Parenting with hope through the hard places by Jennifer Griffis.
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“Here’s the discharge summary. There’s a follow-up appointment for medication management in two weeks. She has an appointment for therapy next week. And here is all of the information on her medication. I just need you to sign here and then I’ll go get her for you.”

After the nurse left the room I turned to my husband, “That’s it? We just take her home now? What do we do if she does this again?”

It was our first discharge experience at a psychiatric hospital. Our daughter, who was six years old, had been there for the past ten days after attempting to kill a sibling and demonstrating some highly concerning thought patterns. We had made the decision to admit her with the hope of finally getting some answers about what was causing the behaviors and how to move forward as a family. But as I walked out of the hospital holding her hand, it felt like all we’d gotten was ten days of respite. I wasn’t sure when, but I knew at some point we’d be back. The question was how long could we survive before it happened again.

The next morning I went to have coffee with a friend. When I got home her behaviors were already beginning a downward spiral. My husband and I spent the afternoon trying desperately to “reset” her, but despite our efforts her behaviors continued to escalate. Eventually we made the decision to head back to our local emergency room for a mental health evaluation. Less than 24 hours after being discharged she was being admitted back into the hospital.

In the medical world it’s called “bounce-back”. In criminal justice it’s called “recidivism”. In the mental health world we hear both terms. It means a person leaves a system and within a defined period of time returns back to the system they just left.

Over the course of the past five years our daughter has experienced three bounce-back admissions to in-patient psychiatric hospitals and had a re-admission to residential treatment after only six months in a community setting. Situations like this are common among children with untreated mental health issues.

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“Bounce-back” admissions and recidivism rates are something that systems track and attempt to avoid. High rates in these areas are not a mark of a healthy system. So why is it common for families of children with a serious emotional disturbance to experience multiple hospitalizations in a short time or to find themselves back in a court room or an treatment center intake room only weeks or months after leaving? Here are a few reasons…

My state is in the process of transitioning to a more child-centered children’s mental health system. Recently I participated in a discharge meeting that left me feeling amazed and hopeful. As professionals from multiple system partners were discussing the services my daughter would need after discharge from residential treatment, one of them said, “If we don’t have the right level of care available within the community then we should consider delaying discharge while we work to get those services in place. We have to make sure the level of care matches her needs.”

If you’re a parent navigating a system that isn’t yet child-centered in its discharge process there are ways you can help the system move in that direction.

Comprehensive, practical discharge planning is possible when parents have the opportunity to participate in authentic conversations about needed services and supports for their family. This can be a positive step in helping children and families receive the care and support they need within their own communities.

One Response

  1. My thoughts about discharge planning in children’s mental health is that there is not enough information available to families experiencing this. Ways to help get this information available is to have mental health providers and case worker in hospitals familiar with options and to provide them to families upon entering the ER. Even if the child is not being admitted, maybe there is a chance they will be down the line. Families should have this information available in the case it is needed. It should be discussed and provided in writing to families upon discharge from hospital inpatient. Having a local counselor can also be helpful to know that this professional is available and familiar with the family and their needs. They can also provide very important information regarding inpatient and discharge from the hospital and can limit the stress on families.

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