Discharge planning in mental health care: a systematic review of the recent literature

Abstract

Objective: To determine and estimate the efficacy of discharge planning interventions in mental health care from in‐patient to out‐patient treatment on improving patient outcome, ensuring community tenure, and saving costs. Method: A systematic review and meta‐analysis identified studies through an electronic search on the basis of defined inclusion and exclusion criteria and extracted data. Results: Of eleven studies included, six were randomised controlled trials, three were controlled clinical trials, and two were cohort studies. The discharge planning strategies used varied widely, most were limited to preparation of discharge during in‐patient treatment. Pooled risk ratios were 0.66 (95% CI = 0.51 to 0.84; P < 0.001) for hospital readmission rate, and 1.25 (1.07 to 1.47; P < 0.001) for adherence to out‐patient treatment. Effect sizes (Hedge’s g) were −0.25 (−0.45 to −0.05; P = 0.02) for mental health outcome, and 0.11(−0.05 to 0.28; NS) for quality of life. Conclusion: Discharge planning interventions are effective in reducing rehospitalisation and in improving adherence to aftercare among people with mental disorders.

What is the Lived Experience of Being Discharged From a Psychiatric Inpatient Stay?

“…The definition of DP, what it entails and exactly when DP concludes and after-care begins is difficult to determine and can differ across studies (Steffen, et al, 2009). Studies that do not distinguish between diagnoses (e.g.…”

“…A less rigorous review of seven studies between 1981 and 1998 examining the effect of DP with psychiatric patients reported the evidence to be too low to conclude whether DP reduces readmission rates (Missio, 2002). A meta-analysis conducted on eleven studies reported readmission rates ranging from 15-46% in control groups, and 7%-25% in the intervention groups (Steffen, et al, 2009). Heterogeneity was low 1 (I 2 = 0%) thus, the relative risk reduction was 35% in favour of the intervention group.…”

“…DP aims to ease the transition between hospital stays and the community by improving the co-ordination of services, and therefore reduce length of hospital stay, readmission rates and costs (Sheppard et al, 2010;Steffen, Kösters, Becker, & Puschner, 2009). The Department of Health (DOH) in its best practice guidance for discharge outlines several recommendations for discharge from hospital (2003).…”

Editorial

“…Of these, 19 articles were identifi ed as eligible for inclusion. There were eleven systematic reviews (Gilbody, Bower & Whitty, 2006;Chiu & Newcomer, 2007;Smith & Newton, 2007;Brink-Huis, van Achterberg & Schoonhoven, 2008;Maciejewski, Chen & Au, 2009;Steuten et al, 2009;Pimouguet et al, 2010;van Steenbergen-Weijenburg et al, 2010;Althaus et el., 2011;de Bruin et el., 2011;Smith et al, 2012b), six systematic reviews and meta-analyses (Neumeyer-Gromen et el., 2004;Phillips et al, 2004;Langhorne et al, 2005;Shepperd et al, 2008;Steffen et al, 2009;Tappenden et al, 2012) and two studies not explicitly labelled as systematic reviews but which were included as they met our basic criteria (Oeseburg et al, 2009;Simoens et al, 2011). Two studies (Shepperd et al, 2009;Smith et al, 2012a) identifi ed by our search were based on Cochrane reviews and we therefore retrieved and included the relevant full review for further assessment (Shepperd et al, 2008;Smith et al, 2012b).…”

“…• adults with dementia or memory loss (Pimouguet et al, 2010), with severe mental health problems (Smith & Newton, 2007) or who received mental health care services (Steffen et al, 2009); • populations with multimorbidity (Smith et al, 2012b). …”