RESUMO
Care extension programs that bridge hospitals into the community are today a mainstream component of psychiatric care around the world. Stronger linkages amongst community resources can help patients and their families transition successfully through the hospital discharge process and reenter the community. Discharge planning is a service that provides the needs-oriented care necessary to link the hospital and community. Such planning, handled in accordance with case management procedures, focuses on medical team cooperation, follow-up services and recovery evaluation. Using a review of the literature and a real case study, this article demonstrates the practical use of discharge planning services, analyzes problems frequently encountered during the discharge process and related interventions. By increasing the proper disease management knowledge of patients and their families, strengthening staff support to families through the creation of "medical leagues", establishing community care and better support networks, and implementing a discharge process evaluation procedure, discharge planning services may provide efficient and continuous medical care essential to prevent re-admission, reduce hospitalization expenses, and strike a better balance between medical service quality and cost.