Abstract
Aims and MethodHome treatment offers an alternative to in-patient care, but little has been written about the practicalities of running such a service. Using routine information sources, details of referral and outcome are presented for patients assessed by a home treatment service over 6 months.ResultsForty-eight per cent of referrals were not accepted, mainly because of lack of cooperation, risk to self or others or the illness not being acute enough. Referrals from junior doctors and accident & emergency were least likely to be accepted. Seventy-two per cent of patients accepted suffered from schizophrenia, bipolar affective disorder or depression with psychosis, similar to the diagnoses for in-patients. Twenty per cent of patients accepted had to be transferred to in-patient care later.Clinical ImplicationsStaffing levels need to take account of time spent assessing patients. Junior doctors need training in how to use home treatment services appropriately and a wider range of options are needed to manage patients in crisis out of hours. It is possible to target patients with severe mental illness in a home treatment setting, but a significant number will need transfer to inpatient care.
Highlights
The Home Options Service in Central Manchester was established in March 1997 as a direct development from the psychiatric day hospital
Information was collected for all in-patient admissions during the same time period and for patients accepted by Home Options who subsequently needed to be transferred to in-patient care
In each case clear reasons could be identified why Home Options was not suitable, for example, the patient may have had a previous admission to Home Options that was not productive
Summary
The Home Options Service in Central Manchester was established in March 1997 as a direct development from the psychiatric day hospital. The day hospital was already managing acutely ill patients as an alternative to inpatient care (Creed et al, 1990, 1997), but was limited by 9 a.m. to 5 p.m. opening hours and a focus on treatment occurring at the team base. The resulting service model is something of a hybrid between day hospital and home treatment, with a roughly equal number of contacts occurring at home and at the base. The Home Options staff must feel the level of risk to self or others is manageable and the patient must be able to offer a degree of cooperation. Short-term intensive treatment is offered in patient's homes and at the team base, with patients and carers able to contact the service at any time. Further details of service delivery have been described elsewhere (Harrison et al, 1999)
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