Discharge planning for the mentally disabled.

Discharge planning is an idiosyncratic process that depends on each patient's needs and situation. Consequently, each mental health professional plays various roles as the process evolves. The most fundamental and pervasive issue in planning for the discharge and placement of the mentally ill patient is balancing the client's need for stability and security against the need for independence and unrestricted functioning. Although the needs and resources relevant to each individual situation must be analyzed, everyone requires some degree of continuity in his or her relationships and in such fundamental aspects of his or her life such as living arrangements and financial security, in order to function well. Stability and consistency are vital for the mentally disabled person, whose very illness is often characterized by severe difficulties with trusting, forming lasting relationships, and an inability to cope with frustrations and problems. Conversely, stability and consistency can translate into overdependence on others or a restricted view of the world that may contribute to overdependence. The discharge planner must maintain a reasonable degree of stability and consistency without totally extinguishing the spark that encourages the degree of risk taking necessary for a normal existence. The discharge planner will also be forced to deal with other issues such as public reactions to the mentally ill and fiscal constraints. The mentally ill have no real constituency to advocate for them; therefore, the services provided for them are often easy targets of a budget crunch. In addition, residences for the mentally ill are difficult to establish because of public attitudes and fears; often communities resist having one developed in their midst. Consequently, many residences are located in impoverished areas where clients are subjected to innumerable obstacles in attempting to live normal, productive lives. The discharge planner also may struggle with the discouragement of repeatedly placing the same patients. Many patients can manage community life for a limited time only before they decompensate and require read-mission, which starts the discharge planning process all over again. Other patients may learn to manipulate the system by getting readmitted when they want respite from the responsibilities of everyday life in the community. Community placement philosophy dictates that, assuming some measure of psychiatric stability, any time spent in the community as opposed to the hospital is advantageous to the patient. Thus readmission rates are not accurate indicators of success or failure in community placement.(ABSTRACT TRUNCATED AT 400 WORDS)