title: "You might lose him through the cracks": clinicians' views on discharge from Assertive Community Treatment.
abstract: Assertive Community Treatment (ACT) teams are increasingly interested in improving access to ACT through discharge of improved clients to less intensive mental health care services. We report results from a process evaluation of three teams in the VA's ACT program, Mental Health Intensive Case Management (MHICM), that began to implement discharge. MHICM clinicians (n=15) describe significant barriers to discharge. Clinicians support the concept of discharge but raise concerns about clients' future stability, clients' feelings about discharge, and other aspects of the discharge process. We propose strategies that can be used to support clinicians and clients in discharge decision-making.
authors.affiliation: Desert Pacific VA Mental Illness Research, Education and Clinical Center (MIRECC), Greater Los Angeles Department of Veterans Affairs Healthcare Center, Los Angeles, CA, USA, ebromley@mednet.ucla.edu.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Bromley
authors.forename: Lisa
authors.initials: L
authors.lastname: Mikesell
authors.forename: Nikki Panasci
authors.initials: NP
authors.lastname: Armstrong
authors.forename: Alexander S
authors.initials: AS
authors.lastname: Young
mesh_terms: D001291:Attitude of Health Personnel; D003156:Community Mental Health Services / Q000458:organization & administration*; D003657:Decision Making; D006297:Health Services Accessibility / Q000458:organization & administration; D006801:Humans; D001523:Mental Disorders / Q000628:therapy*; D010351:Patient Discharge