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Bergamaschi V, Baumann F, Warnke I, Corbisiero S, Ludwig F, Riedel A, Gabriel-Felleiter K, Schmidt SJ. Who Benefits from Acute Psychiatric Home Treatment? A Systematic Review. Community Ment Health J 2024:10.1007/s10597-024-01297-0. [PMID: 38940978 DOI: 10.1007/s10597-024-01297-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 05/13/2024] [Indexed: 06/29/2024]
Abstract
Home treatment (HT) treats patients in an acute crisis through an interdisciplinary team with daily appointments for a short treatment period. The effectiveness of HT has already been confirmed. However, only few studies addressed specific patient characteristics associated outcome of treatment. This study aimed to identify patient characteristics associated with successful outcomes of HT. A systematic literature search was conducted according to the PRISMA guidelines. A total of 13 studies were included in the systematic review. Being employed, having a regular income, having an anxiety disorder and family involvement were associated with a successful treatment outcome in HT. High symptom severity and former hospital admissions were associated with unsuccessful treatment outcome in HT in the selected studies. HT seems to be especially beneficial for patients with paid employment or regular income, patients with anxiety disorders, and patients with familial or other social support.
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Affiliation(s)
- Vera Bergamaschi
- Institue of Psychology, University of Bern, Bern, Switzerland.
- Luzerner Psychiatrie, Voltastrasse 42, 6005, Lucerne, Switzerland.
| | - Felix Baumann
- Institue of Psychology, University of Bern, Bern, Switzerland
- Luzerner Psychiatrie, Voltastrasse 42, 6005, Lucerne, Switzerland
| | - Ingeborg Warnke
- Luzerner Psychiatrie, Voltastrasse 42, 6005, Lucerne, Switzerland
| | | | - Fabian Ludwig
- Luzerner Psychiatrie, Voltastrasse 42, 6005, Lucerne, Switzerland
| | - Andreas Riedel
- Luzerner Psychiatrie, Voltastrasse 42, 6005, Lucerne, Switzerland
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Barakat A, Blankers M, Cornelis JE, Lommerse NM, Beekman AT, Dekker JJ. Prescriptive factors for intensive home treatment in acute psychiatry: a secondary analysis of a randomised controlled trial. Int J Ment Health Syst 2024; 18:2. [PMID: 38172935 PMCID: PMC10763431 DOI: 10.1186/s13033-023-00619-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 12/11/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Intensive home treatment (IHT) aims to prevent psychiatric hospitalisation. Although this intervention is well tested, it is still unknown for whom this intervention works best. Therefore, this study aims to explore prescriptive factors that moderate the effect of IHT compared to care as usual (CAU) on symptom severity. METHODS Using data from a randomised controlled trial, 198 participants that experience an exacerbation of acute psychiatric symptoms were included in this secondary analysis. In order to maximise clinical relevance, generally available environmental and clinical baseline factors were included as tentative moderators: age, gender, employment status, domestic situation, psychiatric disorders, psychological symptoms, psychosocial functioning, alcohol and other substance use. The outcome variable symptom severity was measured using the Brief Psychiatric Rating Scale (BPRS) and collected at 26 and 52 weeks post-randomisation. Multiple regression analysis was used to examine which participants' characteristics moderate the effect of IHT on the total BPRS score. RESULTS Our results suggest that being employed (B = 0.28, SE = 0.13, 95% CI = 0.03-0.53, p = 0.03) at baseline seems to have a moderation effect, which result in lower symptom severity scores at 26 weeks follow-up for patients who received IHT. This effect was not found at 52 weeks. CONCLUSIONS On the basis of the number of factors tested, there is no evidence for robust outcome moderators of the effect of IHT versus CAU. Our conclusion is therefore that IHT can be offered to a diverse target population with comparable clinical results. TRIAL REGISTRATION This trial is registered (date of registration: 2016-11-23) at the international clinical trials registry platform (NTR6151).
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Affiliation(s)
- Ansam Barakat
- Department of Research, Arkin Institute for Mental Health Care, Amsterdam, The Netherlands.
