Because of the nature of higher levels of care, clinicians have to be thinking about discharge from the very beginning of treatment. Given that treatment is meant to stabilize acute symptoms, rather than restore someone to full functioning, what are reasonable treatment goals? What will tell us that the client is ready for discharge to a lower level of care? When should we conclude that the client has gotten as much as they can from this level of care, and lengthening their stay will not be therapeutic?
- Safety is paramount - if the client poses a threat to self or others at a lower level of care, they obviously aren't ready for discharge. Safety is also a consideration from the perspective of self-care, for psychosis, as well as indirect forms of self-harm, such as eating disorders.
- A decline in functioning may indicate that a higher level of care is necessary, while a plateau can be a sign that the client has gotten all they can from the current treatment and is ready for discharge. That said, some regression is possible prior to a planned discharge, and plateaus may not last.
- Disengagement may indicate a higher level of care (when there are safety issues) or discharge (when there are not safety issues)
How do you decide when to discharge or terminate with a client? What factors go into that decision?