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

Stulz, Niklaus; Wyder, Lea; Holtforth, Martin Grosse

doi:10.1007/s10597-021-00814-9

Cited by 6 publications

(6 citation statements)

References 44 publications

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“…Further detailed studies are needed to investigate the effect of different CRHT regimes on readmission rates and lengths. The presence of more married women with affective disorders in the intervention group is in line with other recent findings [26,34,[46][47][48][49][50][51], and raises the question of the impact of CRHT on the entire mental healthcare system. The combination of this finding with the longer CRHT treatment duration might imply the risk of a redistribution of resources towards a specific group of CRHT patients.…”

Section: Discussionsupporting

confidence: 86%

Effectiveness of crisis resolution home treatment for the management of acute psychiatric crises in Southern Switzerland: a natural experiment based on geography

et al. 2022

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Background Crisis Resolution Home Treatment (CRHT) is an alternative to inpatient treatment for acute psychiatric crises management. However, evidence on CRHT effectiveness is still limited. In the Canton of Ticino (Southern Switzerland), in 2016 the regional public psychiatric hospital replaced one acute ward with a CRHT. The current study was designed within this evaluation setting to assess the effectiveness of CRHT compared to standard inpatient treatment. Methods CRHT was offered to patients aged 18 to 65 with an acute psychiatric crisis that would have required hospitalization. We used a natural experiment based on geography, where intervention and control groups were formed according to the place of residence. Primary endpoints were reduction of psychiatric symptoms at discharge measured using the Health of the Nation Outcome Scales, treatment duration in days, and rate and length of readmissions during a two-year follow-up period after discharge. Safety during the treatment period was measured with the number of serious adverse events (suicide/suicide attempts, major self-harm episodes, acute alcohol/drug intoxications, aggressions to caregivers or family members). We used linear, log-linear and logistic regression models with propensity scores for the main analysis. Results We enrolled 321 patients; 67 were excluded because the treatment period was too short and 17 because they were transferred before the end of the treatment. Two hundred thirty-seven patients were available for data analysis, 93 in the intervention group and 144 in the control group. No serious adverse event was observed during the treatment period in both groups. Reduction of psychiatric symptoms at discharge (p-value = 0.359), readmission rates (p-value = 0.563) and length of readmissions (p-value = 0.770) during the two-year follow-up period did not differ significantly between the two groups. Treatment duration was significantly higher in the treatment group (+ 29.6% on average, p-value = 0.002). Conclusions CRHT was comparable to standard hospitalization in terms of psychiatric symptoms reduction, readmission rates and length of readmissions, but it was also characterized by a longer first treatment period. However, observational evidence following the study indicated that CRHT duration constantly lowered over time since its introduction in 2016 and became comparable to hospitalization, showing therefore to be an effective alternative also in terms of treatment length. Trial registration ISRCTN38472626 (17/11/2020, retrospectively registered).

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Section: Discussionsupporting

confidence: 86%

Effectiveness of crisis resolution home treatment for the management of acute psychiatric crises in Southern Switzerland: a natural experiment based on geography

et al. 2022

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“…Considering though that social functioning might also reflect more complex processes such as retaining employment or not becoming homeless, the overall period of these studies might be too short for the manifestation of such differences. Moreover, recent studies indicate that parameters such as initial severity of symptoms and certain demographic features (age, employment, family support) might play a far more definitive role in -functionality than the modality of treatment (Mötteli et al, 2021 ; Stulz et al, 2021 ).…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of a Community-Based Crisis Resolution Team for Patients with Severe Mental Illness in Greece: A Prospective Observational Study

Koureta

Papageorgiou

Asimopoulos

et al. 2022

Community Ment Health J

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This prospective observational study evaluated the effectiveness of a crisis resolution team (CRT) for outpatient treatment of psychiatric patients experiencing an acute episode of severe mental disorder. The effectiveness of the CRT (n = 65) was assessed against the care-as-usual [CAU group (n = 65)]. Patients’ clinical state, overall functioning, quality of life and satisfaction were respectively evaluated at baseline, post intervention and three-month post-intervention.CRT patients compared to the CAU group, had significantly improved outcomes concerning clinical state and patient satisfaction at post intervention phase. Statistically significant improvement was also recorded for the dimensions of environment, physical and psychological health related to quality of life. No significant differences were observed between the two groups regarding overall functioning.On the basis of these results, reforming of existing crisis-management services, in Greece, using the CRT model may improve substantially the services offered to psychiatric patients.

