| In 2005, a mental health study was commissioned to | | | | set up to ensure continuity of care. |
| examine the extent of the problem of discontinuation | | | | - Communication breakdown between settings. |
| of therapy and treatment for patients experiencing | | | | - Psychiatrists from both inpatient and outpatient |
| mental illnesses, including schizophrenia, bipolar disorder | | | | settings report they very rarely interact with mental |
| and depression. The study examined the factors that | | | | illness patients in the other setting. |
| influenced whether these patients followed through | | | | - Most communication between inpatient and |
| with the full course of prescribed medications or not. | | | | outpatient facilities takes place between the inpatient |
| As part of the study, 76 in-depth qualitative interviews | | | | discharge planner (typically a social worker) and the |
| were conducted with a panel of inpatient hospital | | | | outpatient intake coordinator (typically a case |
| psychiatrists and discharge planners and outpatient | | | | manager). |
| (community mental health center) psychiatrists and | | | | - These respondents, the primary conduits of |
| intake coordinators from across four states. The | | | | information flow between settings, characterize their |
| respondents stated that, on average, 50 percent of | | | | work environment as "overburdened" and |
| consumers discharged from inpatient facilities do not | | | | "overworked." |
| appear for their initial intake appointment at the | | | | - Unless specifically mandated or required, processes |
| outpatient/community-based program to which they | | | | pertaining to discharge or intake are unlikely to be put in |
| were referred. | | | | place, let alone followed consistently; when policies |
| Several factors were identified on the system, | | | | exist, they tend to be idiosyncratic to the particular |
| program/provider, and individual levels that were | | | | facility. |
| related to such a poor rate of continuity of therapy for | | | | Provider and Individual Level Health Care Barriers: |
| approximately half of the study participants. | | | | - It was very clear that many consumers, upon |
| System Level Health Care Barriers: | | | | discharge, were not completely stabilized and had little |
| - The system is fragmented and fractured. | | | | specific awareness of their medications beyond the |
| - The basics of the discharge and intake processes | | | | name(s). |
| are similar across states; however, the flow of | | | | - Issues faced by consumers including: stigma, side |
| communication varies significantly by state and | | | | effects from medications, co-occurring disorders, |
| consumer profile. | | | | homelessness, lack of transportation, and lack of |
| - Certain prescribed psychotropic medications do not | | | | support systems. |
| appear on hospital formularies, thus creating transition | | | | - Consumers acknowledged they were provided |
| issues for consumers both within inpatient settings and | | | | information about their medications at discharge, but |
| post-discharge. | | | | report the information was given in very general terms |
| - Financing and cost considerations. | | | | (e.g. "this will make you feel stable") and there was little |
| Facility/Program Level Health Care Barriers: | | | | recall regarding details. |
| - The role of inpatient short-stay hospitals is clearly | | | | Obviously, steps must be taken to improve the |
| defined as triage, stabilization and, discharge. | | | | continuity of care for mental health patients. This can |
| - Most outpatient facilities see their responsibility for the | | | | only be achieved by addressing and removing these |
| continuum of care beginning only when the consumer | | | | barriers on all levels. Mental health professionals agree |
| actually shows up for intake. | | | | that removing these barriers is a reality that can, and |
| - Neither setting (inpatient or outpatient) is appropriately | | | | should, be realized today. |