14 - Acute home-based care and community psychiatry

Summary

Introduction

Before it was believed to foster dependency and promote chronicity, hospitalisation was the main strategy for helping the mentally ill in any situation, including a crisis. Until the mid-1950s, hospitalisation was mainly in remote mental hospitals. Custodial mental health care had expanded during the previous century, even though pre-eminent psychiatrists such as Griesinger (1845) in Germany had warned of disastrous consequences (see in Häfner & an der Heiden, 1989). Unhappy with traditional mental hospital care, professionals began to look at alternative community-based strategies, and to compare the effectiveness with standard hospitalisation (Tyrer, 1985; Hoult, 1986; Kiesler & Sibulkin, 1987; Tansella & Zimmermann-Tansella, 1988; Mosher & Burti, 1989; Thornicroft & Bebbington, 1989).

In emergency situations, community care must offer a rapid response to urgent requests for help, with a minimum use of the hospital. To achieve this, a gatekeeper to the hospital is needed, and care must be offered to the client in his or her own environment. Acute home-based care typically meets both of these requirements. An early example is the ‘psychiatric first aid service’, established by Querido in Amsterdam, during the early 1930s (Querido, 1968). Other early examples of community home visiting and treatment services are reported to have existed since 1949 in Nottingham, UK (MacMillan, 1958), and in Worthing (Carse et al., 1958) and in Boston, USA, since 1957 (Meyer et al., 1967).

The need to care for patients discharged from mental hospitals expanded the practice of home visits both for crisis intervention and follow-up.