Lakeview Medical CenterInpatient Behavioral Health · 4 West

In partnership withinaya

Family Discharge Guide

Form BH-FDG-01

Family contactMaria Rivera (mother)

Discharge date11/06/2026

Follow-up appointment11/12/2026 · 10:30 AM

Discharging nurseK. Okafor, RN

What happens next for your family

This weekScan the code and answer about 20 questions about your family.
Within 72 hrsYou receive your family's plan: programs you qualify for, how to apply, and local resources near you.
Four check-ins across the next 12 monthsInaya checks in on how your family is doing.

Your family support contact

Inaya Health · (555) 555-0142connect@inaya.health · Scan to get started

K. OkaforNurse signature

Maria RiveraFamily member signature

In a crisis, call or text 988. If someone is in danger, call 911.Page 1 of 1

The family discharge guide

Your patient goes home with a plan. Their family should too.

Your social workers build the discharge plan. Families carry it out at home, often without knowing what comes next.

Inaya picks up where the unit's work has to end, so your team's plan holds long after discharge.

Start a pilot conversation

The business case

A unit with 60 discharges a month spends about $1.03M a year on readmissions.

16.2%

Readmitted within 30 days

$8,800

Average hospital cost of that readmission

1 in 4

No documented attempt to contact family

65%

Of behavioral health workers who provide care report bigger caseloads since COVID

Estimate your unitBehavioral health discharges per month 60Readmissions avoided 15%

Expected 30-day readmissions a year117

Potential readmissions avoided a year17

Potential hospital costs avoided a year$154K

How it works

You make the hand-off. We carry it forward.

01
Hand the family the letter.
One page at discharge: what happens next, who to call, and how to reach us.
02
The family tells us their story.
They scan the code on the letter and answer about 20 questions.
03
The Plan within 72 hours.
The programs they can apply to, ranked, with how and when to file, plus local resources near them.
04
We stay with them.
Four check-ins across the next 12 months.

For your social workers

Give families direction. Give your team time back.

Your plan

Carried forward, not replaced.

Your team owns the discharge plan for the patient. We pick up where your scope ends: the family, after discharge.

Benefits questions

Answered for you.

SSI, Medicaid, housing, county programs. The questions families ask that no one has time to answer on the unit.

Your time

Fewer callbacks.

Families leave with a plan and a place to go with their questions, instead of calling the unit back.

What families get

The next steps no one had time to explain.

At discharge

A letter they can follow.

A short, plain-language letter from your team that points the family to Inaya and tells them what to expect.

Within 72 hours

The Plan.

40+ programs checked for their loved one, ranked by fit, with the forms to file, in what order, plus local resources near them.

Before the next crisis

A crisis plan.

What to watch for, what to say, and who to call, so the next hard night doesn't start from zero.

Why families matter at discharge

Family involvement is critical after discharge.

Higher odds of follow-up within 30 days when family and staff were in contact.

45%

Lower relapse risk with family intervention for schizophrenia, compared with usual care.

Questions

Does this replace our social workers?

No. Your social workers own the discharge plan. We pick up where their scope ends: the family, after discharge.

What does our team need to do?

Your team hands the family a guide at discharge. We carry it forward from there.

Do you have outcome data?

The research on family support is strong. The pilot is how we prove it on your unit, by tracking follow-up attendance and 30-day readmissions for the families you refer.

How does pricing work?

We start with a pilot on one unit. Pricing is scoped on a call to fit your discharge volume.

Who is Inaya?

A family advocacy firm for families supporting a loved one with serious mental illness. We answer to the family, not to a system.

Sources

16.2% and $8,800: in 2020, 16.2% of U.S. community hospital stays for mental, behavioral, and neurodevelopmental disorders were followed by a readmission for any cause within 30 days. The average hospital cost of a readmission in that group was $8,800. These are hospital costs, not payments. The dataset excludes freestanding psychiatric hospitals, and the category includes substance use and neurodevelopmental diagnoses. AHRQ HCUP Statistical Brief #304.

1 in 4: in 179 Medicaid records at two New York hospitals, staff made no documented attempt to contact family for 43 patients. This is not a national rate. Haselden et al., Psychiatric Services, 2019.

65%: workers who provide care reporting bigger caseloads since COVID. National Council for Mental Wellbeing and The Harris Poll, 2023 workforce survey.

The estimate is illustrative only. An illustration using 2020 national community-hospital averages. Not actual or predicted spending for a particular unit, and not an Inaya result. Avoided percentage is hypothetical, not measured Inaya savings.

Research findings, not Inaya results.

3x: Association, not proof of cause. One study of 179 Medicaid inpatients at two hospitals. Contact between family and staff was linked to higher odds of a follow-up visit within 30 days (adjusted odds ratio 3.07). This is an association, not proof of cause. Haselden et al., Psychiatric Services, 2019.

45%: Estimated relative reduction. Low-quality evidence may overestimate the effect. Family intervention may reduce relapse for people with schizophrenia. The review estimated a 45% relative reduction in relapse risk (risk ratio 0.55, 32 trials). That is not a 45 percentage point drop. Poor study quality may overestimate the effect. Pharoah et al., Cochrane Database of Systematic Reviews, 2010.