Home Treatment for Acute Mental Healthcare: Who Benefits Most?

Mötteli, Sonja; Jäger, Matthias; Wyder, Lea; Vetter, Stefan; Seifritz, Erich; Stulz, Niklaus

doi:10.1007/s10597-020-00618-3

Cited by 14 publications

(10 citation statements)

References 19 publications

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“…In addition, involvement of the HT team in patients' care resulted in longer overall treatment episodes (HT + hospital bed days) in the routine care setting. The overall length of acute care episodes with involvement of the HT team in our routine care setting was very similar to the mean length of treatment episodes in another Swiss HT service [8,21]. In addition, the median number of hospital bed days among HT patients was rather similar in our study (Md = 10.5 days) and in a German HT model (Md = 12 days) under routine conditions [22].…”

Section: Discussionsupporting

confidence: 74%

From research to practice: Implementing an experimental home treatment model into routine mental health care

et al. 2020

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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. ResultsCompared 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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Section: Discussionsupporting

confidence: 74%

From research to practice: Implementing an experimental home treatment model into routine mental health care

et al. 2020

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“…Also in the UK, Brimblecombe et al ( 11 ) found that a small yet notable number of admissions involved patients treated by a crisis resolution and health treatment team because the carers of patients treated at home had been “unable to cope” (8.1%). Finally, this is in line with the findings of Mötteli et al ( 24 ), whose study in Switzerland suggested that that the greatest benefit of IHT was derived by patients with acute mental health problems who had a certain level of social support. Family support thus seems to be an important aspect of effective crisis management in patients' own domestic environment.…”

Section: Discussionsupporting

confidence: 90%

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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“…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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Home Treatment for Acute Mental Healthcare: Who Benefits Most?

Cited by 14 publications

References 19 publications

From research to practice: Implementing an experimental home treatment model into routine mental health care

From research to practice: Implementing an experimental home treatment model into routine mental health care

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

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

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