This report considers discharge planning for patients leaving mental health inpatient units in New Zealand. The report considers whether discharge planning is completed as intended, whether the needs identified are met after people leave hospital, and whether discharge planning is helping to improve outcomes for people. Staff analysed data for all district health boards, closely inspected practices at three district health boards, and considered the views of a broad range of people directly involved in delivering services.
Mental health problems affect New Zealanders from all walks of life, with one in five people affected each year. The number of people accessing specialist mental health services has been increasing steadily since at least 2003. The office carried out a performance audit that focused on the relatively few people who are most unwell with mental health problems and require a high level of care, including care in a hospital-based inpatient unit.
Overall, the timeliness, quality, and effectiveness of discharge planning (and the associated follow-up work) are impaired by pressures on inpatient and community services and other factors. The extent of these pressures and how well discharge planning is done varies.
There are clearly pressures on parts of the mental health system and support services that demand urgent attention and, potentially, innovative solutions. In this challenging context, the planning for discharging people dealing with acute mental health problems from hospital needs to be done to a high standard.
We recommend that district health boards:
- urgently find ways for inpatient and community mental health teams to work together more effectively to prepare and implement discharge plans, ensuring that all those who need to be – the person to be discharged, family, other carers, and all service providers – are appropriately involved and informed;
- help staff by improving the guidance and tools to support discharge planning (including information systems) so that the information needed for discharge planning can be accessed and brought together easily and efficiently; and
- regularly review the standard of discharge planning and follow-up work to identify and make improvements.
We recommend that the Ministry of Health and district health boards:
4. quickly make improvements to how they use information to monitor and report on outcomes for people using mental health services; and
5. use the information from this monitoring to identify and make service improvements.