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Home treatment for acute psychiatric illness
BMJ (Clinical Research Ed.)
|November 3, 1990
Summary
Community treatment for acute psychiatric illness is feasible for most patients. Social and referral factors, not just illness severity, influence treatment location, highlighting the need for accessible 24-hour services.
Area of Science:
- Psychiatry
- Mental Health Services Research
Background:
- Severe acute psychiatric illnesses traditionally require hospitalization.
- Community-based treatment models offer an alternative for managing these conditions.
Purpose of the Study:
- To identify factors predicting successful community treatment for severe acute psychiatric illnesses.
- To compare outcomes of home treatment versus hospital admission.
Main Methods:
- A two-year audit of 99 patients (aged 16-65) with severe acute psychiatric illness in Sparkbrook, Birmingham.
- Analysis of case notes to determine treatment location (home vs. hospital) and associated patient/referral characteristics.
Main Results:
- 65 patients received home treatment; 34 required hospital admission.
- Treatment location was significantly influenced by patient social factors (marital status, age, ethnicity, living alone) and referral characteristics (timing, assessment location).
- Violence was linked to admission, while self-harm was not; diagnosis had a weaker association.
Conclusions:
- Home treatment is a viable option for the majority of patients with acute psychiatric conditions.
- A 24-hour on-call assessment service enhances success by prioritizing social and referral factors over illness severity for admission decisions.
- Effective community treatment requires integrated services including a local resource center, 24-hour access, open referrals, and proactive follow-up.