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Home-based treatment in Monaghan: the first two years

Published online by Cambridge University Press:  13 June 2014

MacDara McCauley
Affiliation:
Central Mental Hospital, Dundrum, Dublin 22, Ireland
Siobhan Rooney
Affiliation:
Special interest in Substance Misuse, St. Loman's Hospital, Mullingar, Westmeath, Ireland
Ciaran Clarke
Affiliation:
Mater Hospital, Eccles St. Dublin 7, Ireland
Teresa Carey
Affiliation:
St. Davnet's Hospital Monaghan, Ireland
John Owens
Affiliation:
St. Davnet's Hospital Monaghan, Ireland

Abstract

Objectives: To describe a home-based treatment (HBT) service. To profile the patient population using HBT. To determine why HBT was used and to record disposal.

Method: All patients treated by HBT during the first two years of this new service were identified from the HBT logbook. A checklist recording demographic, diagnostic, presenting complaint data and details of HBT contact was used to analyse the patients' charts. A statistical package JMP was used to analyse the data.

Results: Two hundred and six patients (275 episodes) were treated using HBT. These were 101 (49.1 %) males and 105 (50.9%) females. Of these, 89 (43.2%) were single. Forty-eight (19.4%) lived alone and 53 (25.7%) were unemployed. The most common presenting complaint was severe depression (39.3%). A depressive disorder was the most frequent diagnosis (28.7%). Twenty six (13%) episodes of HBT ended in admission. One hundred and eighty five (67.3%) were referred to outpatients and 26 (9.5%) were discharged to the GP.

Conclusions: Home-based treatment is feasible for a wide range of patients with an array of presenting complaints. This model of service delivery is viable in a rural setting. Admission will still be required for some patients. Further work is needed to examine its sustainability and its generalisability to other Irish settings.

