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Lacking preparation for community roles, many patients have failed to survive in the community.
Discharge planning for persons with mental health problems presents a unique set of challenges. This is particularly true for those persons who are considered chronically mentally ill, a group whose many special needs have been highlighted by the deinstitutionalization process. One of the major benefits of deinstitutionalization has been the growing understanding of the chronically mentally ill as individuals with disabilities that complicate their illnesses (Bacharach, 1986).
These chronically mentally ill palients often belong to the lowest socioeconomic group, and they are often undereducated, underskilled, and socially isolated. They are considered difficult to treat (Gomez, 1983). Some authors have likened the process of discharging patients from mental hospitals to throwing puppies on the freeway. Lacking preparation for community roles, many patients have failed to survive in the community, thus requiring frequent and costly rehospitalizations (Peterson, 1986).
Some social disabilities that impede these patients include lack of support networks, social skills, job skills, skills of daily living, and inability to solve problems to obtain basic needs such as food and shelter.
The Discharge Discussion Group
At Ancora Psychiatric Hospital, Hammonton, New Jersey, a discharge discussion group was initiated for patients residing on a 36-bed transitional unit. Goals for the group are to promote positive patient attitudes that have been found to correspond with greater compliance with aftercare, including recognizing the need for treatment, aftercare, and continuing medication (Axelrod, 1989), and to provide opportunities for patients to prepare for community re-entry through group discussion, role playing, and group problem solving. The group, which is held weekly, uses a psychoeducational approach. Concerns addressed in the group include medication compliance, employment, housing, loneliness, aftercare, and fear of not succeeding in the community.
Medication Compliance. "Will I always need to take these medications? If I fee! well, why do I need medication?"
These questions are often asked by patients anticipating discharge. Discontinuing psychotropic medications is a frequent cause of readmission following discharge. A series of videotaped lectures educates patients regarding benefits and side effects of medications, along with administration techniques. Group discussion centers on acceptance of the need for medication as one aspect of an ongoing disability.
Employment. "How long should I wait before I...