What is Home Treatment? A 24/7 system for the rapid response and assessment of mental health crisis in the community Offers comprehensive acute psychiatric care at home until the crisis is resolved, usually without hospital admission. Acute care is delivered by a specialist team so as to provide an alternative to hospital admission for individuals with serious mental illness Staffed by nurses, social workers, psychiatrists, OTs, support workers
Why Home Treatment? Interpersonal problems make a major contribution to many psychiatric crises. If people can stay at home at the time of crisis, team members can observe these problems first-hand. Evidence repeatedly shows service users do not like hospitals (SCMH, 1998). Early intervention and treatment prevents deterioration and leads to quicker improvement. Being a psychiatric inpatient carries more social stigma than being treated at home. Home treatment has been shown to cost less than inpatient treatment. Up to 30% of inpatient costs are for hotel services such as cleaning, cooking, linen, etc., not to mention the capital cost of the building. This money is not available for clinical care (Young & Reynolds, 1981)
Who is it for? Commonly adults (16 to 65 years old) With severe mental illness (e.g. schizophrenia, manic depressive disorders, severe depressive disorder) With an acute psychiatric crisis of such severity that, without the involvement of a crisis resolution/home treatment team, hospitalisation would be necessary
Gatekeeping and Rapid Response Act as a „gatekeeper‟ to mental health services, rapidly assessing individuals with acute mental health problems and referring them to the most appropriate service. Screening for the presence of mental health problems which would benefit from involvement of specialist mental health services. Screening possible hospital admissions, so as to minimise these by the provision of Crisis Resolution/Home Treatment team support. No evidence for reduced admissions unless CRHT “gatekeep” all admissions
Early Discharge Facilitation Remain involved with the patient until the crisis is resolved and the service user is linked to ongoing care. If hospitalisation is necessary, be actively involved in discharge planning and provide intensive care at home to enable early discharge. Discharge planning from the point of admission
What effect do they have? Research evidence suggests that when CRHT teams are shaped around specific service characteristics and principles they: Are likely to reduce the number of admissions to hospital (by between 20% and 40%) and the length of stay for people who are admitted Improve service users‟ experiences of acute mental health care (Minghella et al., 1998).