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“…Stulz et al ( 12 ) also investigated the triage process of indicating IHT, but mostly after facilitated discharge. They found a primary diagnosis of anxiety or stress-related disorder, employment status and the degree of social problems affected the probability of whether or not HT was initiated.…”

Section: Discussionmentioning

confidence: 99%

“…The findings of an observational study to the patient and process characteristics of patients treated by a home treatment team compared to patients treated on hospital wards in Switzerland ( 12 ) found a primary diagnosis of anxiety or stress-related disorder, employment status and the degree of social problems affected the probability of whether or not HT was initiated. Almost all of the patients in this study were initially treated on hospital wards, where these results applied mostly to the aim of facilitated discharge and less to prevent hospital admission.…”

Section: Introductionmentioning

confidence: 99%

Referral for Intensive Home Treatment or Psychiatric Inpatient Care? A Retrospective, Observational Comparison of Patient and Process Characteristics

et al. 2022

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IntroductionIntensive home treatment (IHT) is intended to prevent the (mostly voluntary) admission of mentally ill patients by providing intensive care in their domestic environment. It requires approaches to referral that ensure the delivery of the best possible acute care. Indications for referral may be improved by greater understanding of the clinical profiles of patients referred for IHT and of those referred for inpatient care. As such understanding may also further the development of IHT and innovations within it, we compared the patient and process characteristics associated with IHT referral for those associated with inpatient care.MethodsThis retrospective, observational, explorative study was conducted from 2016 to 2019. Patients aged 18 years and older were assessed by the emergency psychiatric outreach services in the greater Rotterdam area (Netherlands). Anonymized data were used to compare patient and process characteristics between patients referred for IHT and those admitted voluntarily. Patient characteristics included gender, age, cultural background, living situation and main diagnosis. Additional the case mix was measured using the Severity of Psychiatric Illness (SPI) scale. Process characteristics included psychiatric history, the total number of contacts with the emergency psychiatric outreach services, assessments during office hours, place of assessment, referrer, and the reason for referral. Using multiple logistic regression analysis, the patient and process characteristics associated with IHT referral were compared with those associated with voluntary admission.ResultsThe emergency psychiatric outreach services undertook 12,470 assessments: 655 were referred for HT and 2,875 for voluntary admission. Patient characteristics: referral for IHT rather than voluntary admission was associated with higher motivation for treatment and better family involvement. Process characteristics: referral for IHT rather than voluntary admission was associated with assessment by the crisis services within office hours, no mental health treatment at the time of referral, and referral by a family doctor.DiscussionIHT in a specific Dutch setting seems to function as an intensive crisis intervention for a subgroup of patients who are motivated for treatment, have social support, and are not in outpatient treatment. The patient and process characteristics of patients referred for IHT should now be studied in more detail, especially, for having more social support, the role of the family members involved.

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

Cited by 6 publications

References 44 publications

Effectiveness of crisis resolution home treatment for the management of acute psychiatric crises in Southern Switzerland: a natural experiment based on geography

Effectiveness of crisis resolution home treatment for the management of acute psychiatric crises in Southern Switzerland: a natural experiment based on geography

Effectiveness of a Community-Based Crisis Resolution Team for Patients with Severe Mental Illness in Greece: A Prospective Observational Study

Referral for Intensive Home Treatment or Psychiatric Inpatient Care? A Retrospective, Observational Comparison of Patient and Process Characteristics

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