Exploring the role of carers in psychiatric home treatment: qualitative multi-method study

BACKGROUND: This qualitative study explored the roles, experiences, and needs of informal carers such as family and close friends in acute psychiatric home treatment in Germany. METHODS: Data was collected through individual interviews, focus groups, and participant diaries with 27 carers and analyzed using grounded theory methodology. RESULTS: The findings highlight the central yet multifaceted role carers play in facilitating care - initiating treatment, providing emotional containment, supporting daily functioning, and acting as intermediaries between service users and professionals. However, these roles were often poorly defined, leading to uncertainty, role conflicts, and occasional exclusion from the treatment process. Limited or unclear communication about expectations, responsibilities, and boundaries exacerbated this ambiguity. Carers also reported significant emotional and practical burdens, sometimes reaching a level of strain that jeopardized the continuation of home treatment. Recognition of their contributions, proactive engagement by the treatment team, and tailored support strategies were identified as key facilitators of positive involvement. CONCLUSIONS: The results underscore the need to systematically embed role clarification, structured collaboration, and carer support into the design and delivery of home treatment services. Future research should further explore how explicit clearly defined role negotiation and early joint planning meetings can enhance carer involvement while mitigating strain. TRIAL REGISTRATION: German Clinical Trials Register (DRKS), DRKS00022476. Registered December 3rd 2020, https://drks.de/search/de/trial/DRKS00022476 ; ClinicalTrials.gov, Identifier: NCT0474550. Registered February 9th 2021.