Definition
Discharge of a client in a psychiatric unit refers to the process of formally releasing a patient from inpatient psychiatric care after their condition has stabilized or improved. This involves ensuring the patient is ready to transition to outpatient care or community support, providing a comprehensive discharge plan, and addressing any safety concerns or follow-up needs.
Types of Discharge
Discharge from a mental health hospital can occur in several ways, depending on the patient’s condition, legal status, and treatment progress. Here are the main types:
1. Voluntary Discharge
- Patients who were admitted voluntarily can request discharge when they feel ready.
- The healthcare team assesses whether the patient is stable enough to leave.
2. Medical Discharge
- Patients are discharged when their treatment goals have been met, and they no longer require inpatient care.
- Follow-up care is arranged to ensure continued support.
3. Against Medical Advice (AMA) Discharge
- A voluntary patient may choose to leave against medical advice, even if healthcare providers recommend continued treatment.
- The risks and consequences of leaving early are explained to the patient.
4. Involuntary Discharge
- Patients admitted under legal provisions (such as court orders) may be discharged when they no longer meet the criteria for hospitalization.
- This decision is made by mental health professionals or legal authorities.
5. Conditional Discharge
- Some patients are discharged under specific conditions, such as mandatory outpatient treatment or regular psychiatric evaluations.
- Failure to comply with conditions may result in re-hospitalization.
6. Administrative Discharge
- Patients may be discharged due to insurance limitations, facility policies, or transfer to another institution for specialized care.
7. Deferred or Supervised Discharge
- Some patients are discharged with ongoing supervision, such as community mental health programs or residential care.
Discharge Criteria
The procedure of discharging a patient from the psychiatric ward differs depending on the type of admission made when first entered the hospital.
- A client who is a major and admitted voluntarily to the unit, if he feels his condition has improved, can ask for discharge by writing a request to the medical superintendent.
- In the case of a minor, the parent will write an application and the medical superintendent after observing the client will decide whether he can be discharged.
- The client who was admitted through a magistrate can be discharged after a judicial inquisition.
- Clients admitted through police are discharged after the family members or relatives agree in writing that they will take proper care and the client is found to be medically fit.
Procedure
| Nursing actions | Rationale | |
| 1. | Prior to discharge, a trial leave, and placement in half way home will be planned. | Helps in planning the client’s discharge. |
| 2. | Discuss the discharge plans with client and family. | Prepares them for life out of the hospital. |
| 3. | Assist patient in making travel plans and arrange for utilization of community resources if any. | Ensures acceptance by family and community. |
| 4. | Intimate follow-up visits and care at home. Return any jewellery and/or belongings kept in sale custody in the hospital. Arrange for patient to obtain discharge summary sheet along with follow up visit instructions and treatment plan. Explain the medical instructions. | Ensures continuation of treatment and/or healthy living. Provides confidence as the client prepares to leave the care givers and co-patients in the hospital. |
| 5. | Complete all patient records and hand over to medical records department. | Saves the total records for future reference. |
Special considerations
- Develop a detailed discharge plan in collaboration with the patient, family, and healthcare team.
- Include follow-up appointments, medication schedules, and contact information for crisis support.
- Ensure the patient understands the discharge plan and provide it in a clear, written format.
- Educate the patient and caregivers about prescribed medications, including dosage, timing, and potential side effects.
- Arrange for a sufficient supply of medications or prescriptions to avoid interruptions.
- Connect the patient with community resources, such as support groups, counseling services, or rehabilitation programs.
- Address practical needs like housing, transportation, and financial assistance if required.
- Assess the patient’s risk for relapse, self-harm, or harm to others.
- Provide emergency contact numbers and ensure the patient knows how to access help if needed.
- Educate family members or caregivers about the patient’s condition, warning signs of relapse, and how to provide support.
- Encourage open communication and involve them in the discharge process.
- Complete all necessary documentation, including a discharge summary and medical records.
- Ensure a smooth handover to outpatient care providers or community services.
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwers, ISBN-13:978-9388313285
- Adrianne Dill Linton, Medical-Surgical Nursing, 8th Edition, 2023, Elsevier Publications, ISBN: 978-0323826716
- Donna Ignatavicius, Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care, 11th Edition ,2024, Elsevier Publications, ISBN: 978-0323878265
- Lewis’s Medical-Surgical Nursing, 12th Edition,2024, Elsevier Publications, ISBN: 978-0323789615
- R.Sreevani, A Guide to Mental Health & Psychiatric Nursing, 6th Edition, 2024, Jaypee Publishers, ISBN 978-9366161686
- Sheila L. Videbeck, Psychiatric Nursing, Seventh Edition , 2017, Wolters Kluwer Publications, ISBN: 978- 1496355911
- Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. 2nd edition. Eau Claire (WI): Chippewa Valley Technical College; 2024. PART IV, NURSING PROCESS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK610818/
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