- Department of Psychiatry Amsterdam UMC/VUmc, Amsterdam Public Health research institute Amsterdam UMC, Amsterdam, The Netherlands.
| | - Matthijs Blankers
- Department of Research, Arkin Institute for Mental Health Care, Amsterdam, The Netherlands
- Trimbos-Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
- Department of Psychiatry Amsterdam UMC/AMC, Amsterdam Public Health research institute Amsterdam UMC, Amsterdam, The Netherlands
| | - Jurgen E Cornelis
- Department of Research, Arkin Institute for Mental Health Care, Amsterdam, The Netherlands
- Department of Emergency Psychiatry, Arkin Institute for Mental Health Care, Amsterdam, The Netherlands
| | - Nick M Lommerse
- Department of Research, Arkin Institute for Mental Health Care, Amsterdam, The Netherlands
| | - Aartjan Tf Beekman
- Department of Psychiatry Amsterdam UMC/VUmc, Amsterdam Public Health research institute Amsterdam UMC, Amsterdam, The Netherlands
- Department of Research and Innovation, GGZ InGeest Specialized Mental Health Care, Amsterdam, The Netherlands
| | - Jack Jm Dekker
- Department of Research, Arkin Institute for Mental Health Care, Amsterdam, The Netherlands
- Department of Clinical Psychology, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute Amsterdam UMC, Amsterdam, The Netherlands
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Effectiveness of a Community-Based Crisis Resolution Team for Patients with Severe Mental Illness in Greece: A Prospective Observational Study. Community Ment Health J 2023; 59:14-24. [PMID: 35588027 PMCID: PMC9118182 DOI: 10.1007/s10597-022-00983-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 04/16/2022] [Accepted: 05/02/2022] [Indexed: 01/07/2023]
Abstract
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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Mötteli S, Schori D, Menekse J, Jäger M, Vetter S. Patients' experiences and satisfaction with home treatment for acute mental illness: a mixed-methods retrospective study. J Ment Health 2022; 31:757-764. [PMID: 32772614 DOI: 10.1080/09638237.2020.1803233] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Home treatment (HT) has been proposed as a patient-centred alternative to acute mental inpatient care although evidence of patient-reported outcomes has remained limited. AIMS The aim of this study was to examine patient experiences and satisfaction with HT. METHODS This retrospective mixed-methods study included telephone interviews of 159 patients receiving HT between 2016 and 2019. Associations between patients' characteristics and global satisfaction (ZUF-8 scale) were assessed. Differences between HT patients and inpatients were tested on a propensity score -matched inpatient sample. Qualitative analyses were conducted using thematic analysis. RESULTS Global satisfaction with HT was slightly higher than in the inpatient sample (p = 0.019). There was no relationship between satisfaction and patients' characteristics, such as gender, age, main psychiatric diagnosis, and treatment duration, but satisfaction was higher for patients who perceived HT as their only treatment option. Participants particularly appreciated the person-centred care and practical support whereas staff continuity and medical treatment were main sources of dissatisfaction. CONCLUSION The results indicate that HT seems to be a more patient-centred alternative to inpatient treatment and might close a gap in the psychiatric care of patients who preferred not to use inpatient services but needed higher treatment intensity than outpatient treatment.
