There are times in which care should be discontinued:
a. When the patient has benefited, is at maximum improvement and further gains are either unlikely or unnecessary for the patient to function in his/her society and workplace.
b. When the patient is not responding to, care and little, if any, progress is being made or is likely to be made.
c. When the patient is manipulating, and it is felt that he/she is using the patient role to further some other agenda whether interpersonal or financial.
In most cases, patients are released when they are maximally improved. Additional contact from the patient rarely occurs.
In the vast majority of cases, closure is achieved by seeing that patient in a final one month return visit to insure that there has not been a change in status.
In some case, however, the patient is orchestrating symptoms for some tangible gain. The patient does not need or want care but feels that continuing in care serves some purpose. In the latter case, the patient can be released to prn return but told that he/she will not be rescheduled unless the case manager has valid reasons for the patient to again be seen.