Discharge From Coordinated Specialty Care: Timing, Reasons, and Predictors in a National Early Psychosis Network

OBJECTIVE: Retention in coordinated specialty care (CSC) is critical for optimizing outcomes of first-episode psychosis, yet discharge from CSC is heterogeneous and poorly characterized. This study aimed to examine the timing of, reasons for, and predictors of discharge in a large early psychosis intervention network. METHODS: Data were drawn from the Academic-Community Early Psychosis Intervention Network. Participants (N=701) were followed for up to 36 months after CSC admission. Discharges were classified as positive, ambiguous, or adverse. Kaplan-Meier and competing-risk Cox models were used to examine time to discharge and baseline predictors, respectively. RESULTS: Over 36 months, 44% of participants were discharged. Ambiguous discharges were most common (55% of discharges), followed by adverse (28%) and positive (17%) discharges. Twenty-five percent of participants were discharged by 10 months. Positive discharge was associated with commercial insurance (hazard ratio [HR]=3.48, p=0.001) and weekly family contact (HR=3.96, p=0.02). A longer duration of untreated psychosis (HR=1.18, p=0.002), prior hospitalization (HR=1.66, p=0.03), and cannabis use (HR=1.81, p=0.005) increased the risk for ambiguous discharge, whereas living with family (HR=0.51, p=0.03) and older age (HR=0.93, p=0.008) were protective. Legal involvement increased the risk for adverse discharge (HR=2.40, p=0.02), whereas antipsychotic use at admission was protective (HR=0.55, p=0.02). CONCLUSIONS: Discharge from CSC programs reflects distinct clinical and structural pathways. Findings from this study highlight the need for early engagement strategies, improved discharge documentation, and strong transition supports to promote continuity of care in early psychosis services.