Clinician perspectives on endings and discharges in community mental health work

Abstract

Purpose

The process of ending mental health support is often not well-attended to in practice or research, and clinicians in UK mental health services lack focused clinical guidance in this area. This paper aims to report on a service evaluation that sought to understand from clinicians working in a single adult community mental health team (CMHT) their experiences of discharge and issues arising in the process, factors considered in decision-making and what constitutes “good” endings and what support could be helpful to them in navigating this with clients.

Design/methodology/approach

Semi-structured interviews were completed with six members of the multi-disciplinary team and analysed thematically.

Findings

Clinicians described a range of criteria considered in discharge decision-making. Collaboration, planning and preparation were represented as key ingredients for “good” endings. Factors viewed as complicating discharge included complexity and changes in presentation, psychosocial contexts and re-referrals. Perceptions of clients’ feelings (resistance and dependence, fear and anger, relief and gratitude) and varying feelings evoked for clinicians (from little or no reported impact, to pride and confidence, sadness and worry) at the ending of the working relationship were reported. Suggested organisational supports for clinicians with endings and discharges involved opportunities to consult with colleagues, psychological formulation and advice and reflective supervision.

Originality/value

There has been limited empirical attention to practitioner experiences of discharge in the work of CMHTs in a UK context; this practitioner-led evaluation explored clinician perspectives.

Citation

Moore, I., Archard, P.J. and Simmonds, S. (2024), "Clinician perspectives on endings and discharges in community mental health work", Mental Health Review Journal, Vol. 29 No. 4, pp. 360-373. https://doi.org/10.1108/MHRJ-06-2022-0040