The dilemma of discharge and some possible solutions.

Discharging clients with acquired brain injury can be a challenging process for all parties involved. In this response to Hersh (2010), three issues are raised which are relevant to the discussion of discharge and may offer some solutions to the dilemmas faced during this time. The first issue is that discharge may not always be necessary depending on the service delivery model that is used. The second issue is that recent advances in experience-dependent neuroplasticity research may change the way clinicians determine treatment goals, which has implications for discharge decisions. Finally, an alternative strategy to assist with discharge is the facilitation of social engagement for the person with brain injury and their social networks. While it is acknowledged that discharge can be a positive time for some clients, it can also be a time where people feel abandoned, even bereft and, in some cases, angry. Avoiding this scenario requires forward planning from the outset of treatment and the use of strategies to ensure that the person is well supported at the time of discharge. This paper presents some of these strategies which may be useful for clinicians to consider as they plan discharge in collaboration with their clients.