Type
Original Papers
Copyright
Copyright © Cambridge University Press 2000

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References

1.Brown, P. The transfer of care. Psychiatric deinstitutionalization and its aftermath. New York: Routledge, 1985.Google Scholar
2.Audit commission. Making a reality of community care. London: HMSO, 1975.Google Scholar
3.Hoult, J. Mobile crisis services [Letter]. Psychiatr Serv 1996; 47: 311–12.Google ScholarPubMed
4.Dick, P, Ince, A, Barlow, M. Day treatment: suitability and referral procedure. Br J Psychiatry 1985; 147: 250–53.CrossRefGoogle ScholarPubMed
5.Franklin, JL, Solovitz, B, Mason, M, Clemons, JR, Miller, GE. An evaluation of case management. Am J Public Health 1987; 77: 674–78.CrossRefGoogle ScholarPubMed
6.Smyth, MG, Hoult, J. The home treatment enigma. BMJ 2000; 20: 305–8.CrossRefGoogle Scholar
7.Muijen, M, Marks, IM, Connolly, J, Audini, B. Home-based Care versus standard hospital-based care with severe mental illness: a randomised controlled trial. BMJ 1992; 304: 749–54.CrossRefGoogle Scholar
8.Joy, CB, Adams, CE, Rice, K. Crisis intervention for severe mental illness. In: Cochrane Collaboration. Cochrane Library. Issue 4. Oxford: Update Software, 1998.Google Scholar
9.IM, Marks, Connolly, J, Muijen, M, Audini, B, McNamee, G, Lawrence, RE. Home-based versus hospital-based care for people with serious mental illness. Br J Psychiatry 1994; 165: 179–94.Google Scholar
10.Pelosi, AJ, Jackson, GA. Home treatment-enigmas and fantasies. BMJ 2000; 320: 308–9.Google ScholarPubMed
11.Burns, T. [Letter] Vigorous, well designed trials are needed. BMJ 2000; 321:177.CrossRefGoogle ScholarPubMed
12.Hogan, K, Orme, S. [Letter] Treatment at home is nationwide and successful. BMJ 2000; 321:178.Google ScholarPubMed
13.Sandor, A, Orme, S, [Letter] Home treatment teams. Psych Bull 2000; 24:394.CrossRefGoogle Scholar
14.Kluiter, H, Geil, R, Nienhuis, FJ, Ruphan, M, Wiersma, . Predicting feasibilty of day treatment for unselected patients referred for inpatient psychiatric treatment: Result of a randomized trial. Am J Psychiatry 1992; 149:11991205.Google Scholar
15.Braun, P, Kochansky, G, Shapiro, Ret al.Overview: deinstitutionalisation of psychiatric patients, a critical review of outcome studies. Am J Psychiatry 1981; 6: 736–49.Google Scholar
16.Stein, LI, Test, MA, Alternative to Mental Hospital Treatment. Conceptual model, treatment program, and clinical evaluation. Arch Gen Psych 1980; 37: 392–7.CrossRefGoogle ScholarPubMed
17.Coid, JW. Failure in community care: psychiatry's dilemma. BMJ 1994;308: 805–6.CrossRefGoogle ScholarPubMed
18.Minghella, E, Ford, R, Freeman, T, Hoult, J, McGlynn, P, O'Halloran, P. Open all hours. 24hour response for people with mental health emergencies. London: Sainsbury Centre for Mental Health, 1998.Google Scholar
19.Owen, AJ, Sashidhran, SP, Edwards, LJ. Availability and acceptability of home treatment for acute psychiatric disorders. A national survey of mental health trusts and health authority purchasers. Psych Bull 2000; 24: 169–71.CrossRefGoogle Scholar
20.Dean, C, Gadd, EM. Home treatment for acute psychiatric illness. BMJ 1990; 301:1021–3.CrossRefGoogle ScholarPubMed
21.Reynolds, I, Hoult, JE. The relatives of the mentally ill; a comparative trial of community-orientated and hospital orientated psychiatric care. J Nerv Ment Dis 1984;172:480–9.CrossRefGoogle Scholar
22.Harrison, J, Alam, N, Marshall, J. Home or away: which patients are suitable for a psychiatric home treatment service. Psych Bull 2001; 25: 310–13.CrossRefGoogle Scholar
23.Bracken, P, Cohen, B. Home treatment in Bradford. Psych Bull 1999; 23: 349–62.CrossRefGoogle Scholar
24.Hoult, J. Dissemination in New South Wales of the Madison model. In: Mental Health Delivery: Innovations, Impediments and Implementation, (eds Marks, IM & Scott, R) ch.4: 4157. Cambridge: Cambridge University Press, 1990Google Scholar
25.Test, MA, Theoretical and research bases of community care programmes. In Mental Health Delivery: Innovations, Impediments and Implementation, (eds Marks, IM & Scott, R) 1990; pp. 11-16, 254256. Cambridge: Cambridge University Press.Google Scholar
26.Carroll, A, Pickworth, J, Protheroe, D. Service innovations: An Australian approach to community care- the Northern Crisis Assessment and Treatment Team. Psych Bull 2001;25:439441.CrossRefGoogle Scholar
27.Goldberg, DP, Blackwell, P. Psychiatric illness in general practice. BMJ 1970;2: 439–43.CrossRefGoogle Scholar
28. World Health Organisation. Psychiatry and primary medical care: WHO. Regional Offices for Europe, 1973.Google Scholar
29.Kluiter, H. Inpatient treatment and care arrangements to replace or avoid it-searching for an evidence-based balance. Curr Opin in Psych 1997; 10:160–7.CrossRefGoogle Scholar
30.Knapp, M, Beecham, J, Koutsogeorgopoulou, Vet al.Service use and costs of Home-Based versus Hospital-based care for people with serious mental illness. Br J Psych 1994;165:195203.CrossRefGoogle ScholarPubMed
31.Marshall, M, Lockwood, A. Assertive community treatment for people with severe mental disorders. Cochrane Database of Systematic Reviews. Issue 3, 2001.Google Scholar