“You Might Lose Him through the Cracks”: Clinicians’ Views on Discharge from Assertive Community Treatment



Elizabeth Bromley, Lisa Mikesell, Nikki Panasci Armstrong, Alexander S. Young

Administration and Policy in Mental Health and Mental Health Services Research

April 2014






Assertive Community Treatment (ACT) teams are increasingly interested in improving access to ACT through discharge of improved clients to less intensive mental health care services. We report results from a process evaluation of three teams in the VA’s ACT program, Mental Health Intensive Case Management (MHICM), that began to implement discharge. MHICM clinicians (n = 15) describe significant barriers to discharge. Clinicians support the concept of discharge but raise concerns about clients’ future stability, clients’ feelings about discharge, and other aspects of the discharge process. We propose strategies that can be used to support clinicians and clients in discharge decision-making.