Purpose: Social workers in inpatient psychiatric settings provide discharge planning to facilitate community re-integration, recovery and improved quality of life for clients. Yet, there is little research to guide empirical and theoretical understanding of this important intervention. The objective of this study was to contribute to research and theory in the area by exploring quality of life outcomes for psychiatric inpatients who had received discharge planning services during a hospital admission. This paper reports on the second phase of a research study exploring processes of discharge planning on a general psychiatry unit (Williams, 2004).

Methods: Fifty-six inpatients (28 women, 28 men) were interviewed within three days of their discharge from a general psychiatry unit and then were re-interviewed six months later. At discharge and six months later, interviewers administered measures of symptom level, social support (affective and confidante social support), satisfaction with discharge planning, and objective quality of life and subjective quality of life. Paired t-tests were performed to establish if there had been changes in symptom level, affective social support and confidante social support, objective quality of life and subjective quality of life during the six month interval. Regression analyses were performed to explore the contributions of individual attributes and aspects of discharge planning to changes in quality of life experienced over the six month period.

Results: Paired t-tests revealed that there were no significant changes in symptom level, affective social support, confidante social support or objective quality of life during the six month interval. Yet, the participants had experienced significant improvements in subjective quality of life (t=-2.224, p=.03). A regression model using discharge planning satisfaction, confidante support and affective support as predictors of residualized change scores for subjective quality of life predicted 41% of the variance (Adjusted R² = .405, F (4,51)=9.679, p<.001). Independent predictors in the model were confidante and affective support as measured at time 1 and ratings of discharge planning satisfaction at time 2.

Implications for Practice: The results of this study suggest that discharge planning in psychiatric settings can have an impact on subjective quality of life even when there are not concurrent positive shifts in symptom level, social support or objective quality of life. Phase I results demonstrated that social work discharge planning interventions were focused on mobilizing social support most frequently. The Phase II finding that social support and satisfaction with the discharge planning process predict changes in subjective quality of life, despite the absence of concurrent improvements in objective quality of life or symptom level, reinforces that social interventions are a valuable component of the discharge planning process. The results of this study provide empirical support for promoting social interventions as part of discharge planning and also reinforce social work's theoretical emphasis on intervening from a person-in-environment perspective.

Williams, C.C. (2004). Discharge planning process on a general psychiatry unit. Social Work in Mental Health, 2(1), 17-31.