Archard, Philip, Moore, Isobel and Simmonds, Sarah (2024) Clinician perspectives on endings and discharges in community mental health work. Mental Health Review Journal, 29 (4). pp. 360-373. ISSN 1361-9322

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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.

Item Type:	Article
Additional Information:	Article publication date: 14 October 2024. Issue publication date: 12 November 2024
Uncontrolled Keywords:	Clinical decision making, Community mental health services, Endings, Service evaluation, Discharge planning, Therapeutic relationships
Subjects:	Disabilities & Disorders (mental & physical) > Mental Health - Social Welfare Health and Medical Sciences > Patient Care Psychological Therapies, Psychiatry, Counselling > Patient/Therapist Interaction
Department/People:	Children, Young Adult and Family Services
URI:	https://repository.tavistockandportman.ac.uk/id/eprint/2942

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