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Affiliation(s)
- Sonja Mötteli
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Zurich, Switzerland
| | - Dominik Schori
- Directorate of Nursing, Therapies and Social Work, University Hospital of Psychiatry Zurich, Zurich, Switzerland
| | - Jasmin Menekse
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Zurich, Switzerland
| | - Matthias Jäger
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Zurich, Switzerland.,Psychiatrie Baselland, Liestal, Switzerland
| | - Stefan Vetter
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Zurich, Switzerland
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Holgersen KH, Pedersen SA, Brattland H, Hynnekleiv T. A scoping review of studies into crisis resolution teams in community mental health services. Nord J Psychiatry 2022; 76:565-574. [PMID: 35148238 DOI: 10.1080/08039488.2022.2029941] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND AND PURPOSE OF ARTICLE Crisis Resolution Teams (CRT) for rapid assessment and short-term treatment of mental health problems have increasingly been implemented internationally over the last decades. Among the Nordic countries, the CRT model has been particularly influential in Norway, where 'Ambulante akutteam (AAT)' is a widespread psychiatric emergency service for adult patients. However, the clinical practice of these teams varies significantly. To aid further development of the service and guide future research efforts, we carried out a scoping review to provide an up-to-date overview of research available in primary studies focusing on phenomena related to CRTs in English and Scandinavian literature. METHODS A systematic literature search was conducted in the bibliometric databases MEDLINE, Embase, PsychINFO, Scopus, and SveMed+. Included studies were thematically analyzed using a qualitative method. RESULTS The search identified 1516 unique references, of which 129 were included in the overview. Thematic analysis showed that the studies could be assigned to: (1) Characteristics of CRTs (k = 45), which described key principles or specific interventions; (2) Implementation of CRTs (k = 54), which were descriptive about implementation in different teams, or normative about what clinical practice should include; and (3) Effect of CRTs (k = 38). CONCLUSIONS The international research literature on CRTs or equivalent teams is extensive. Many sub-themes have been studied with various research methodologies. Recent studies provide a better evidence base for how to organize services and to select therapeutic interventions, but there is still a need for more controlled studies in the field.
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Affiliation(s)
- Katrine Høyer Holgersen
- Nidelv Community Mental Health Center, Tiller, Clinic of Mental Health, St Olavs Hospital, Trondheim, Norway.,Department of Psychology, NTNU Norwegian University of Science and Technology, Trondheim, Norway
| | - Sindre Andre Pedersen
- Library Section for Medicine and Health Sciences, NTNU University Library, NTNU-Norwegian University of Science and Technology, Trondheim, Norway
| | - Heidi Brattland
- Nidelv Community Mental Health Center, Tiller, Clinic of Mental Health, St Olavs Hospital, Trondheim, Norway
| | - Torfinn Hynnekleiv
- Department for Acute Psychiatry and Psychosis Treatment, Psychiatric Health Services Division, Sykehuset Innlandet Trust, Reinsvoll, Norway
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Reinke B, Mahlke C, Botros C, Kläring A, Lambert M, Karow A, Gallinat J, Zapf A, Ozga AK, Höller A, Bustami N, Reimer J, Lüdtke J, Schaper O, Lison M, Bechdolf A, Baumgardt J, Spiegel J, Hardt O, Rout S, Memarzadeh S, von Peter S, Schwarz J, Langer C, Glotz S, Frasch K, Rüsch N, Künstler U, Bock T, Becker T. Study protocol of a randomized controlled trial evaluating home treatment with peer support for acute mental health crises (HoPe). BMC Psychiatry 2022; 22:619. [PMID: 36123649 PMCID: PMC9483879 DOI: 10.1186/s12888-022-04247-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 09/07/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Home treatment (HT) is a treatment modality for patients with severe mental illness (SMI) in acute mental crises. It is frequently considered equivalent to psychiatric inpatient treatment in terms of treatment outcome. Peer Support (PS) means that people with lived experience of a mental illness are trained to support others on their way towards recovery. While PS is growing in international importance and despite a growing number of studies supporting its benefits, it is still not comprehensively implemented into routine care. The HoPe (Home Treatment with Peer Support) study investigates a combination of both - HT and PS - to provide further evidence for a recovery-oriented treatment of psychiatric patients. METHODS In our randomized controlled trial (RCT), HT with PS is compared with HT without PS within a network of eight psychiatric clinical centers from the North, South and East of Germany. We investigate the effects of a combination of both approaches with respect to the prevention of relapse/recurrence defined as first hospitalization after randomization (primary outcome), disease severity, general functioning, self-efficacy, psychosocial health, stigma resistance, recovery support, and service satisfaction (secondary outcomes). A sample of 286 patients will be assessed at baseline after admission to HT care (data point t0) and randomized into the intervention (HT + PS) and control arm (HT). Follow-Up assessments will be conducted 2, 6 and 12 months after admission (resulting in three further data points, t1 to t3) and will be analyzed via intention-to-treat approach. DISCUSSION This study may determine the positive effects of PS added to HT, prove additional evidence for the efficacy of PS and thereby facilitate its further implementation into psychiatric settings. The aim is to improve quality of mental health care and patients' recovery as well as to reduce the risk of relapses and hospitalizations for patients with SMI. TRIAL REGISTRATION The trial is registered with ClinicalTrials.gov: NCT04336527 , April 7, 2020.
