08 Treating people with acute mental illnesses at home
Over the past 30 years, the home treatment of patients with acute mental illnesses has raised many hopes and questions. The results of the Ticino study show that treatment at home is an effective, safe, feasible and cost‐effective alternative compared to standard inpatient treatment.
Project description (completed research project)
The effectiveness of home treatment was studied using a quasi-experimental approach. Patients in the Bellinzona and Valli area were assigned to the treatment group (psychiatric treatment at home), while those from the Lugano district were assigned to the control group (inpatient treatment). Indicators such as the treatment length, symptoms’ variation and relapses, measured at the end of the treatment and during a two years follow-up period, were quantitatively compared between the two groups. Furthermore, the experiences of patients, medical professionals, and relatives with the treatment at home were qualitatively analyzed.
In 2016, the Ticino Cantonal Psychiatric Clinic replaced an acute inpatient ward with a new service for psychiatric treatment and care for patients at home in the Bellinzona and Valli district. Although this form of treatment was already widespread particularly in English speaking countries, in Switzerland there were still little data on its effectiveness and cost-effectiveness. The peculiar situation in the canton of Ticino allowed the conduction of a study to compare hospital treatment with home treatment.
The aim of the study was to assess the feasibility, acceptance, effectiveness and cost-effectiveness of care for people with acute mental illnesses at home compared to standard inpatient treatment.
The data showed that the duration of the treatment, the psychiatric symptoms’ variation after completion of treatment and the frequency and duration of relapses were comparable between the two groups. Overall, treatment at home proved to be cost-effective when compared to inpatient treatment, in particular during the follow-up phase. Patients, relatives, and health professionals experienced home treatment as a good, person-centered and diversity-oriented offer; this good result was achieved thanks to the collaboration of all the actors in meeting the challenges of this particular type of care.
Relevance / Application
Significance of the results for research and practice
In Ticino, treatment of acute psychiatric crises at home is a feasible, safe, effective, cost-effective and accepted alternative to inpatient treatment. Further research should show which conditions (patient’s characteristics, composition and organization of the treating team, intervention structure, etc.) ensure optimal treatment at home. The present results served to inform the extension of the service to the region of Southern Ticino. Furthermore, they can be consulted as evidence for the future revision of the cantonal law on socio-psychiatric assistance (LASP).
There's no place like home: Testing the cost-effectiveness of home treatment for acute mental illness in Ticino