The transition from hospital to community living from mental health patients and carers

Abstract

This thesis explores the transition from hospital to community living for mental health patients and carers. This period presents a number of challenges and risks for patients and the support from family members throughout this period is invaluable. Through further exploration of the discharge process and period, this thesis considers how both patients and carers can be better supported to manage the challenges and increase the likelihood of a successful transition. The first paper is a systematic literature review investigating the predictors of suicide up to a year after discharge from mental health inpatient services. After database and manual searches were complete, thirteen studies met inclusion criteria and were reviewed and critically evaluated. Despite inconsistent findings across studies, the review identified some predictors of post-discharge suicide which have been replicated within and across cultures. Clinical implications in relation to thorough discharge planning and maintaining continuity of care are discussed. The second paper reports on a qualitative exploration of family members’ experiences of the discharge process from inpatient mental health services. Six family members were recruited and interviewed using a semi-structured method. The data was analysed using Interpretative Phenomenological Analysis. The three phenomenological themes emerging from participants’ accounts indicated that the discharge process was characterised by isolation, fear and exhaustion. The themes are discussed, explored and considered in relation to how services can increase carers’ involvement and strengthen their position in the discharge process. The final paper reflects on insights into the world of carers gained through the research process, with a focus on loss and grief in caring. Comparing the processes of therapy and research, the paper considers how research offered greater freedom to ‘hear’ experiences and the potential advantages of transferring these reflections to the therapy room