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Affiliation(s)
- Britta Reinke
- grid.13648.380000 0001 2180 3484Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Candelaria Mahlke
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Christina Botros
- grid.13648.380000 0001 2180 3484Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alexa Kläring
- grid.13648.380000 0001 2180 3484Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Lambert
- grid.13648.380000 0001 2180 3484Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anne Karow
- grid.13648.380000 0001 2180 3484Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jürgen Gallinat
- grid.13648.380000 0001 2180 3484Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Antonia Zapf
- grid.13648.380000 0001 2180 3484Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ann-Kathrin Ozga
- grid.13648.380000 0001 2180 3484Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alexandra Höller
- grid.13648.380000 0001 2180 3484Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Nadia Bustami
- Department of Psychiatry and Psychotherapy, Psychiatric Hospital Lüneburg, Lüneburg, Germany
| | - Jens Reimer
- grid.13648.380000 0001 2180 3484Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany ,Department of Psychiatry and Psychotherapy, Gesundheit Nord - Bremen Hospital Group, Bremen, Germany
| | - Jenny Lüdtke
- Department of Psychiatry and Psychotherapy, Gesundheit Nord - Bremen Hospital Group, Bremen, Germany
| | - Oliver Schaper
- Department of Psychiatry and Psychotherapy, Gesundheit Nord - Bremen Hospital Group, Bremen, Germany
| | - Martin Lison
- Department of Psychiatry and Psychotherapy, Gesundheit Nord - Bremen Hospital Group, Bremen, Germany
| | - Andreas Bechdolf
- grid.6363.00000 0001 2218 4662Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Vivantes Hospital Am Urban Und Vivantes Hospital Im Friedrichshain, Charité – Universitätsmedizin Berlin, Berlin, Germany ,grid.415085.dDepartment of Psychiatry, Psychotherapy and Psychosomatics, Vivantes Friedrichshain Hospital, Berlin, Germany ,grid.411097.a0000 0000 8852 305XDepartment of Psychiatry and Psychotherapy, University Hospital Cologne, Cologne, Germany
| | - Johanna Baumgardt
- grid.6363.00000 0001 2218 4662Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Vivantes Hospital Am Urban Und Vivantes Hospital Im Friedrichshain, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Jennifer Spiegel
- grid.6363.00000 0001 2218 4662Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Vivantes Hospital Am Urban Und Vivantes Hospital Im Friedrichshain, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Olaf Hardt
- Department of Psychiatry, Psychotherapy and Psychosomatics, Vivantes Neukölln Hospital, Berlin, Germany
| | - Sandeep Rout
- Department of Psychiatry, Psychotherapy and Psychosomatics, Vivantes Neukölln Hospital, Berlin, Germany
| | - Sonja Memarzadeh
- Department of Psychiatry, Psychotherapy and Psychosomatics, Vivantes Neukölln Hospital, Berlin, Germany
| | - Sebastian von Peter
- grid.473452.3Department of Psychiatry and Psychotherapy, Brandenburg Medical School Theodor Fontane, Immanuel Clinic Rüdersdorf, Rüdersdorf, Germany
| | - Julian Schwarz
- grid.473452.3Department of Psychiatry and Psychotherapy, Brandenburg Medical School Theodor Fontane, Immanuel Clinic Rüdersdorf, Rüdersdorf, Germany
| | - Claudia Langer
- grid.473452.3Department of Psychiatry and Psychotherapy, Brandenburg Medical School Theodor Fontane, Immanuel Clinic Rüdersdorf, Rüdersdorf, Germany
| | - Sabine Glotz
- grid.6582.90000 0004 1936 9748Department of Psychiatry II, Ulm University, Günzburg Regional Hospital, Günzburg, Germany
| | - Karel Frasch
- grid.6582.90000 0004 1936 9748Department of Psychiatry II, Ulm University, Günzburg Regional Hospital, Günzburg, Germany ,Donauwörth Regional Hospital, Donauwörth, Germany
| | - Nicolas Rüsch
