Mental Health

Admission & Discharge

Diploma Nursing
Lecturer: Donald Conteh
Mental Health Admission
• The decision to admit a person in a Psychiatric Hospital is based on the nature of the
mental distress or psychological difficulties; duration of the psychological difficulties;
disability and deterioration on the level of daily function as a result of the psychological
difficulty and significant risk to self and / or others.
• Admission in a mental health hospital is either an informal (voluntary) or restricted
(involuntary) admission and based on a Mental Health Act.
• Voluntary Admission: the patient voluntarily agrees to hospital admission; and is not
deem by the Psychiatrist to be a danger to self and other; and agrees to the treatment
plan including medication compliance.
• Involuntary admission: the patient with mental illness and who is deem to be a danger
to self and / or others is admitted to an approved mental health hospital against his/ her
will; and not allowed to leave the hospital unless given leave of absence by psychiatrist
or senior mental health nurse. The person may be detained on a Mental Health Act.
• The psychiatrist must be satisfied that the person has a mental illness and needed
treatment that is available in the hospital and without the treatment the person’s health
will deteriorate.
• The Mental Health Act should guide the admission. For a person to be detained he/ she
must have been diagnosed with mental illness or impaired or suffering from a
psychopathic disorder; the treatment required must be available only in the hospital
Admission (cont)
• The admission procedure is initiated with an assessment of the
person’s mental state using validated tools such as TAG, level of risk
and support systems.
• The assessing practitioner also considers the person’s behaviour in
the past 48 hours and deterioration in the level of functioning.
• The assessment should consider what is most relevant to meet the
person’s needs and to utilize the strength of the person, which will
result in reduced risk of causing additional stress during the course of
the assessment.
• Following the of needs and level of risk, the assessing practitioner
mostly psychiatrist or a senior mental health nurse advice on the level
of observation that is to be placed on the person during the initial
days of admission. The observation level should be reviewed on an
on-going basis and should reflect the principle of least restriction.
Admission (cont)
• Admission to hospital is a potentially distressing experience for the patient, carer
and relevant others. Therefore, staff should be aware of the patient and family
potential emotions and must provide information and support to them
throughout the admission procedure.
• The provided information should be given in a manner that reflect all care
options, embraces the principles of recovery and should convey hope. The
information should be clear about the reasons of the patient’s admission, tailored
to the needs of the patient’s, carer and relevant others.
• The patient should be assigned to a named nurse on the ward and his/ her role
identified to the patient so as to enable trust, build a therapeutic relationship and
enhance confidence to devolve information.
• The mental health nurse should be aware of the patient lack of ability to absorb
information at the time of distress and environmental change.
Admission (cont)
• The mental health nurse should inform relevant practitioner and
agencies that were engaged with the patient care about the
admission and request relevant information.
• The social needs of the patient should be considered as early as
possible on admission in order to allow a multi-disciplinary approach
to support the patient following discharge.
• The planning of the patient’s recovery journey must be patient-
centred taking into consideration the assessment of needs and care
planning approach.
• The care plan must address the nursing diagnosis such as
hallucination ( hearing voices); and planning should involve the
patient so as to promote share understanding of the recovery-focused
interventions
Discharge
• The discharge planning requires dedicate time for discussion in a ward
round or clinical meeting involved the patient, nearest family and relevant
professionals and agencies; to agree on interventions and facilitate required
support; making the patient’s transition back home as smoothly as possible.
• There should be updated progress medical and nursing records, current risk
assessment and management plan, contingency plan, and information
about community services for support and follow-up appointment to be
provided to the patient and family in the discharge meeting.
• The discharge of the patient should be well-planned and coordinated
through proper multidisciplinary meetings in the hospital involving all
relevant practitioners and/ or agencies.
• There should be prescribed medication on discharge.
• All communications must be recorded accurately and comprehensively; and
with a thorough care plan with explicit details about follow-up of the
patient and written in a format that the patient and carer understands.
Discharge Follow-up
• The discharge patient should be referred to a Home Treatment Treatment (if
available)
• The patient should be provided 48 Hours follow-up with a Psychiatrist in an Out-
patient clinic to review progress and medication compliance at home.
• If the patient is suffering from a severe and enduring mental illness and/ or a risk
to self and others, he/she should be allocated to a Community Psychiatric Nurse
for case management.
• The patient should be provide initially 3-monthly follow-up and subsequently 6-
monthly follow-up appointments as regular review of mental state and efficacy of
prescribed medication.
Reference
• National Health Service (2009) Admissions to Mental Health Inpatient Services.
Scotland. NHS Quality Improvement
• Ndetei, DM. Szabo, CP. Okasah, T. Mburu, JM (2006) The African textbook of
Clinical Psychiatry and Mental Health. Kenya, AMREF.