Table 1.

Barriers and facilitators of discharge

Barriers
Patient Related	Primary Care Capacity Related	Transition Process/Support Related
Patient stability - Recent symptom onset - Beckers 2019 - Recent acute crisis care - Ramanuj - History of high risk events - Castelino 2016 Care needs - High need for secondary care services - Filia 2012, Stangroom 2014 - High risk symptoms - Beckers 2019 - High symptom load - Filia 2013 - Psychosocial impairment - Filia 2013 - Higher substance use - Filia 2013 - Need for medications - Ramanuj 2015 Socioeconomic status - Limited support network - Beckers 2019 - Homelessness - Holmes - Ability to pay for PCP services in private or semi-private models of care - Agyapong 2012 Engagement with treatment - Low motivation to engage in treatment - Beckers 2019 - CTO - Filia 2013 - Medication and/or treatment compliance - Filia 2012, Filia 2013, Stangroom 2014 Readiness for discharge - Unexpected or abrupt discharges - Lester 2012 - Feeling passed on/over by early intervention services - Lester 2012 - Concern about loss of contact with a psychiatrist - Lester 2012, Rodenburg 2004	Accessibility and care context-related factors - Patient low levels of personal organizational skills impacting self-management - Filia 2012 - Less patient accountability for attending appointments in primary care - Filia 2012 - Stress related to unfamiliar environment of PCP - Rodenburg 2004 - Patient and PCP concerns about time constraints in PC - Rodenburg 2004, Stangroom 2014 - Patient preference to remain in secondary care - Agyapong 2012 PCP ability to meet patient needs - Medication complexity - Beckers 2019, Filia 2012 - Need to establish therapeutic relationship - Filia 2012 - Patient concerns about quality of psychiatric care from PCPs - Agyapong 2012, Rodenburg 2004	Quality of communication and support across care settings - Poor communication across care settings - Stangroom 2014, Lester 2012 - Lack of information about transition process - Filia 2012 - Lack of support from PC/private psychiatry sector - Filia 2012 - Lack of support from secondary care services - Filia 2012, Stangroom 2014 Work and time required to facilitate discharge - Time required for transition process - Filia 2012 - Amount of paperwork required - Filia 2012
Facilitators
Patient Related	Primary Care Capacity Related	Transition Process/Support Related
Stability - General stability - Castelino 2016, Beckers 2019 - Functional remission of SMI/high overall functioning - Beckers 2018, Beckers 2019, Jespersen 2009, Ramanuj - Employment - Jespersen 2009 - Fewer medical conditions - Jespersen 2009 - Less medication needs - Ramanuj, Jespersen 2009 - Less acute care time/encounters - Ramanuj, Jespersen 2009 - Absence of substance abuse - Filia 2012 - Less psychosocial stress - Jespersen 2009 - Less current/past CTO - Jespersen 2009 Patient strengths - Strong support systems - Beckers 2019, Beckers 2018 - High motivation - Beckers 2019, Beckers 2018 - Medication compliance - Filia 2012 - Presence of skills - Beckers 2018, Beckers 2018 - Good cognitive function - Castelino 2016 - Insight into illness - Beckers 2018, Castelino 2016 - Ability to attend appointments and blood tests independently - Filia 2012 Readiness for discharge - Feeling prepared for discharge - Lester 2012 - Patient aware of and expecting discharge - Lester 2012, Rodenburg 2004 - Patient approval of discharge - Beckers 2018, Filia 2012 - Patient faith in transfer of care - Beckers 2018 - Patient not feeling pressured to transfer - Rodenburg 2004 - Patient viewing PC as less stigmatizing - Agyapong 2012	Accessibility and care context-related factors - Accessibility and convenience of PC - Agyapong, 2012, Rodenburg, 2004, Filia 2012 - Physical access to a pharmacy - Filia 2012 - Ability to access services for free or to afford services in semi-private or private healthcare systems - Agyapong 2012, Rodenburg, 2004, Filia 2012 - Patient preference for primary care - Agyapong, 2012 PCP ability to meet mental health care needs - Patient belief in PCP ability to meet needs - Agyapong 2012 - Previous strong and trusting relationship between patient and PCP - Lester 2012 - PCP ability to recognize need for additional services - Lester 2012 - Welcoming environment in PCP office - Rodenburg 2004 - Ability for patient to receive coaching and mental health monitoring - Baker 2019 - Ability to have consistent contact with patient - Baker 2019	Discharge planning process - Planned process involving interdisciplinary team - Backus, Horner & Asher, 2005 - Inclusion of PCP in discharge planning process - Horner & Asher, 2005 - Inclusion of patient in discharge planning and care plan development - Rodenburg, 2004, Lester, 2012 - Personalized and flexible discharge process - Lester, 2012 - Transparency in discharge planning process - Rodenburg 2004 - Collaborative development of care plan - Horner & Asher, 2005 - Recognition of patient’s self-management ability - Lester, 2012 Communication and support across services - Ongoing communication and support between primary, secondary care, and patient - Baker 2019, Horner & Asher, 2005, Stangroom 2014, Lester 2012, Hamilton-West 2017 - Organization of services - Becker 2018 - Facilitated re-entry or access to secondary care services when needed - Filia 2012, Lester 2012 - Primary and secondary care healthcare providers having faith in the transfer (Beckers et al., 2018)