My loved one is being discharged from hospitalization, and I don't think they're ready. What can I do?

Your loved one is being released from inpatient hospitalization, and you're worried they are not ready. This is a common concern for caregivers who support loved ones with serious mental health conditions.

It's important to note that inpatient hospitalization is mainly focused on stabilizing symptoms until someone is safe to go home. It's much less common than it used to be for people with mental illness to receive long-term mental health treatment while they are hospitalized. However, any symptoms that put your loved one in urgent danger or make it impossible for them to function independently should be well-stabilized before they are discharged from the hospital.

Signs that your loved one may not be ready for hospital discharge include:

Talking or seriously thinking about suicide
Talking or seriously thinking about hurting others
Inability to meet basic survival needs like eating and drinking

If you believe your loved one is being discharged from the hospital before they are ready, there are two routes you may wish to take. The first is to advocate for your loved one to remain hospitalized until they are more stable. If extending their hospital stay is not possible, you can try advocating for your loved one to be connected with a highly structured treatment program or other supportive services to encourage their safety and recovery once discharged.

Advocate for your loved one to remain hospitalized until they are more stable

A helpful place to start may be to ask yourself why you think your loved one is not ready to be discharged from the hospital. Ask yourself these questions:

Do you believe your loved one is in danger of harming themselves or someone else?
Do you feel your loved one is unable to care for their basic living needs like eating and drinking?
Do your loved one's symptoms make it difficult for them to safely interact with the world around them?
What are you worried might happen if your loved one is discharged too early?

Put your concerns in writing. Be specific about what you have seen or heard that makes you worried your loved one is not ready to be discharged from inpatient hospitalization. Use direct quotes, with specific dates and times, whenever possible. For example:

“During visiting hours on [insert date], my daughter stated to me and her mother that she intends to overdose on her medication when she is released."
"My brother called me at [insert time] on [insert date] shouting that he believes his neighbor is plotting against him. He said he will 'neutralize her' when he is released from the hospital."
"I am concerned that my mother is still unable to meet her basic survival needs at this time. She still appears to be having thoughts that the water is poisoned. On three occasions in the past two days [insert dates], I have observed her pouring out or spitting out water after hospital staff leave the room."

After outlining your concerns, include a request for your loved one to remain hospitalized until any symptoms or behaviors affecting their safety have stabilized. Once this information has been prepared, share it with your loved one’s treatment team both verbally and in writing.

Sharing one-way information with the treatment team

If your loved one has not signed a release of information for you to speak with their treatment team, you still have the right to participate in one-way information sharing by communicating your concerns to their treatment provider(s). This often happens to families who receive limited notice about their loved one’s release and need to act quickly.

It is especially important to exercise the right to one-way information sharing when you are concerned about your loved one’s safety. Any information you share should be uploaded to your loved one’s patient chart, where their treatment provider(s) can see it.

It is not a violation of HIPAA for a family member to communicate one-way with their loved one’s treatment team. However, many people don’t realize that it is OK for families to do this. You may need to take these steps to make sure the treatment provider receives your concerns:

Contact the hospital unit where your loved one is staying
Inform the hospital staff member you speak with that you have important information to share about your loved one’s safety and well-being
If they tell you that there is no release of information on file for you to share information, kindly inform them that HIPAA does not prevent you from sharing one-way information about your loved one’s safety and treatment needs
Ask how to urgently communicate with the treatment provider(s) by fax, email, or even by delivering a letter directly to the hospital
Restate your request, emphasizing the urgent nature of the situation, until you receive instructions for delivering your written concerns via fax, email, or hand delivery
Write “ATTENTION:” followed by the name of the treatment provider(s) responsible for your loved one’s care at the top of the documents you deliver
Request that your written concerns be included in your loved one’s patient chart

Expressing your concerns to the treatment team

If your loved one has signed a release of information, you should be able to speak with their treatment team about your concerns. You can kindly ask them to explain on what basis your loved one is being discharged. If you firmly believe that the safety of your loved one or someone else will be at risk, use the evidence you documented to advocate as much as possible for your loved one to stay in inpatient care.

If you start this conversation with a nurse, social worker, or discharge planner, you may consider asking to speak directly with your loved one’s psychiatrist or treating professional. Restate your concerns and ask what options there may be for extending your loved one's stay until they are more stable.

Contacting the Patient Ombudsman Office

If your loved one signed a release of information, but you are being denied access to speak with their psychiatrist or treating professional, consider contacting the hospital’s Patient Ombudsman Office. This office is responsible for ensuring that patients receive fair and respectful treatment.

When you reach the Patient Ombudsman Office, explain that you have serious concerns about your loved one being discharged and that you are unable to speak with their psychiatrist. Advocate for a meeting with the treating professional so you can discuss your urgent concerns before your loved one is discharged.

You may also wish to contact the Patient Ombudsman Office if you have strong reason to believe your loved one should not be discharged due to safety reasons, and you have expressed these concerns to your loved ones treatment provider(s), but your loved one is set to be discharged anyway. Ask the ombudsman who you can elevate your concerns to and continue advocating as much as possible. Keep good notes of your interactions with hospital staff and any steps you are advised to take throughout the process.

Advocate for your loved one to be connected with highly supportive step-down services

Despite your best efforts, there may be some situations in which your loved one is discharged from the hospital before you feel like they are ready. When this happens, you can advocate for your loved one to be connected with highly supportive mental health services and other resources that give them the best chance at safely pursuing recovery when they get out of the hospital.

Part of discharge planning involves connecting your loved one to “step-down” mental healthcare services. Step-down services help your loved one get the treatment and support they need in an environment that is less restrictive than the hospital. They can include highly structured treatment programs or standard outpatient therapy and psychiatric services, depending on the person being discharged and their treatment needs.

Working with their treatment team and/or discharge planner, you can advocate for your loved one to be connected with the highest level of care possible as they “step-down” from inpatient care. Options may include a partial hospitalization or day treatment program, intensive community services like Assertive Community Treatment (ACT), or Assisted Outpatient Treatment (AOT). The goal should be for your loved one to get the services and resources they need to stay safe and pursue recovery once they are discharged.

Last, be sure that a safety/crisis plan is included in your loved one’s hospital discharge plan. The plan should clearly outline what signs and symptoms might show up if your loved one is nearing a mental health crisis. It should list steps your loved one can take, like coping skills they can practice and people they can call, to stay safe and well when they notice these signs. Most importantly, the plan should include information about what circumstances would lead to your loved one being re-hospitalized, and where your loved one can go for an evaluation if they experience a mental health crisis in the future.

We understand that this may be a difficult and overwhelming time, and we hope the information shared above will be helpful. If you are interested in connecting with other families who have navigated the hospitalization process in your area, consider connecting with your local NAMI Affiliate and participating in an Education Course, Support Group, or other local NAMI event.

Hours of operation: Monday-Friday, 10 a.m. – 10 p.m. EST

Call: 800-950-NAMI (6264)

Text: 62640

Email: helpline@nami.org

Website: www.nami.org/help