“You Might Lose Him Through the Cracks”: Clinicians’ Views on Discharge from Assertive Community Treatment

  • Elizabeth Bromley
  • Lisa Mikesell
  • Nikki Panasci Armstrong
  • Alexander S. Young
Original Article

DOI: 10.1007/s10488-014-0547-3

Cite this article as:
Bromley, E., Mikesell, L., Armstrong, N.P. et al. Adm Policy Ment Health (2015) 42: 99. doi:10.1007/s10488-014-0547-3

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.

Keywords

Assertive Community Treatment Serious mental illness Community mental health Therapeutic alliance 

Copyright information

© Springer Science+Business Media New York (outside the USA) 2014

Authors and Affiliations

  • Elizabeth Bromley
    • 1
    • 2
    • 5
  • Lisa Mikesell
    • 3
  • Nikki Panasci Armstrong
    • 4
  • Alexander S. Young
    • 1
    • 2
  1. 1.Desert Pacific VA Mental Illness Research, Education and Clinical Center (MIRECC)Greater Los Angeles Department of Veterans Affairs Healthcare CenterLos AngelesUSA
  2. 2.Center for Health Services and Society, Semel Institute for Neuroscience and Human BehaviorDepartment of Psychiatry and Biobehavioral Sciences, University of California, Los AngelesLos AngelesUSA
  3. 3.School of Communication and InformationRutgers UniversityNew BrunswickUSA
  4. 4.San Francisco Veterans Affairs Medical CenterSan FranciscoUSA
  5. 5.West Los Angeles VA Healthcare CenterUCLA Center for Health Services and SocietyLos AngelesUSA

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