Learning Objectives
By the end of this section, you will be able to:
- Explain the role of discharge planning in psychiatric-mental health nursing
- Describe the procedure for transfer of a client
- Describe the procedure for transfer of client health information
Discharge and transfer are crucial times in the treatment process for mental health clients. Both transfer and discharge require careful planning to ensure the client’s safe transition to another level of care, another facility, or their home. Each client must receive appropriate education and follow-up services in order to maximize their likelihood of adhering to their plan and achieving positive outcomes.
Discharge Planning
Discharge planning is a critical aspect of psychiatric-mental health nursing. It involves developing a comprehensive and individualized plan for a client’s safe and successful transition from an inpatient psychiatric facility or unit to their home or community or to another facility. The primary goal of discharge planning is to ensure that clients receive continuity of care and support after leaving the hospital, which can help to prevent relapse, reduce hospital readmissions, and promote overall recovery. This process involves collaboration between the client, nurse, family members, other health-care providers, and community resources to identify the client’s needs, strengths, and resources, and develop a plan that addresses their unique needs. Some of the key components of discharge planning include assessing the client’s mental health status, identifying potential risk factors, evaluating the client’s support system, coordinating with community resources, and ensuring that the client has access to appropriate medication, therapy, housing, and other resources.
Psychiatric-mental health nurses play a vital role in discharge planning by facilitating communication and coordination between clients, families, and health-care providers; advocating for the client’s needs and preferences; and providing education and support to promote successful community reintegration. Effective discharge planning can help clients with mental health conditions achieve their treatment goals, improve their quality of life, and minimize the risk of relapse or hospital readmission.
When clients with mental health disorders are hospitalized, their admission status may affect their rights related to discharge. Voluntary and involuntary admission statuses will influence discharge considerations and legal constraints. There are four main types of discharge:
- Unconditional discharge: Unconditional discharge refers to unconditional termination of the legal client and institution relationship. Discharge may be ordered by a psychiatrist, advanced practice provider, or the court.
- Release against medical advice (AMA): Clients who were admitted voluntarily may elect to leave an institution against the advice of the health-care provider.
- Conditional release: Conditional release means the client is discharged from inpatient care but requires outpatient treatment for a specified period of time. If the client was involuntarily admitted, they can be readmitted based on the original commitment order if they don’t participate in outpatient treatment. These laws vary by state and are not uniform throughout the country.
- Assisted outpatient treatment: Assisted outpatient treatment (AOT) means the conditional release is court-ordered. This treatment is tied to services and goods provided by social welfare agencies, such as disability benefits and housing. As with conditional releases, these laws are not available in every state.
Transfer of a Client
Like discharge, transferring a client with mental illness into or out of a mental health unit or between departments can be a complex and sensitive process that requires careful planning and consideration. Client safety is paramount when transferring clients with psychiatric needs. It is important to evaluate the client’s condition, including their mental state, physical health, and potential risks, to determine the safest mode of transportation and level of supervision required during the transfer. The client may be transferring between medical units, from a medical unit to a behavioral health unit, from a medical or behavioral health unit to a corrections facility, or to an outside facility.
Transferring clients with mental illness requires adherence to legal and ethical guidelines. It is critical to respect clients’ rights, and obtain all necessary consents and permissions. Additionally, client confidentiality and privacy are paramount throughout the transfer process. Whenever possible, take clients’ preferences into account when transferring them. This includes considering the client’s choice of destination, mode of transportation, and any other preferences they may have. Clients should receive appropriate care throughout the transfer process, and their treatment plan should be communicated to the receiving facility or care team. This ensures continuity of care and minimizes the risk of adverse events.
The staff involved in the transfer process must be trained and competent in handling clients with mental illness. Such staff may include nursing, nursing assistants, security, law enforcement, and others. They must be aware of the unique challenges and potential risks involved in the transfer of such clients and know how to respond to emergencies. Effective communication is essential when transferring clients with mental illness. Clear and concise communication between all parties involved in the transfer process, including the client, their family, health-care providers, and transportation staff, is crucial for a successful transfer.
Protective Placement
Guardianships and protective orders are legal methods in states for appointing an alternative decision-maker and identifying required services for individuals who are legally incompetent. Legally incompetent individuals may have developmental disabilities, chronic and serious mental illness, severe substance use disorders, or other conditions that limit their decision-making ability. A court can issue orders for a person who has a guardian to be placed protectively. The legal standard basically states that without the protective placement, the individual is so incapable of providing for their own care and well-being that it creates a substantial risk of serious harm to themselves or others. Protective services may include case management, in-home care, nursing services, adult day care, or inpatient treatment. Protective placements must be the least restrictive setting necessary to meet the individual’s needs and must be reviewed annually by the court.
EMTALA
The Emergency Medical Treatment and Active Labor Act (EMTALA) was passed by the U.S. Congress in 1986 and requires hospitals to provide emergency medical treatment to clients regardless of their ability to pay or their insurance status (Warby & Borger, 2023). The law also prohibits hospitals from transferring clients with emergency medical conditions to other facilities without stabilizing them first, or without the client’s consent.
With regard to mental health client transfers, EMTALA requires that clients with emergency mental health conditions receive the same level of care as those with emergency medical conditions. This means that if a client is brought to the emergency department with a mental health crisis, the hospital is required to provide a medical screening examination to determine the nature and severity of the client’s condition. If the examination determines that the client has an emergency mental health condition, the hospital is required to provide stabilizing treatment before transferring the client to another facility.
EMTALA also requires that any client transfer must be done in compliance with applicable state and federal laws, and that the receiving facility must be able to provide the appropriate level of care to meet the client’s unique needs. This is particularly important for mental health clients who may require specialized care and treatment that may not be available at all hospitals. Overall, EMTALA helps ensure that mental health clients receive appropriate care and treatment, regardless of their ability to pay or their insurance status.
Transfer of Client Health Information
Transferring a psychiatric client’s health information is a sensitive process that requires careful attention to privacy and confidentiality. There are several important considerations to keep in mind.
Privacy Concerns
The Health Insurance Portability and Accountability Act (HIPAA) outlines specific rules for handling and transferring protected health information (PHI). All parties involved in the transfer of psychiatric client health information must adhere to HIPAA regulations to protect the privacy and confidentiality of the client’s information. It is crucial to ensure the security of the client’s health information during the transfer process. This includes, for example, using encrypted electronic communication methods and secure faxes or mailing hard copies of the information in a sealed envelope.
Informed Consent
Before transferring any health information, the client must provide informed consent, which includes information about the purpose of the transfer, who will receive the information, and any potential risks or benefits. The client’s mental state should be taken into account when transferring their health information. If they are in crisis or experiencing acute symptoms, the transfer may need to be delayed; otherwise, the legal guardian or proxy may give consent. A legal guardian will need to consent for the transfer of a minor’s health information.
Communication
It is essential to ensure continuity of care for the client during and after the transfer process. This may include providing the receiving nurse with the client’s treatment plan, medication list, and contact information for their treatment team. Effective communication is crucial during the transfer process to ensure that all parties involved understand the purpose of the transfer, who will receive the information, and any special considerations that need to be taken into account.
Link to Learning
The video Family Attend Discharge presents important information regarding the discharge process.