- grid.6582.90000 0004 1936 9748Department of Psychiatry II, Ulm University, Günzburg Regional Hospital, Günzburg, Germany
| | - Ulf Künstler
- Department of Psychiatry and Psychotherapy, Asklepios Western Hospital Hamburg, Rissen, Germany
| | - Thomas Bock
- grid.13648.380000 0001 2180 3484Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas Becker
- grid.6582.90000 0004 1936 9748Department of Psychiatry II, Ulm University, Günzburg Regional Hospital, Günzburg, Germany
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Soldini E, Alippi M, Zufferey MC, Lisi A, Lucchini M, Albanese E, Colombo RA, Rossa S, Bolla E, Mellacqua ZB, Larghi G, Cordasco S, Kawohl W, Crivelli L, Traber R. Effectiveness of crisis resolution home treatment for the management of acute psychiatric crises in Southern Switzerland: a natural experiment based on geography. BMC Psychiatry 2022; 22:405. [PMID: 35715789 PMCID: PMC9204869 DOI: 10.1186/s12888-022-04020-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 05/25/2022] [Indexed: 11/10/2022] Open
Abstract
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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Affiliation(s)
- Emiliano Soldini
- Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Palazzo E, Via Cantonale 16e, CH-6928, Manno, Switzerland.
| | - Maddalena Alippi
- grid.482997.90000 0001 1091 9932Cantonal Psychiatric Clinic, Organizzazione Sociopsichiatrica Cantonale, Via Agostino Maspoli 6, CH-6850 Mendrisio, Switzerland
| | - Maria Caiata Zufferey
- grid.16058.3a0000000123252233Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Palazzo E, Via Cantonale 16e, CH-6928 Manno, Switzerland
| | - Angela Lisi
- grid.16058.3a0000000123252233Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Palazzo E, Via Cantonale 16e, CH-6928 Manno, Switzerland
| | - Mario Lucchini
- grid.7563.70000 0001 2174 1754Department of Sociology and Social Research, Università Degli Studi Di Milano Bicocca, piazza dell’Ateneo nuovo 1, 20126 Milan, Italy
| | - Emiliano Albanese
- grid.29078.340000 0001 2203 2861Institute of Public Health (IPH), Faculty of Biomedical Sciences, Università Della Svizzera Italiana, Via Giuseppe Buffi 13, CH-6900 Lugano, Switzerland
| | - Raffaella Ada Colombo
- grid.482997.90000 0001 1091 9932Cantonal Psychiatric Clinic, Organizzazione Sociopsichiatrica Cantonale, Via Agostino Maspoli 6, CH-6850 Mendrisio, Switzerland
| | - Simona Rossa
- grid.482997.90000 0001 1091 9932Cantonal Psychiatric Clinic, Organizzazione Sociopsichiatrica Cantonale, Via Agostino Maspoli 6, CH-6850 Mendrisio, Switzerland
| | - Emilio Bolla
- grid.482997.90000 0001 1091 9932Cantonal Psychiatric Clinic, Organizzazione Sociopsichiatrica Cantonale, Via Agostino Maspoli 6, CH-6850 Mendrisio, Switzerland
| | - Zefiro Benedetto Mellacqua
- grid.482997.90000 0001 1091 9932Cantonal Psychiatric Clinic, Organizzazione Sociopsichiatrica Cantonale, Via Agostino Maspoli 6, CH-6850 Mendrisio, Switzerland
| | - Giuseppina Larghi
- grid.482997.90000 0001 1091 9932Cantonal Psychiatric Clinic, Organizzazione Sociopsichiatrica Cantonale, Via Agostino Maspoli 6, CH-6850 Mendrisio, Switzerland
| | - Severino Cordasco
- grid.482997.90000 0001 1091 9932Cantonal Psychiatric Clinic, Organizzazione Sociopsichiatrica Cantonale, Via Agostino Maspoli 6, CH-6850 Mendrisio, Switzerland
| | - Wolfram Kawohl
- Clienia Schlössli, Psychiatric Hospital, Schlösslistrasse 8, 8618 Oetwil Am See, Switzerland
| | - Luca Crivelli
- grid.16058.3a0000000123252233Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Palazzo E, Via Cantonale 16e, CH-6928 Manno, Switzerland
| | - Rafael Traber
- grid.482997.90000 0001 1091 9932Cantonal Psychiatric Clinic, Organizzazione Sociopsichiatrica Cantonale, Via Agostino Maspoli 6, CH-6850 Mendrisio, Switzerland
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Is Home Treatment for Everyone? Characteristics of Patients Receiving Intensive Mental Health Care at Home. Community Ment Health J 2022; 58:231-239. [PMID: 33735397 DOI: 10.1007/s10597-021-00814-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 03/06/2021] [Indexed: 10/21/2022]
