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Discharge planning

Discharge Planning After a Mental Health Crisis: A Family Checklist

When your loved one is being discharged from a psychiatric hold, know what to expect, understand your rights, and learn how to advocate for the best outcome. A practical checklist for Bay Area families.

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Karina Marwan, RN, MSN, Family Mental Health Advocate
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Updated
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11 min read
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The biggest predictor of psychiatric re-hospitalization is a poorly planned discharge. Not the diagnosis. Not the severity of the crisis. The discharge.

If your loved one has been in a psychiatric unit at Mills-Peninsula, El Camino, Cordilleras MHRC, or anywhere else in San Mateo County, and the team is now talking about discharge, this is the checklist I walk every family through.

This guide is educational only. It is not legal or medical advice. If your loved one is in immediate danger, call 911 or go to the nearest hospital.

What is psychiatric discharge planning?

Discharge planning is the legally required process of preparing a patient to leave inpatient care safely. In a hospital with a strong unit, it begins on day one of admission. In a busy psychiatric unit under bed pressure, it can compress into a 30-minute conversation on the day of discharge.

The hospital's job is to discharge with a plan. Your job, as the family, is to make sure the plan is appropriate and realistic, including medications, follow-up, and the first 72 hours after the door closes behind them.

Why do the first 72 hours after discharge matter most?

Three reasons:

  1. Medication transitions. New doses, new side effects, missed pickups. The pharmacy often does not have the prescription ready when you arrive.
  2. Follow-up gaps. The first outpatient appointment may be weeks out. The risk window is the gap.
  3. Sleep and routine. A psychiatric unit is regimented; home is not. Disrupted sleep in the first nights home is itself a risk factor for a setback.

What to do when discharge is announced

The goal of this checklist is to compress the gap and stabilize those first 72 hours.

1. Get the discharge plan in writing and read it right away

Ask for the written discharge summary and read it right away. If something is missing (a follow-up appointment, a medication dose, a phone number), point it out and ask the social worker to add it. Once your loved one is signed out, getting changes added is almost impossible. The discharge plan should include, at minimum:

  • Discharge diagnosis (or working diagnosis)
  • Medication list with doses and instructions
  • Follow-up appointments with dates, times, providers, phone numbers, and addresses
  • Crisis plan and emergency contacts
  • Any pending labs, referrals, or tests

2. Confirm the first follow-up appointment is actually scheduled

"Will be scheduled" is not scheduled. Before your loved one leaves, you want a scheduled date, time, provider name, and address. If the appointment is more than 7–10 days out, ask whether a bridge appointment can be added. The risk is in the gap.

For Bay Area families: ask whether your loved one qualifies for an intensive outpatient program (IOP) or partial hospitalization program (PHP) as a step-down. Perhaps a step-down residential home is needed for a few weeks. These are supported homes with staff trained in supporting a stabilized re-entry into the community. All of these are designed for exactly the post-discharge window and are widely underused.

3. Reconcile the medication list against what they were taking before

Compare:

Surface any differences with the discharging psychiatrist, in writing. The most common cause of post-discharge readmission is a medication change that was not explained, was not tolerated, or was not filled.

  • What they were taking before the crisis
  • What they were given on the unit
  • What the discharge prescription says

4. Pick up the prescriptions before you go home

Drive to the pharmacy on the way home, with the patient if appropriate. If the prescription is not ready, find out exactly when it will be, and make sure your loved one has at least one dose to bridge. A 24-hour gap on antipsychotics or mood stabilizers is not a small thing.

5. Map who will be where for the first 72 hours

Sit down before discharge, even if you only have ten minutes, and write down:

The number of families who skip this step and end up with a re-admitted loved one is enormous.

  • Who will be at home with your loved one each night for at least three nights
  • Who is on call if something escalates, or what is the plan
  • Who has the medication
  • Who is making sure they eat and sleep
  • What is the plan for the first morning

6. Build a written escalation plan

A one-page document everyone has a copy of, covering:

This is the single highest-leverage document in psychiatric advocacy. Most families do not have one. Most readmissions could have been caught earlier with one.

