Deconstructing home‐based care for mental illness: can one identify the effective ingredients?

Abstract

It is premature to define an optimal configuration for home based care services. The need for introducing differing components of such care will depend on what is currently available locally. Where regular home visiting to psychotic patients plus a broad service model incorporating health and social care objectives are provided, major reductions in in-patient care are not currently to be anticipated by service re-configurations.

Assertive community treatmentIssues from scientific and clinical literature with implications for practice

“…ACT team members must work interdependently in community settings and employ initiative, pragmatism, "street smarts," and the ability to work as a group [53], although being able to engage the consumer one-onone in an ongoing therapeutic alliance may be equally important [35][36] [16] that built on the DACTS and headed toward expectancy-referenced criteria linked to better outcomes, which then led to a brief grading system that clearly discriminated ACT from other forms of case management. European researchers assert that they replicated ACT in Europe without the advantageous outcomes found in North American and Australian studies [76][77], but their purported ACT proxy interventions, e.g., "intensive case management," have been shown to meet far fewer fidelity criteria than most ACT studies [2,[78][79].…”

“…After criticizing Teague et al's DACTS [15] as being too "theoretical" and prone to "heated argument," Burns et al used the Delphi technique together with a systematic review to ascertain the operative features of effective home-based care [76][77]. These features included-1.…”

The place for nidotherapy in psychiatric practice

“…For a good assessment it is necessary to see the patient at home, for it is only in this setting that all important environmental factors can be evaluated. There is considerable debate about the value of home treatment in psychiatry at present (Burns et al, 2002(Burns et al, , 2006, but this is considered mandatory in nidotherapy. Understanding the environmental problems of the individual involves 'collateral collocation' (Tyrer et al, 2003a), literally placing yourself in the exact position of the patient in relationship to the environment.…”

„Gender differences” w programie wsparcia społecznego dla osób chorujących psychicznie

“…Odnotowywane różnice dotyczą przede wszystkim momentu wystąpienia pierwszego epizodu, który pojawia się później u kobiet i charakteryzuje się stosunkowo łagodniejszym przebiegiem, związanym prawdopodobnie z szybszą odpowiedzią na leczenie [2]. Wydaje się także, że w przypadku kobiet przebieg schizofrenii charakteryzuje się lepszym rokowaniem [3]. Ważnym elementem leczenia jest także umiejętność współpracy z lekarzem oraz przestrzeganie zaleceń medycznych, co w przypadku kobiet występuje istotnie częściej niż u mężczyzn chorujących na schizofrenię [4].…”