Exploring the barriers and facilitators of discharging children and young people from child and adolescent mental health services.

Abstract

BackgroundThe pressures on community Children and Young People's Mental Health Service (CYPMHS) clinicians to manage and maintain caseloads can be immense, therefore discharging young people from CYPMHS in a safe and timely way is often discussed as a priority. However, there is limited research into how discharge can be done well, especially for discharge occurring prior to children and young people (CYP) reaching the upper age limit of CYPMHS. Thus, this study aimed to gain a better understanding of the barriers and facilitators discharging CYP from community CYPMHS, by exploring clinicians experiences of discharging CYP from their service.MethodSemi-structured interviews of 30-40 minutes were conducted with 12 clinicians working at different CYPMHS in England and analysed using codebook thematic analysis.ResultsSix themes were identified. These included, "perfectionistic approach towards treatment outcomes", "reducing dependence on CYPMHS through empowerment", "a lack of flexibility in the wider system", "lack of collaborative care", "an increasing pressure on the service" and "keeping the focus on discharge".ConclusionClinicians face multiple barriers when discharging CYP which should be addressed, alongside enhancing the use of reported facilitators to ensure timely, safe and well-managed discharges.