A Historical Perspective of Treatment and Discharge Planning for the Seriously, Chronically, Mentally Ill Patient: A Review of the Literature

Abstract

The movement from institutionalized care to community and home care is evident in all aspects of health care. This shift began in the 1950's in the United States changing the inpatient and outpatient treatment of the chronically mentally ill. The nature of psychiatric illness, however, differs significantly from other ailments. The stigma of mental illness, combined with the cardinal symptom of lack of self-care, often leaves the patient vulnerable impacting safe discharge to the family and community. Advances in mental health care, increased pressure from the public, and changing federal policies over the last six decades have contributed to the American shift towards a more community-centered care model. This review of the literature will examine three defining periods reflecting shifts in care paradigms (1950-1975, 1976-1995, and 1996-2015), and the subsequent changes in treatment provision for the seriously, chronically mentally ill in the United States.

Discharge planning in mental healthcare settings: A review and concept analysis

“…Given the complexity of needs of the mental health population, coordinated and integrated multidisciplinary care is warranted to address patient care, services, and referrals after hospital discharge (Simons & Petch ). The importance of multidisciplinary teams to provide individualized treatment, support, and rehabilitation to people with severe and persistent mental illness was widely noted in the literature (DeForge & Belcher ; Dlabal & Marshall ; Hochberger ; Simons & Petch ). The most prominent healthcare providers identified during the discharge planning process were nurses, who provided information on medication effects, taught self‐care and activities of daily living, and established therapeutic and supportive relationships with patients and families (Buckwalter & Kerfoot ; Hochberger ), and social workers, who aided patients in decision‐making processes, coordinated housing placements and financial support, and liaised with community care providers (Ledbetter & Batey ; Tuzman & Cohen ).…”

“…Globally, the development of community‐based mental health care has inadvertently shifted the burden of care to caregivers and families (Dlabal & Marshall ). Families are critical to the discharge planning process as they advocate and aid patients in decision‐making, implement discharge plans, and facilitate continuity of care as patients transition from hospital to community settings (Christ ).…”

“…Further, as more patients are discharged to community‐based mental health care, there is a need for improved allocation and distribution of resources and collaboration among key stakeholders to develop high quality, community treatment programmes and social services. Currently, one of the biggest constraints for a patient's successful discharge is the timely availability of community resources, such as housing (Dlabal & Marshall ). Macro‐level or system‐level strategies are needed to improve the integration between mental health and social care systems, increase investment in community‐based services, and to institute measures for ongoing quality evaluation of discharge planning processes in mental health care.…”