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BOARDING OF PATIENTS IN A MENTAL HEALTH CRISIS IN EMERGENCY ROOMS WOULD BE REDUCED BY PSYCHIATRIC HOSPITALIZATION AT HOME PROGRAMS
When it comes to addressing the contribution of acute mental disorders to this crisis, simply adding more beds would be a blunt instrument. Current evidence-based mental health services planning requires incorporation of hospital alternatives, such as crisis residences, acute day hospitals and psychiatric hospitalization at home programs (PHAH) (1).
A study in 2002 (2) examined this issue at the Louis-H Fontaine Hospital in Montreal using a "bottom-up" methodology whereby psychiatrists decided on a given day, which of their current in-patients -- including newly admitted patients -- could be treated in one or more alternative services, even if those alternatives were no available. Only 29% of a sample of acute care patients were unsuitable for a hospital alternative.
This article will focus on PHAP's. There is a confusing variety of terms for these including Crisis Resolution and Home Treatment in England and Australia, and a term I prefer: Intensive Home Treatment (IHT).
I started Canada's first IHT program -- Hazelglen Program in 1989 in Kitchener-Waterloo (3). We have been able to treat patients with severe acute schizophrenia, bipolar disorder and depression without admitting them.
A multidisciplinary team makes frequent home visits, provides all the treatment that the hospital provides...
Show MoreCompeting Interests: None declared.References
- 2. Lesage A, Bonsack C, Clerc D, et al. Alternatives to Acute Hospital Psychiatric Care in East-End Montreal. Can J Psychiatry 2002n; 47; 49-55
- 3. Heath D S ( 2005) Home Treatment for Acute Mental Disorders: An Alternative to Hospitalization New York: Routledge
- 4. Johnson S. Crisis resolution and home treatment teams: an evolving model. Advances in Psychiatric Treatment 2013;19(2):115-123
- 5. McCrone P, Johnson S, Nolan F, et al. Economic evaluation of a crisis resolution service: a randomized controlled trial. Epidemiol Psychiatr Soc 2009;18(1):54-8
- 6. Cornelis J, Barakat A, Blankers M et al The effectiveness of intensive home treatment as a substitute for hospital admission in acute psychiatric crisis resolution in the Netherlands:. Lancet Psychiatry 2022 ( 8) 625-6358