Is Home Treatment for Everyone? Characteristics of Patients Receiving Intensive Mental Health Care at Home

Abstract Background In line with previous findings, in a recent randomized controlled trial (RCT), we found that home treatment (HT) for acute mental health care can reduce (substitute) hospital use among severely ill patients in crises. This study examined whether the findings of the RCT generalize to HT services provided under routine care conditions. Methods We compared patients who received HT during the RCT study phase with patients who received the same HT service after it had become part of routine mental health services in the same catchment area. Sociodemographic and clinical characteristics as well as service use (HT and hospital bed days) were compared between the RCT and the subsequent routine care study period. Results Compared to patients who received HT during the RCT, routine care HT patients were more often living with others, less often admitted compulsorily, more often diagnosed with anxiety and stress-related disorders (ICD-10 F4) and less often diagnosed with schizophrenia spectrum disorders (F2). When compared to patients who were exclusively treated on hospital wards, involvement of the HT team in patients’ care was associated with a clear-cut reduction of hospital bed days both during the RCT and under routine care conditions. However, unlike during the RCT study period, involvement of HT was associated with longer overall treatment episodes (inpatient + HT days) under routine care conditions. Conclusions HT seems to reduce the use of hospital bed days even under routine care conditions but is at risk of producing longer overall acute treatment episodes.

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Psychological response of children to home confinement during COVID-19: A qualitative arts-based research

International Journal of Social Psychiatry ◽

10.1177/0020764020972439 ◽

2020 ◽

pp. 002076402097243

Author(s):

Deldar Morad Abdulah ◽

Bayar Mohammed Omar Abdulla ◽

Pranee Liamputtong

Keyword(s):

Mental Health ◽

Health Care ◽

Mental Health Care ◽

Health Care Providers ◽

Care Providers ◽

Arts Based Research ◽

Daily Lives ◽

Global Pandemic ◽

High Level ◽

At Home

Background: The evidence has shown that children are more susceptible to the emotional effects of traumatic events such as outbreaks with the possible disruption in their daily lives. Aim: In this paper, we discussed the psychological wellbeing of children during the COVID-19 outbreak through the art-based qualitative study using the drawing method among children in Iraqi Kurdistan. Methods: In this qualitative arts-based research study, 15 children aged 6 to 13 years old who were confined at home during the COVID-19 outbreak for at least 1 month were included following obtaining the consent from their parents. The children were asked to draw his/her feelings, reflections, and responses during the COVID-19 on a paper. The children were guided to paint their reflections during the COVID-19 based on the following criteria: if they experienced loneliness, tiredness, insomnia, depression, worry or anxiety, or have behavior changes and their relationship with their parents and other siblings. Results: This study showed that children have a high level of stress at home during the COVID-19 outbreak. The children had great fear about the coronavirus. They experienced loneliness and stress, and felt sad, depressed due to home confinement and social distancing. The possibility of infection by coronavirus has occupied their entire mind. Mental health care providers must take the experiences of children who are caught in this global pandemic seriously and ensure that appropriate care is offered to the children and their parents. Conclusions: The children exhibited a strong feeling of distress, loneliness, and fear during the COVID-19 outbreak. This has implications for mental health care.

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12 - PREVENT AND TREAT AT HOME – AN APPROACH TO COMMUNITY MENTAL HEALTH CARE

10.26226/morressier.5d1a038657558b317a14101c ◽

2019 ◽

Author(s):

Mariana Silva ◽

Inês Caldas ◽

Camila Pereira ◽

Marco Gonçalves ◽

Beatriz Lourenço ◽

...

Keyword(s):

Mental Health ◽

Health Care ◽

Community Mental Health ◽

Mental Health Care ◽

Community Mental Health Care ◽

At Home

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Implementation, efficacy, costs and processes of inpatient equivalent home-treatment in German mental health care (AKtiV): protocol of a mixed-method, participatory, quasi-experimental trial

BMC Psychiatry ◽

10.1186/s12888-021-03163-9 ◽

2021 ◽

Vol 21 (1) ◽

Cited By ~ 1

Author(s):

Johanna Baumgardt ◽

Julian Schwarz ◽

Andreas Bechdolf ◽

Konstantinos Nikolaidis ◽

Martin Heinze ◽

...

Keyword(s):

Mental Health ◽

Health Care ◽

Mental Health Care ◽

Home Treatment ◽

Satisfaction With Care ◽

Service Users ◽

Inpatient Hospital ◽

Implementation Processes ◽

Treatment Processes ◽

Quasi Experimental

Abstract Background Over the last decades, many high-income countries have successfully implemented assertive outreach mental health services for acute care. Despite evidence that these services entail several benefits for service users, Germany has lagged behind and has been slow in implementing outreach services. In 2018, a new law enabled national mental health care providers to implement team-based crisis intervention services on a regular basis, allowing for different forms of Inpatient Equivalent Home Treatment (IEHT). IEHT is similar to the internationally known Home Treatment or Crisis Resolution Teams. It provides acute psychiatric treatment at the user’s home, similar to inpatient hospital treatment in terms of content, flexibility, and complexity. Methods/design The presented naturalistic, quasi-experimental cohort study will evaluate IEHT in ten hospitals running IEHT services in different German regions. Within a multi-method research approach, it will evaluate stakeholders’ experiences of care, service use, efficacy, costs, treatment processes and implementation processes of IEHT from different perspectives. Quantitative surveys will be used to recruit 360 service users. Subsequently, 180 service users receiving IEHT will be compared with 180 matched statistical ‘twins’ receiving standard inpatient treatment. Assessments will take place at baseline as well as after 6 and 12 months. The primary outcome is the hospital re-admission rate within 12 months. Secondary outcomes include the combined readmission rate, total number of inpatient hospital days, treatment discontinuation rate, quality of life, psycho-social functioning, job integration, recovery, satisfaction with care, shared decision-making, and treatment costs. Additionally, the study will assess the burden of care and satisfaction with care among relatives or informal caregivers. A collaborative research team made up of researchers with and without lived experience of mental distress will conduct qualitative investigations with service users, caregivers and IEHT staff teams to explore critical ingredients and interactions between implementation processes, treatment processes, and outcomes from a stakeholder perspective. Discussion By integrating outcome, process and implementation research as well as different stakeholder perspectives and experiences in one study, this trial captures the various facets of IEHT as a special form of home treatment. Therefore, it allows for an adequate, comprehensive evaluation on different levels of this complex intervention. Trial registration Trial registrations: 1) German Clinical Trials Register (DRKS), DRKS000224769. Registered December 3rd 2020, https://www.drks.de/drks_web/setLocale_EN.do; 2) ClinicalTrials.gov, Identifier: NCT0474550. Registered February 9th 2021.

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