Most Wisconsinites assume the most vulnerable moment in a mental health crisis is the crisis itself, the emergency room, the inpatient stay, the days of acute symptoms. The clinical evidence tells a different story. The most precarious moment, statistically, is the one almost no one is watching: the days and weeks after a patient leaves a higher level of care.
A 2016 study in JAMA Psychiatry by Olfson and colleagues, examining a national sample of psychiatric inpatient discharges drawn from U.S. Medicaid records, found that suicide rates in the 90 days after discharge ran more than 16 times higher than in the general population, with the greatest risk concentrated in the first 30 days. The Joint Commission, the body that accredits American hospitals, has likewise identified the period immediately following psychiatric discharge as one of the highest-risk windows in mental health care.
About 900 people in Wisconsin die by suicide each year, according to data from the Wisconsin Department of Health Services. The state does not publicly track how many of those deaths follow a recent discharge from inpatient care, partial hospitalization, or intensive outpatient programming, and it should. Whatever the number is, it is too high, because we know how to lower it.
One of the strongest predictors of safety in the post-discharge period is not which medication a patient is taking or which therapy they completed. It is whether a supported transition between higher level treatment and ongoing outpatient care happened. Did the patient leave with a follow-up appointment already scheduled? Did the outpatient clinician receive a discharge summary in time to use it? Did anyone, at any point, communicate across the gap between programs?
In Wisconsin, the answer is too often no. This is not because clinicians do not care – they care enormously, often to the point of burnout, but because the system is not built to facilitate a supported transition. Discharge summaries arrive weeks after the appointments they were supposed to inform. Patients are released to outpatient providers who did not know they were ever admitted.
This is fixable, and it is fixable quickly. We know because some programs already practice it well. At our mental health care center in Brookfield, Wisconsin, where structured transitions and ongoing communication with referring clinicians are built into how we operate, fewer than 10 percent of patients who complete our partial hospitalization or intensive outpatient programs return to a higher level of care within 12 months. The model is not theoretical; it is a matter of choosing to build it.
First, every level of psychiatric care in Wisconsin should be held to a measurable continuity standard: a documented transition to the next provider before the patient walks out the door, a structured discharge summary delivered within 48 hours, and a follow-up appointment scheduled, not recommended, before discharge. These are operational standards, not aspirational ones.
Second, Wisconsin commercial payers should reimburse the coordination work that makes continuity possible. Care coordination is currently treated as overhead. It is not overhead. It is the intervention. Until clinicians are paid for that time, billable work will continue to crowd it out.
Third, the state’s mental health data infrastructure should capture post-discharge mortality. We cannot fix what we do not measure. Wisconsin already collects most of the relevant data through the Wisconsin Violent Death Reporting System and the Department of Health Services; linking it to discharge records would tell us, for the first time, how many of our suicide deaths cluster in the weeks after treatment.
Fourth, patients should be offered integrated step-down care. A patient leaving a partial hospitalization program should not have to start over with a new team and a new treatment plan in the most fragile weeks of their recovery. The clinical relationship should continue rather than restart. That is one of the strongest safeguards we have against post-discharge crisis.
I have spent my career in mental health care, and I have watched gaps in continuity cause preventable harm to patients who should have been all right. With continuity, they would have been. Without it, some of them were not.
Wisconsin is not unusual in this. The question is whether we are content with a status quo that is robbing us of our neighbors, or whether we want to be the place that gets it right.
The patient transition is not paperwork. Done well, it is the part of mental health care most likely to keep someone safe. We should treat it that way.
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Bio
Allison Lancione, LPC, ICS is the Site Director for Compass Health Center Brookfield. With over 13 years of clinical experience in PHP and IOP levels of care, Allison specializes in trauma, mood disorders, and substance use treatment. She has dedicated much of her career to clinical supervision and clinician well-being, ensuring that teams feel supported and empowered to provide high-quality, patient-centered care.
