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Discharge meetings

Mental Health Crisis: Questions to Ask Before Your Loved One Goes Home

Questions to bring to the psychiatric discharge meeting, covering diagnosis, medication, follow-up, family role, and what to do to prevent it from happening again.

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Karina Marwan, RN, MSN, Family Mental Health Advocate
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Discharge meetings move fast. The team has a checklist; you should have one too. This is the question script I give every family before they walk into their loved one's discharge meeting or call, whether the admission is at Mills-Peninsula, El Camino, or anywhere else. Print it, take it with you, take notes, follow up in writing.

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.

How to use this list

Before the meeting

  • Print the list. Have a pen and paper.
  • Decide who in the family is the note-taker and who is the lead question asker. Two roles, two people if possible.
  • Add 2–3 questions specific to your loved one's history at the top.
  • Ask permission to record the session if that helps you. Some teams allow this.

During the meeting

  • Do not be afraid to interrupt politely. "Before we move on, can you say more about that?"
  • Write down direct quotes when you can. "The dose is 5mg twice daily" is more useful than "they explained the meds."
  • If the team is rushing, name it. "I want to make sure I understand this before we leave. Can we slow down for two minutes?"

After the meeting

Email a summary of what was decided to the social worker or lead clinician that same day. "Confirming what we discussed today: discharge on Friday (date, approx time), follow-up with Dr. X on (next date and time), lithium 600mg twice daily…" If something was misstated or omitted, you have documented it.

Questions about the diagnosis

What's working: a team that can name the diagnosis, explain how they arrived at it, and/or say what they are still ruling out.

What's a red flag: a team that will not name a diagnosis at all, or one that gives a diagnosis without ruling-outs.

  1. What is the working diagnosis? What other diagnoses are you considering or ruling out?
  2. What changed during this admission to support that diagnosis?
  3. Who will update the outpatient psychiatrist about this admission, the current medications, and the discharge plans?

Questions about discharge readiness

  1. Discuss why the team feels their loved one is ready for discharge.
  2. Does the family agree? Does the family feel safe taking their loved one home?
  3. What happens if the family does not feel safe taking their loved one home right now?

Questions about medication

This is where the most preventable readmissions start.

  1. What medications are being prescribed at discharge, at what doses, and for how long before reassessment?
  2. How is this regimen different from what they were taking before admission, and why?
  3. What are the side effects we should watch for and report? Report it to who?
  4. Which side effects mean "call the office," "call the advice nurse," and which mean "go to the ED"?
  5. Is this medication being given over my loved one's objection? If so, has there been a Riese hearing?
  6. What's the plan for refills? Who writes the next prescription, and when? Have they been notified?
  7. Is there a long-acting injectable option that should be discussed (especially if medication noncompliance has been an issue)? Should it be started before discharge?

A "good" answer covers the next 30 days, not just the next 3. If the team can only tell you what to do for a week, ask who is responsible for the rest.

Questions about follow-up care

The follow-up gap is where a well intended plan can go wrong.

  1. When is the first outpatient appointment? With whom, and where?
  2. If that appointment is more than 7–10 days out, can we add a bridge appointment, an IOP/PHP intake, or a primary care visit in the meantime?
  3. Is my loved one eligible for an Intensive Outpatient Program (IOP) or Partial Hospitalization Program (PHP)?
  4. Who is responsible for re-engaging with care if the first appointment is missed?
  5. What should we do if my loved one refuses to go?
  6. Are there community supports we should be connected to, including NAMI Family-to-Family for family members, peer-run programs, or supported housing for your loved one?

Questions about the family's role

The team may have assumptions about what the family will and will not do. Surface them.

  1. What does the team need from us in the next 72 hours?
  2. What does "supportive home environment" look like in this case, concretely?
  3. Who in the family is being asked to be the point of contact?
  4. Are there things we should not do, such as not pushing certain conversations, not changing household routines, or not enforcing certain expectations in the first weeks?
  5. How do we balance support with our own boundaries?

This last one matters. The most sustainable family caregivers are the ones who understand and maintain healthy boundaries. Burnout is a risk factor for everyone.

Questions about safety and crisis planning

If you do not leave the meeting with answers to these, the discharge plan is not done.

  1. What are the specific warning signs for this person, not generic warning signs, but theirs?
  2. What's the escalation plan if a warning sign appears? Do what? Call whom, in what order?
  3. Do they have a means-restriction plan for medications, alcohol, or firearms in the home?
  4. Has a safety plan or WRAP plan been completed with the patient?
  5. Is mobile crisis response available in our area? (In San Mateo County, ask BHRS Access at 800-686-0101.)
  6. What should we do if my loved one is showing warning signs and refuses to engage?

The companion to this list is our discharge planning checklist for families , which walks through how to set up the first 72 hours at home.

Questions about insurance and continuity of care

High-leverage.

  1. Who handles insurance authorization for the next level of care?
  2. What if the IOP or desired outpatient provider is not in our network, and what is the appeal process?
  3. Will the unit help arrange transportation if needed?
  4. Will medical records be sent to the outpatient psychiatrist automatically, or does there need to be a signed release?
  5. If we want a second opinion, what's the cleanest way to arrange it without disrupting care?

Questions to ask your loved one (privately, if possible)

The team's plan only works if your loved one is part of it.

  1. What do you want to happen at home? What are you worried about?
  2. What was helpful on the unit? What wasn't?
  3. How do you want us to respond if you say you're not feeling safe?
  4. Do you want to develop a WRAP while things are clear?
  5. What's one thing we can do this week that would make this easier for you?

Common mistakes at discharge meetings

  • Allowing a loved one to be discharged too soon without pushing back when necessary.
  • Asking too many questions at once. The team will pick the easiest one to answer. Ask one, get the answer, write it down, ask the next.
  • Letting the team rush. Discharge meetings are often back-to-back. It is okay to say, "I need five or ten more minutes."
  • Not asking the patient. If or when well enough, they are the expert on themselves.
  • Forgetting to ask about side effects. First-week side effects on antipsychotics or mood stabilizers can scare a person or family into stopping medication. Knowing what to expect and what can be done prevents that.
  • Trusting your memory. Do not. Write everything down. As soon as possible. Confirm in writing afterward.

San Mateo County resources

Every 5150-designated facility has a Patients' Rights Advocate; ask the unit social worker for their direct number.

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.

Call the outpatient psychiatrist for medication side effects, missed doses, or behavioral changes that do not rise to 911/988 but concern you.

How an advocate helps in the discharge meeting

What I do, if you bring me in: Prepare you for meetings and/or sit in on discharge meetings, ask the questions you likely did not even know to ask, take the notes, push back with or for you, send the same-day summary email to the social worker, and check in to help troubleshoot during the first 72 hours after discharge. I work for you, not the hospital or your insurance.

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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