Work

Improving discharge planning from acute inpatient mental health care settings: a realist review

Year: 2026

Type: preprint

Abstract: Objectives Discharge from acute inpatient mental health care is a known time of high risk, with elevated rates of suicide and readmission. Person-centred, collaborative approaches to discharge planning are recommended. However, these have received limited attention and there is little understanding about how to achieve this in practice. The dynamic interplay of personal, service and system factors impact when, how and if discharge planning with service users occurs. This review aimed to understand how and in what way discharge can be improved. Method A realist review was conducted across three iterative steps in collaboration with ten lived experience and five professional stakeholders to; 1) develop initial theories, 2) identify evidence, and 3) refine theories through analysis and synthesis. Documents reporting experiences of service users and staff and interventions related to discharge planning within adult acute inpatient mental health care settings were included. Data were extracted and analysed using realist logic. Results Evidence from 77 documents and discussions with ten people with lived experience and four staff refined initial theorising to five programme theories for how discharge planning worked and for whom. These theories, set out as context-mechanism-outcome configurations, defined relationships between factors across macro, meso and micro system levels. Macro level factors, such as ongoing lack of investment in mental healthcare, stigmatising social narratives about mental illness and organisational priorities on containing risk were found to reinforce meso level practices; entrenching risk-averse cultures and staff fears they would be blamed for poor discharge outcomes. Consequently, micro level relational care was impacted, inhibiting discharge planning with service users. Conclusions This review highlights how discharge planning occurs in acute inpatient mental health care settings. Drawing together evidence from across system levels demonstrated the necessity for a system-wide approach to designing interventions if person-centred, collaborative discharge planning is to be achieved.

Source: Research Square

DOI: 10.21203/rs.3.rs-10194486/v1