  • What warning signs look like for this person (specific behaviors, not vague descriptions)
  • What to do at each level: call the outpatient psychiatrist, call BHRS, call 988, call 911
  • The phone numbers, in order
  • Who in the family is the point of contact, and do they have a signed release to speak to providers

7. Identify warning signs together

If your loved one is willing and able, build the warning-signs list with them, not for them, when they are stable. They may know their own pattern better than you do: what their first sign of escalation looks like, what helps and what does not, what they want done if they slip past their own ability to ask for help.

This is sometimes called a psychiatric advance directive, and while it is not yet recognized in San Mateo County, it can serve as a good template. Or consider developing a WRAP plan (a Wellness Recovery Action Plan), which guides decisions every step of the way with the goal of thwarting a crisis.

What to ask before discharge

  1. "What is the medication regimen at discharge, and what side effects should we watch for in the first 7 days?"
  2. "When is the first follow-up appointment, with whom, and how do we get non-emergent help if we need it?"
  3. "What are the warning signs that should prompt us to call the outpatient psychiatrist? To call 988? To call 911?"
  4. "If this happens again, what should we do differently?"
  5. "Is my loved one eligible for IOP, PHP, residential support, or assertive community treatment?"

The detailed version of this checklist is in our companion guide, Questions to Ask Before Your Loved One Goes Home . The five highest-leverage questions:

Common mistakes families make at discharge

  • Trusting the verbal handoff. What is said in the discharge meeting often does not match what is written. Get it in writing and check.
  • Assuming the patient has a primary care provider (PCP). Many do not. The discharging psychiatrist may not be following up; the outpatient psychiatrist appointment may be weeks out. The PCP is the bridge.
  • Not asking about side effects. Antipsychotic side effects in the first 7–10 days can be alarming. Knowing what is normal vs. concerning matters.
  • Filling the prescription "tomorrow." Do not. Fill the prescription today. Ask for a few days worth of medications if the full prescription is delayed. It is worth the ask, especially over the weekend.
  • Not having a script for "if X happens." Hope is not a plan. Write down what you will do, in order, before the moment arrives.

San Mateo County discharge resources

For families navigating a hold and discharge in the Belmont and mid-Peninsula corridor, the typical handoff sequence is: inpatient unit → IOP/PHP at El Camino or Mills-Peninsula → community psychiatrist + therapist + (recommended) NAMI Family-to-Family for family members.

When to call 988 or 911 after discharge

Call 911 if there is an immediate threat to life, such as active self-harm, an attempt in progress, or a credible threat to someone else. Tell the dispatcher it is a mental health emergency and ask for crisis-trained officers if available.

Call 988 if your loved one is in emotional distress, expressing suicidal thoughts, or you are not sure whether the situation is escalating. 988 can connect to local mobile crisis teams; in San Mateo County, those teams can sometimes respond instead of police.

Call the outpatient psychiatrist for medication side effects, missed doses, or any change in behavior that does not rise to the level of 911/988 but worries you.

How an advocate helps with discharge

What I do, if you bring me in to support discharge planning: sit in on the discharge meeting, get the plan in writing in real time, reconcile medications against the pre-admission list and psychiatrist's written plan, confirm follow-up is actually booked, build an escalation plan with you, and check in during the first 72 hours. I can untangle the jargon, and help avoid an early or inappropriate discharge.

You do not have to be the only one taking notes, the only one tracking medications, and the only one watching for warning signs.

Karina Marwan, RN MSN

RN, MSN, Family Mental Health Advocate

Karina Marwan, RN MSN, brings over 40 years of nursing expertise and two decades of personal experience supporting family members with serious mental illness. She has worked in the behavioral health field for many years. Karina assists families throughout the Bay Area and nationally in navigating psychiatric crises and the complexities of the mental health system. More about Karina

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