Poor transition between inpatient mental health settings and community or care home settings has negative effects on people using services and their families and carers. A key issue affecting transitions between inpatient mental health settings and the community is a lack of integrated and collaborative working between mental health and social care services, and between practitioners based in hospitals and those in the community. Both can result in inadequate and fragmented support for people using mental health services.
People who use inpatient mental health services and their families and carers have reported a number of problem areas:
delayed assessment and admission, so that the person is not treated until they are in crisis
inadequate planning for – and support after – discharge, resulting in readmissions
the person and their family or carers not being involved in planning admission, treatment and discharge
people being discharged having no help to manage the mental health symptoms and other problems that contributed to their admission
failure to give people the information, advocacy and support they need
failure to arrange support to help the person reintegrate into the life they want to lead in the community (for example, returning to employment, education and social activities).
The consequences of a poor transition can be very serious for the person and their family or carers. For example, the University of Manchester's National Confidential Inquiry into Suicide and Homicide by People with Mental Illness found that, between 2003 and 2013 in England, 2,368 mental health patients died by suicide in the first 3 months after being discharged from hospital (compared with 1,295 inpatient deaths in the same period).
Older people are sometimes discharged to care homes when they might have been able to return to their own homes if extra support, such as home care, had been arranged in advance.
The impact of poor discharge planning on young people who are not supported to reintegrate into education and training can have long‑lasting consequences for their life chances.
People placed in inpatient facilities away from their home communities are particularly vulnerable to delayed discharges, because case management is difficult at a distance. Delayed discharge is an unnecessary expense to the NHS, but also has consequences for patients, who may become dependent on inpatient care, lose coping skills that they will need after discharge, and find that personal relationships are damaged, and housing or jobs lost.
This guideline is about everyone who uses mental health inpatient facilities, including children, young people and adults, and people who have other health issues and care needs. It primarily covers transitions – admissions and discharges – and makes recommendations about how they might be handled in order to maximise the benefits of the treatment being offered, and continuity of care. It includes people who are admitted from, or discharged to, care homes and other community settings. The guideline also covers the preparation for discharge that takes place during the inpatient stay.
You can also see this guideline in the NICE pathway on transition between community or care home and inpatient mental health services.
To find out what NICE has said on topics related to this guideline, see our web page on service transition.