[Home treatment for people with acute mental illnesses]

Home treatment has been proposed as an alternative to acute psychiatric inpatient treatment. Health insurance systems in Germany and in Switzerland hinder the nationwide implementation of home treatment teams into mental health systems, although the German S3 guidelines for psychosocial treatments of severe mental illnesses recommend provision of acute care at home. Evidence for home treatment is positive, yet there are only few up-to-date studies from Europe and differential indication criteria are lacking. The aim of home treatment is to reduce inpatient bed-days by nonadmission or early discharge. Home treatment teams are mobile, interdisciplinary, and provide 24 h services. The average treatment length in home treatment should not exceed the duration of the inpatient treatment. The home treatment team usually takes the responsibility for the gatekeeping for inpatient treatment. Future research should focus on precise definitions of the structures and interventions of home treatment teams. Home treatment for severely mental ill patients should be distinguished from assertive community treatment and case management, which offer continuing rather than acute crises care.