Development of a comprehensive discharge framework for adolescent in-patient mental health care in Malaysia

Abstract

Background: In the Malaysian mental health setting, adolescents with psychiatric disorders (APDs) are admitted to psychiatric wards for treatment due to conditions such as suicidal behaviour, substance use, and worsening of psychiatric symptoms. These patients are particularly vulnerable to relapses and readmissions following hospital discharge. An effective and patient-tailored discharge plan is essential to ensure continuity of care, reduce readmission rates, and support long-term recovery. However, there remains a lack of qualitative research capturing the perspectives of key stakeholders—patients, caregivers, and healthcare providers - on the discharge process for APDs in Malaysia. Objectives: This study aims to (i) explore key components of previous discharge interventions for APD, (ii) examine stakeholder perspectives on discharge practices and challenges, and (iii) develop a discharge intervention framework for inpatient adolescent with psychiatric disorders. Methodology and Methods: A generic qualitative approach was employed across three phases. Phase one involved a document review of 221 patients' records to identify existing discharge-related interventions within psychiatric units. Phase two comprised of semi-structured interviews with 10 APD and 6 parents of APD (PAPD), alongside focus group discussions (FGD) with 25 mental health professionals. Phase three focused on synthesising the findings to inform the development of a discharge intervention framework. Findings: Analysis revealed two overarching themes and their sub-themes; Theme One: coordination in discharge planning and documentation of APD; 1) system and documentation process, 2) education and collaborative actions and 3) home and follow-up care. Theme Two: psychosocial support, engagement and mental health recovery. 1) family and peer support, 2) formal and informal community mental health services, 3) utilisation of technology on app, and 4) persistent stigma when support is not enough. Conclusion and Implications: The study offers to propose the framework of discharge interventions for inpatient adolescent mental health care in Malaysia based on insights from multiple stakeholders. The results highlight the need to develop adolescent-focused discharge plans, enhance clinician training, support caregiver involvement, and strengthen coordination practice to improve continuity of adolescent psychiatric care in Malaysia.

Keywords: Discharge Intervention, Adolescent with Psychiatric Disorder, Adolescent, Mental Health