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Discharge Policy | Atrium Prison Counselling Service.

Discharge Policy | Atrium Prison Counselling Service

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1. Background

Discharge planning is key to safe services and addresses:

  • Risk management and mitigation.
  • Continuity of the work after the therapy intervention has finished.
  • Multi agency communication and systemic care.
  • The closure of a case is important therapeutically too. Endings matter particularly to those who have known abrupt endings or difficult attachments. Endings in terms of the individual’s experience and the collective understanding of the work are a priority in our work.
2. Assess and be curious to the unplanned discharge.

If clients want to end the work suddenly without reasonable explanation where risk features are evident; risk assess because:

2i. Sudden absences or increased withdrawal from services and commitments may be representative of suicidal advanced planning.

When there is a planned or unplanned discharge Atrium procedure is to task the mental health team, to inform them of discharge from Atrium, inform them of the reason for discharge and enquire if necessary, any follow up required on behalf of the client. This will then be due for discussion at the next referral meeting.

If you have heightened concern regarding a clients unplanned discharge. Enquiring with officers as to the prisoner’s general behaviour is always beneficial. Even if an officer says that they appear to be okay, follow this up with a discussion with the wider multi-disciplinary team, aka in healthcare MHT, G.P, Psychiatrists and Safer Custody on the prison side.

Consider other factors in the client’s life; underlying neurodiversity, history of mental health illness, history of self-harm, isolation or self-isolating behaviour that has increased, difficult personal life circumstances and recent or pending changes. Look out for unusual behaviours (reported or observed such e.g. the client is giving away his belongings/canteen and/or the client seems to have stopped making plans. Also assess protective factors or lack thereof. Speak to MHT as a matter of urgency. This might lead to involving the wider professional network if you have concerns and cannot get consent from the client.

3. Extension requests towards final sessions.

If there is an increased in risk and/or something occurs during therapy for example, a death of loved one, prisoner is attacked, parole is denied etc, and you believe the client would benefit from additional sessions, take this to supervision for discussion to assess whether this would be of benefit to the client.

4. Final session disclosures and risk.

If the client decides to disclose something at the end of the final session, it is imperative to follow up any risk and if need be, extend the final session to ascertain level of risk. Contact Prison Leads and/or Supervisor to determine course of action. Heightened risk to self or others is not always a reason to extend sessions. Appropriate and timely referral to relevant services will be required always and can be done without permission from the client due to risk. This or other actions are to be communicated to the client in the session if it is deemed safe enough to do so.

5. Expectations of the practitioner for final session.
  • Always communicate with the client about the upcoming final session at beginning of the penultimate session. Often clients do not register that our service is time limited.
  • Review the work (preferably with the client) and complete the CORE closure forms (e.g. CORE 34, End of therapy form – including benefits of therapy), Goal attainment form and client feedback form.
  • Ensure that the client has a plan for moving forward that they can articulate or share or if preferred is written out.
  • For clients who have a history of being at risk, or who have shown features of risk in our assessments, always ensure there is a safety plan agreed in place and shared with other agencies on discharge (by client consent). See Appendix for Safety planning
  • Risk assess with the client (where appropriate) the impact of the closure, potential added risks by the closure, history of closures and endings and strategies for management of abrupt endings. Consider the wider support services within the prison, key worker, safer custody, MHT health team, Samaritans and listeners. Communicate with the client, routes back into our services.
  • Record session notes and your actions for closure in your notes on System 1 and CORE
Discharge Letters

All clients completing sessions or who have agreed to end sessions, will be sent a discharge letter (template on S1) this informs them of the date started and completed sessions, the number of sessions completed and their level of engagement.

(See Appendix to Referral and Discharge Policy for process of creating letter on S1)

Last Review Date: August 2023
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