What are the discharge criteria for a patient with anxiety disorder?

Discharge Criteria for Anxiety Disorders

Patients with anxiety disorders should be discharged when they demonstrate adequate symptom control, possess sufficient knowledge about their condition and treatment plan, have reliable outpatient follow-up arranged, and have adequate social support systems in place—not when they simply state they are no longer anxious. 1, 2

Core Discharge Readiness Assessment

Clinical Stability Indicators

• Symptom severity must be reduced to a manageable level, not necessarily absent, as complete symptom resolution is unrealistic at discharge 2, 3
• Assess using standardized tools (GAD-7, PHQ-9) rather than subjective patient statements alone 4, 3
• Avoid coercive statements such as "you cannot be discharged until you say you're not anxious," as this encourages dishonesty and impairs therapeutic alliance 1
• Note that 37-56% of psychiatric patients still meet criteria for moderate anxiety/depression at discharge—this alone should not delay discharge if other criteria are met 3

Knowledge and Self-Management Capacity

• Patient must demonstrate understanding of:
  • Their diagnosis and symptom triggers 2
  • Medication regimen, including dosing, timing, and expected side effects 2
  • Warning signs requiring urgent care 2
  • Coping strategies and when to use them 2
• Low knowledge scores at discharge predict 30-day readmission and unscheduled clinic visits, making this a critical discharge criterion 2

Safety Assessment

• Evaluate suicide risk comprehensively rather than relying on "no-suicide contracts," which have limited protective value and may reduce honest communication 1
• Active suicidal ideation alone should not automatically prevent discharge; assess intent, plan, access to means, and protective factors 1
• Ensure patient can identify crisis resources (hotline numbers, emergency department) and when to use them 1

Required Discharge Planning Elements

Outpatient Treatment Continuity

• Schedule first follow-up appointment within 7-14 days of discharge—the first month post-discharge carries the highest risk for adverse outcomes 1, 5
• Provide closely-spaced initial appointments rather than standard monthly intervals 1
• Confirm appointment details in writing and consider reminder calls 1
• If appointment is missed, actively contact the patient rather than waiting for them to reschedule 1

Medication Management

• Ensure 30-day supply of medications is available before discharge 2
• Verify patient can afford and access prescribed medications 2
• For patients on SSRIs/SNRIs, confirm they understand the 8-12 week timeline for full therapeutic effect 4
• If benzodiazepines are prescribed, provide explicit tapering plan with specific reduction schedule and warnings about abrupt discontinuation risks 1

Social Support Verification

• Assess and document specific support persons who can monitor the patient and respond if symptoms worsen 1, 2
• Low expected support scores predict unscheduled post-discharge clinic visits 2
• Ensure family/support persons understand warning signs and have emergency contact information 1
• Patients without adequate home support may require partial hospitalization or intensive outpatient programs rather than direct discharge home 1

High-Risk Discharge Situations Requiring Enhanced Planning

Patients with Recent Self-Harm

• Prior self-harm within 12 months increases readmission risk 4.9-fold 5
• These patients require weekly (not biweekly) initial follow-up 5
• Ensure means restriction counseling is completed 5
• Consider crisis response plan card with specific coping strategies 5

Patients with Poor Baseline Readiness

• Low personal status scores (feeling physically/emotionally unprepared) predict poor quality of life post-discharge 2
• May benefit from 1-2 additional days of stabilization or step-down to partial hospitalization 1, 2
• Intensify discharge education focusing on symptom management and self-care 2

Patients with Comorbid Depression

• Depression co-occurs in the majority of anxiety disorder patients 4
• Requires assessment of both anxiety and depressive symptoms before discharge 3
• Ensure treatment plan addresses both conditions, as undertreating either increases relapse risk 4

Common Discharge Pitfalls to Avoid

• Do not discharge based solely on length of stay or bed pressure—short stays are associated with higher self-harm risk 5
• Do not accept vague discharge plans such as "follow up with primary care"—specific appointments with specific providers must be scheduled 1
• Do not assume patient understanding—use teach-back methods to verify knowledge retention 2
• Do not discharge on Fridays without weekend crisis coverage plans, as access gaps increase early readmission 1
• Avoid discharging patients who lack stable housing without connecting them to social services, as housing instability predicts poor outcomes 3

Documentation Requirements

Document the following in discharge summary:

• Current symptom severity scores (GAD-7, PHQ-9) 3
• Patient's demonstrated knowledge of diagnosis, medications, and crisis plan 2
• Specific outpatient appointments scheduled with dates/times 1
• Identified support persons and their contact information 2
• Medication supply confirmed and reconciliation completed 2
• Safety plan including crisis resources 1