Intensive Home Treatment for Acute Mental Disorders: An Alternative to Hospitalization

This article by David Heath has been published by Mad in America. It begins:

“In 1978, I became the medical director of a general hospital psychiatric unit serving the twin cities of Kitchener/Waterloo in southwestern Ontario, Canada. Over the next four years, population growth accelerated, and more psychiatrists joined the department, both of which resulted in increasing pressure on beds. We reached a point where patients had to wait a dangerously long time to be admitted.

The provincial Ministry of Health policy was clear: no more funding for hospital beds—only funding for community programs. I couldn’t see a way forward. An acute day hospital did not seem feasible; most of our patients were too ill to reliably attend, and public transportation is poor. There were no workable models for a crisis residence at that time.

The solution arrived fully formed in August 1982, when, casually flipping through a psychiatric journal, I spotted a review of the book Home and Hospital Psychiatric Treatment by psychiatrist Fred Fenton and his home treatment team at the Montreal General Hospital: ‘The results are clear and consistent. Home treatment emerges as a safe, acceptable, effective, economic alternative to hospital care for all three diagnostic groups’ (schizophrenia, affective psychosis, and depressive neurosis, all ICD 8 terms).

In 1979, Fenton’s group had conducted a randomized controlled trial of home treatment versus hospital treatment published in the Archives of General Psychiatry—a respected journal. Depending on diagnosis, 35-58% of patients avoided hospital completely. In 1982, it was an epiphany to suddenly look around the ward at all the patients and realize that we didn’t need to admit all these people; we could actually treat many of them in their own homes! …”

You can read more from here.

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