Sat. Sep 26th, 2020

I’VE EXPERIENCED SEVERAL SERIOUS PLANNED AND UNPLANNED HOSPITALIZATIONS 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 RE-ADMISSIONS, 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 PROGRAM ISN’T PLANNING FOR YOUR ULTIMATE RELEASE AND RE-ENTRY INTO THE COMMUNITY, THERE IS AN ENORMOUS PROBLEM.

Whether its a question of lengthening your stay in the hospital or outpatient treatment program 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 spent a patient will finish in a given facility or on the outpatient program census. Still, as the patient, you really should always persist in enquiring with your treatment team about your ultimate discharge.

There are several reasons why being relentless around your discharge planning is essential. 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. Thus, your inpatient 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-hospitalization. There are so many reasons to stay focused on future discharge and your aftercare plan. Depending on the basis, or precipitating factor that triggered hospitalization, 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 or currently receiving services in an inpatient psychiatric setting, discharge planning can be very much dependent on your initial diagnosis upon admission. Other variables, including the number of hospitalizations under your belt, relative chronicity of your symptoms, the intensity of your symptoms, and prognosis will determine your length of stay. These are primarily situational and based on your personal life circumstances or psychosocial history.

Discharge planners, given the enormous task of interpreting those factors, your current mental and medical status. In general, discharge planners will begin to provide a more firm and concrete discharge day when fewer uncertainties and unknowns are to be addressed in your projected prognosis.

Aside from the known information that is difficult enough to interpret to gain a clear indication of your recovery rate, discharge planners will be more willing to commit to a window of time you will be released when these indicators become more visible during the continuing course of your treatment.

You may need to hit the ground running when returning to your life before for those of you with little experience with discharges from extreme unplanned circumstances upon discharge hospitalization. In doing so, depending on your mental and medical status, this may be a challenge.

You must be realistic about your recovery; understanding you are on a journey and discharge doesn’t mean cured, 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 facing discharge from an extended- or short-term hospitalization in mental health, and many other medical inpatient treatments for various comorbidities. For the most successful release, remembering, you don’t need to be completely healed, just very aware of the follow-up and aftercare plan will significantly 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, too lengthy hospitalizations can create feelings of learned helplessness. Relying upon others and feeling less motivated to be self-driven are some of the side effects of re-entering the community after prolonged hospitalizations. Be prepared for the adjustment. Expect to feel strange, awkward, exhausted, and everything in between.

Discharge planning should always begin when you enter the facility and become a patient in the hospital. If the facility isn’t planning for your ultimate release and re-entry into the community, there is a BIG problem.

There are several reasons why being relentless around discharge planning is essential. Firstly:

  1. Staying focused on your recovery always means thinking about transitioning to a lower level of care.
  2. Reminding your treatment team about your pending discharge will keep them motivated to put together the best possible plan.
  3. Future-oriented thinking suggests to your team you have a vested interest in your aftercare. Thus, your inpatient treatment will more likely target how to handle ongoing and chronic issues, which usually put people at risk of re-hospitalization.

There are so many reasons to stay focused on future discharge and you’re aftercare plan.

Depending on the reason or precipitating factor that triggered the hospitalization will impact the work you and your team will need to invest in discharge planning. Suppose you are in an inpatient psychiatric setting.

Discharge planners, given the enormous task of interpreting the factors as mentioned earlier, your current mental status, etc. it is unlikely anyone will give a firm and concrete discharge day because there are too many uncertain and unknowns to be addressed. Aside from the known information, which is difficult enough to gain a clear clinical picture without years of experience discharge planning for complex cases. Finding a discharge planner willing to commit to a window of time, you will be released can be challenging. Given projecting a good prognosis for psychiatric admissions is usually more unclear at day one and early on in your hospitalization than medical or rehab for acute injuries and substance abuse.

Upon discharge, you will need to hit the ground running when returning to life, and depending on your health, this may be a challenge. Being:

  1. Realistic about your recovery
  2. Understanding you are on a journey and discharge doesn’t mean cured
  3. Open and honest with your supports about your situation
  4. Ready to ask for additional help or cheering on
  5. Allowing yourself time to heal

These are all critical agenda items for anyone who is facing discharge from a long or short term hospitalization. For a successful release, you don’t need to be completely healed, just very aware that the follow-up and aftercare pan will significantly reduce the likelihood of relapse or re-admission.

“After Care” plans need to be (1) tailored to your personal circumstances and lifestyle choices, (3) realistic and accessible to use even if your condition worsens or doesn’t improve, (3) contain a plan “b” or what to do next when you have to divert from the plan from either insurance issues, transportation or rescheduling of doctors appointments, or any number of things that can go wrong when re-entering the community and taking care of yourself again, living more independently, or adjusting to life outside of an institution. When revising, be prepared for anything and everything to happen.

Preparedness goes a long way when you show up for your outpatient care and intake, and they tell you there is a six-month waitlist for services or stopped taking your insurance. While these may seem like trivial snafus, many times, these admin issues, or technical problems derail people from their recovery and shift the focus away from their health. So, instead of focusing on the matters ahead directly, the problem solves the issue keeping you from connecting to your outpatient patient care. If you are too tired or exhausted and can’t work out these possible connection issues to aftercare, call the unit or case planner on the unit you were hospitalized and have them make some calls or suggest a new plan.

Re-entry into the community can feel strange. It can seem surreal, depending on the length of your stay in the hospital. Sometimes, too lengthy hospitalizations can create feelings of learned helplessness, which can come from being institutionalized. Relying upon others and feeling less motivated to be self-driven are some of the side effects of re-entering the community after prolonged hospitalizations. Be prepared for the 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.

By J. Peters

J. Peters writes on his lived experience, and also brings his story into the work. Mr. Peters blogs daily on his site mentalhealthaffairs.blog and for other sites around the United States and Europe, bringing his passion for mental health to people everywhere.

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