Abstract
We aimed at determining differential characteristics of patients treated by a home treatment (HT) team compared to patients treated on hospital wards. Of 412 consecutively admitted patients, 194 (47.1%) were at least partially treated at home, whereas 218 (52.9%) received inpatient treatment only during an episode of acute illness. A multivariate logistic regression model identified current employment to increase the odds of HT (p < 0.001). A primary diagnosis of anxiety or stress-related disorder (p < 0.001), other rare primary diagnoses such as personality disorders (p < 0.001), and more pronounced clinician-rated social problems (p = 0.041) decreased the odds of HT. Overall, it remained difficult to clearly specify suitability for HT based on available sociodemographic and clinical characteristics. This might indicate that responsible clinicians consider HT to be a viable alternative to hospital care and hence initiate HT for a relatively broad spectrum of patients.
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Barakat A, Blankers M, Cornelis JE, van der Post L, Lommerse NM, Beekman ATF, Dekker JJM. Police Encounters, Agitation, Diagnosis, and Employment Predict Psychiatric Hospitalisation of Intensive Home Treatment Patients During a Psychiatric Crisis. Front Psychiatry 2021; 12:602912. [PMID: 33633607 PMCID: PMC7901988 DOI: 10.3389/fpsyt.2021.602912] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 01/13/2021] [Indexed: 11/30/2022] Open
Abstract
Objective: This study aims to determine factors associated with psychiatric hospitalisation of patients treated for an acute psychiatric crisis who had access to intensive home treatment (IHT). Methods: This study was performed using data from a randomised controlled trial. Interviews, digital health records and eight internationally validated questionnaires were used to collect data from patients on the verge of an acute psychiatric crisis enrolled from two mental health organisations. Thirty-eight factors were assigned to seven risk domains. The seven domains are "sociodemographic", "social engagement", "diagnosis and psychopathology", "aggression", "substance use", "mental health services" and "quality of life". Multiple logistic regression analysis (MLRA) was conducted to assess how much pseudo variance in hospitalisation these seven domains explained. Forward MLRA was used to identify individual risk factors associated with hospitalisation. Risks were expressed in terms of relative risk (RR) and absolute risk difference (ARD). Results: Data from 183 participants were used. The mean age of the participants was 40.03 (SD 12.71), 57.4% was female, 78.9% was born in the Netherlands and 51.4% was employed. The range of explained variance for the domains related to "psychopathology and care" was between 0.34 and 0.08. The "aggression" domain explained the highest proportion (R 2 = 0.34) of the variance in hospitalisation. "Quality of life" had the lowest explained proportion of variance (R 2 = 0.05). The forward MLRA identified four predictive factors for hospitalisation: previous contact with the police or judiciary (OR = 7.55, 95% CI = 1.10-51.63; ARD = 0.24; RR = 1.47), agitation (OR = 2.80, 95% CI = 1.02-7.72; ARD = 0.22; RR = 1.36), schizophrenia spectrum and other psychotic disorders (OR = 22.22, 95% CI = 1.74-284.54; ARD = 0.31; RR = 1.50) and employment status (OR = 0.10, 95% CI = 0.01-0.63; ARD = -0.28; RR = 0.66). Conclusion: IHT teams should be aware of patients who have histories of encounters with the police/judiciary or were agitated at outset of treatment. As those patients benefit less from IHT due to the higher risk of hospitalisation. Moreover, type of diagnoses and employment status play an important role in predicting hospitalisation.
