Clinician perspectives on endings and discharges in community mental health work
| Date | 14 October 2024 |
| Pages | 360-373 |
| DOI | https://doi.org/10.1108/MHRJ-06-2022-0040 |
| Published date | 14 October 2024 |
| Author | Isobel Moore,Philip John Archard,Sarah Simmonds |
Clinician perspectives on endings
and discharges in community mental
health work
Isobel Moore, Philip John Archard and Sarah Simmonds
Abstract
Purpose –The process of ending mental health support is often not well-attended to in practice or
research, and clinicians in UK mental health services lack focused clinical guidance in this area. This
paper aims to report on a serviceevaluation that sought to understand from clinicians workingin a single
adult community mental health team (CMHT) their experiences of discharge and issues arising in the
process, factorsconsidered in decision-making and what constitutes‘‘good’’ endings and what support
could behelpful to them in navigating this with clients.
Design/methodology/approach –Semi-structuredinterviews were completed with six members of the
multi-disciplinaryteam and analysed thematically.
Findings –Clinicians described a range of criteria considered in discharge decision-making. Collaboration,
planning and preparation were represented as key ingredients for ‘‘good’’ endings. Factors viewed as
complicating discharge included complexity and changes in presentation, psychosocial contexts and re-
referrals. Perceptions of clients’ feelings (resistance and dependence, fear and anger, relief and gratitude)
and varying feelings evoked for clinicians (from little or no reported impact, to pride and confidence, sadness
and worry) at the ending of the working relationship were reported. Suggested organisational supports for
clinicians with endings and discharges involved opportunities to consult with colleagues, psychological
formulation and advice and reflective supervision.
Originality/value –There has beenlimited empirical attention to practitionerexperiences of discharge in
the workof CMHTs in a UK context; this practitioner-ledevaluation explored clinicianperspectives.
Keywords Clinical decision making, Community mental health services, Endings, Service evaluation,
Discharge planning, Therapeutic relationships
Paper type Case study
Introduction
Guidance on best practice in mental health care (e.g.National Collaborating Centre for
Mental Health, 2012;Webb et al.,2021) and service user accounts (e.g. Webb et al., 2019)
highlight how discharge from services can evoke difficult emotional reactions for the person
being discharged and sometimes prompt the re-emergence of particular issues (e.g.
feelings of abandonment). Nevertheless, endings-specific practiceguidance for mental
health services is lacking. The significance accorded to endings in psychotherapy is
extensively addressed in writingand research (e.g. Ra
˚bu et al.,2013;Vasquez et al.,2008).
From a psychodynamic perspective, the impending separation brought about in working
towards ending is viewed as a critical period in the therapeutic endeavour. It can, at once,
be a catalyst that remobilises conflicts for which therapy was sought, and a decisive
juncture in the client’s developmentof self-understanding (see, e.g. Huntley, 2002;Nursten,
1997). Yet, research suggests that when outcomes do not improve, poor experiences of
ending are common and can lead to mental health setbacks(Bear et al., 2022).
Isobel Moore is based at
Adult Mental Health,
Leicestershire Partnership
NHS Trust, Leicester, UK
and Derbyshire Healthcare
NHS Foundation Trust,
Derby, UK.
Philip John Archard is
based at Child and
Adolescent Mental Health
Service, Leicestershire
Partnership NHS Trust,
Leicester, UK and
Tavistock and Portman
NHS Foundation Trust,
London, UK.
Sarah Simmonds is based
at Adult Mental Health,
Leicestershire Partnership
NHS Trust, Leicester, UK.
Received 26 June 2022
Revised 27 February 2024
31 July 2024
Accepted 28 August 2024
PAGE 360 jMENTAL HEALTH REVIEW JOURNAL jVOL. 29 NO. 42024, pp. 360-373,©Emerald Publishing Limited, ISSN 1361-9322DOI 10.1108/MHRJ-06-2022-0040
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