55(11):1425-1438. doi: 10.1007/s00127-020-01881-1. Epub 2020 May 14. PMID: 32409885; PMCID: PMC7578147.
[5] Morgan C Shields, Mara A G Hollander, Alisa B Busch, Zohra Kantawala, Meredith B Rosenthal, Patient-centered inpatient psychiatry is associated with outcomes, ownership, and national quality measures, Health Affairs Scholar, Volume 1, Issue 1, July 2023, qxad017, https://doi.org/10.1093/haschl/qxad017