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Affiliation(s)
- Ansam Barakat
- Department of Research, Arkin Institute for Mental Health Care, Amsterdam, Netherlands.,Department of Psychiatry, Amsterdam University Medical Centres (UMC), Location VUmc, Amsterdam Public Health Research Institute Amsterdam UMC, Amsterdam, Netherlands
| | - Matthijs Blankers
- Department of Research, Arkin Institute for Mental Health Care, Amsterdam, Netherlands.,Trimbos-Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, Netherlands.,Department of Psychiatry, Amsterdam University Medical Centres (UMC), Location AMC, Amsterdam Public Health Research Institute Amsterdam UMC, Amsterdam, Netherlands
| | - Jurgen E Cornelis
- Department of Research, Arkin Institute for Mental Health Care, Amsterdam, Netherlands.,Department of Emergency Psychiatry, Arkin Institute for Mental Health Care, Amsterdam, Netherlands
| | - Louk van der Post
- Department of Research, Arkin Institute for Mental Health Care, Amsterdam, Netherlands
| | - Nick M Lommerse
- Department of Research, Arkin Institute for Mental Health Care, Amsterdam, Netherlands
| | - Aartjan T F Beekman
- Department of Psychiatry, Amsterdam University Medical Centres (UMC), Location VUmc, Amsterdam Public Health Research Institute Amsterdam UMC, Amsterdam, Netherlands.,Department of Research and Innovation, GGZ InGeest Specialized Mental Health Care, Amsterdam, Netherlands
| | - Jack J M Dekker
- Department of Research, Arkin Institute for Mental Health Care, Amsterdam, Netherlands.,Department of Clinical Psychology, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute Amsterdam UMC, Amsterdam, Netherlands
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Stulz N, Kawohl W, Jäger M, Mötteli S, Schnyder U, Hepp U. From research to practice: Implementing an experimental home treatment model into routine mental health care. Eur Psychiatry 2020; 63:e94. [PMID: 33168129 PMCID: PMC7681154 DOI: 10.1192/j.eurpsy.2020.91] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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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Affiliation(s)
- N Stulz
- Integrated Psychiatric Services Winterthur-Zurcher Unterland, P.O. Box 144, CH-8408Winterthur, Switzerland
| | - W Kawohl
- Psychiatric Services Aargau, P.O. Box 432, CH-5201Brugg, Switzerland.,KPPP, University Hospital of Psychiatry Zurich, Lenggstrasse 31, CH-8008Zurich, Switzerland
| | - M Jäger
- KPPP, University Hospital of Psychiatry Zurich, Lenggstrasse 31, CH-8008Zurich, Switzerland.,Psychiatrie Baselland, Bienentalstrasse 7, CH-4410Liestal, Switzerland
| | - S Mötteli
- KPPP, University Hospital of Psychiatry Zurich, Lenggstrasse 31, CH-8008Zurich, Switzerland
| | - U Schnyder
- University of Zurich, CH-8001Zurich, Switzerland
| | - U Hepp
- Integrated Psychiatric Services Winterthur-Zurcher Unterland, P.O. Box 144, CH-8408Winterthur, Switzerland
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