Discharge starts early
Aftercare planning should begin soon after admission, not during the final 48 hours. The team should understand where the patient will live, who will support them, what risks await and what continuing providers are available.
Continuity components
A plan may include outpatient psychotherapy, psychiatry, medication continuity, recovery coaching, mutual-help or peer support, family agreements, testing when clinically appropriate and structured follow-up.
International coordination
For patients returning abroad, the program should seek to establish a warm handoff to local providers whenever feasible and obtain appropriate consent for information exchange.