What Care Should You Plan Before
You Leave the Hospital
Leaving the hospital, especially from a mental health ward, secure unit, or acute setting, can be a major step. While it can bring relief, it also comes with questions and concerns about what happens next. That’s why discharge planning is such an important part of the process. It helps make sure that the right care, support, and safety measures are in place before you return to the community.
At Standby24, we specialise in supporting individuals with complex needs, including those with learning disabilities, autism, mental health diagnoses, and behaviours that challenge. We are often called in to assist with high-risk discharges from hospitals or secure settings, helping to ensure the transition is as safe, structured, and person-centred as possible.
Why Discharge Planning Matters for Complex Needs
When someone is being discharged from a hospital or secure setting, there are often risks involved, especially for people who require high levels of support. Without the right care in place, they may struggle with changes in routine, medication, safety, or behaviour. In some cases, a lack of planning can lead to further crises or even readmission.
Discharge planning ensures that:
⦿ The individual’s needs are assessed before leaving the hospital
⦿ A personalised care plan and risk assessment are created
⦿ Support is ready as soon as they return to the community
⦿ Families, professionals, and care staff have clear guidance
⦿ The handover between services is smooth and structured
This kind of planning is especially important for individuals who have experienced multiple placements, complex trauma, or are leaving mental health units, secure hospitals, or police custody.
What to Think About Before Leaving the Hospital
Every person’s needs are different, and that’s why care plans must be tailored to the individual. If you or a loved one is preparing for discharge, these are key things to consider:
⦿ Does the person need support for mental health, autism, or behaviours that challenge?
⦿ Is the environment they’re returning to safe and appropriate?
⦿ Is there a plan in place to manage any triggers or risks?
⦿ Who will support them during the first hours and days at home?
⦿ Are care staff trained and able to respond to challenging behaviours?
⦿ Is there a clear crisis plan in case support is needed urgently?
How Standby24 Supports Hospital Discharge
At Standby24, we are frequently called upon to assist with urgent or complex discharges where risk is high and specialist support is required. Our team can respond within four hours in crisis situations and is trained to manage high-risk behaviours in a safe, trauma-informed way.
Here’s how we help:
⦿ Crisis response within 4 hours, including from secure hospitals, acute mental health units, or police custody
⦿ Person-centred care planning, with bespoke risk assessments tailored to each individual
⦿ BILD-accredited PBS practitioners and experienced staff trained in physical intervention (Team Teach)
⦿ Bridging support while permanent placements are arranged
⦿ Support worker upskilling, helping future staff shadow and learn from our experienced teams
⦿ Technology-enabled care, using PASS to ensure live note-taking, care plan access, and incident tracking
⦿ Close collaboration with families, making sure the person’s voice and goals are central to the care plan
We don’t offer general domiciliary or medical home care, but for individuals with complex needs, we provide structure, stability, and professional support exactly when it’s needed most.
What You Can Ask Before Discharge
Being involved in discharge planning can make a big difference. If you’re a family member or professional supporting someone, it’s okay to ask questions like:
⦿ Who is responsible for writing the care plan and risk assessment?
⦿ What support will be in place the moment they leave the hospital?
⦿ Is there a Positive Behaviour Support (PBS) plan in place?
⦿ What happens if the person enters a crisis at home?
⦿ Are the staff trained in the right intervention techniques?
⦿ How will information be shared between professionals?
The more detailed the planning, the safer and more stable the transition is likely to be.
Conclusion
Care after leaving the hospital should never be rushed, especially when someone has complex needs. With the right discharge planning and support from services like Standby24, individuals can return to the community with dignity, safety, and the necessary structures in place.
Our team specialises in stepping into high-risk situations, offering short-term, intensive support that stabilises and protects individuals during their most vulnerable moments. Whether you’re a commissioner, a professional, or a family member looking for help during a difficult discharge, we’re ready to respond and support you.
Need help planning a safe discharge from a hospital or secure setting? Get in touch with Standby24. We’re here when you need us, ready to respond and care.