NEWS & BRIEFINGS

Home Care as an Alternative to Psychiatric Hospital

A small proportion of patients with mental illness become too unwell for standard outpatient treatment with their psychiatrist or therapist. Their condition graduates to a higher level of severity and/ or an elevated risk of further deterioration. The treatment needs of patients under these circumstances involve four key requirements:

  1. Optimise medication quickly through monitoring and review of mental state, prompt adjustments to regular medication, and administering further medication to relieve distressing symptoms as required.
  2. Frequent evaluations of risk and appropriate response to changing circumstances e.g. adjusting levels of support, providing reassurance, de-escalation, and relaxation, or giving additional medication.
  3. Other treatments that help patients treat symptoms e.g. cognitive and behavioural remodelling, exercise, nutrition.
  4. Allowing time for the patient to respond to treatment.

The aim is to safely treat and manage patients in the least restrictive environment and still address the aforementioned needs. The choice of where treatment takes place - whether in hospital or in the community - will depend on, amongst other factors:

  • Patient preference;
  • Illness type and severity
  • Nature of potential risks
  • Rate at which illness is changing or responding to treatment
  • Household make-up (e.g. presence of relatives as carers or young children who may become upset by patient’s behaviour)
  • Past history
  • Financial circumstances and local resources
  • Experience of treating clinicians.

For example, patients with severe mental illness requiring treatment against their wishes will need to be in hospital, or if the risks of deterioration, harm to self or other people are serious; they may require summoning a greater number of staff at short notice, or undergo measures that restrict their wishes or enforce treatment. For most other acutely ill patients who retain their capacity to make decisions and are willing to engage in treatment, yet require more support than can be provided by their psychiatrist or therapist, home treatment would be suitable.  

The NHS has acute psychiatric hospitals and patients requiring acute services can also access nurse-led Community Mental Health Teams, which have been helping patients overcome episodes of illness and preventing admissions to hospital for over 50 years in the UK. Yet, levels of severity for acceptance by NHS services are significantly higher than might expected, and waiting times often long due to resource limitations. In the private sector, hospital is often the only choice, even though it is not actually indicated or necessary, due to low awareness or promotion of community services beyond what psychiatrists can manage. This document sets out some of the similarities and differences between private hospital and private home treatment, both of which address the four key elements above:

IN HOSPITAL:

  • 2-3/weekly visits by psychiatrist at set times
  • On-call doctor
  • 24/7 nursing care
  • Group therapy
  • Structure/Containment in a group environment

Patients’ experience of care can be mixed in hospitals during an already difficult time and they have little control of when and who they see:

  1. Nurses primarily provide the core of the care in hospitals. Yet, in-patient nurses: carry out many non-care related tasks that take them away from patients; are allocated case loads of between 4-6 patients per shift with different levels of acute need; and, in many cases, have less experience.
  2. Uninviting hospital surroundings; lottery with other patients.
  3. Patients tend to find input by psychiatrists and therapists most beneficial. Yet, individual therapy is not generally available and group therapy can be disappointing due to group sizes, suitability of subject, frequency of sessions, patients being too unwell to participate, or preference for individual therapy.

AT HOME:

  • Reviews by consultant psychiatrist as required
  • Psychiatrist available for advice
  • Flexible nursing care, from an hour a day to live-in
  • Individual therapy easy to access
  • Structure/Containment provided on individual basis

Patients have more control and choice of treatment, and their experience is generally enhanced:

  1. Nurses primarily provide the core of the care in hospitals. Yet, in-patient nurses: carry out many non-care related tasks that take them away from patients; are allocated case loads of between 4-6 patients per shift with different levels of acute need; and, in many cases, have less experience.
  2. Uninviting hospital surroundings; lottery with other patients.
  3. Patients tend to find input by psychiatrists and therapists most beneficial. Yet, individual therapy is not generally available and group therapy can be disappointing due to group sizes, suitability of subject, frequency of sessions, patients being too unwell to participate, or preference for individual therapy.

To find out how BREVIN can help with it's approach to treating mental illness, dealing with the individual on a one to one level in the luxury of their home surroundings, please contact us for more information.

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Here are some useful considerations when enquiring about our service:

  • We treat adults over the age of 18
  • We are regulated by the CQC
  • Our treatment services are available in London and the surrounding areas
  • We can work alongside your existing clinical team
  • We do not need a referral
  • We can work with your existing GP or appoint
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Brevin Homecare Ltd trading as BREVIN is regulated by The Care Quality Commission. ©BREVIN 2018. All rights reserved.