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Psych patients in crisis can be treated at home, says expert

Canadian Medical Association Journal report explores the benefits of helping psychiatric patients in crisis get better care away from the hospital emergency room

A commentary in the Canadian Medical Association Journal has suggested that psychiatric hospital-at-home programs could be more helpful than sending mental health patients in crisis to a hospital emergency room. 

The article was authored by Waterloo, Ont. psychiatrist Dr. David S. Heath discussing how to provide the best treatment to patients with acute mental health disorders. He wrote that bringing patients in-crisis to the emergency room is not necessarily the best solution.

"Current evidence-based planning for mental health services requires incorporation of alternatives to hospital-based care, such as crisis residences, acute day hospitals, and psychiatric hospital-at-home programs," Heath wrote.

He quoted a 2002 study at the Louis-H. Lafontaine Hospital in Montréal that examined using a “bottom–up” methodology, whereby psychiatrists decided which of their current inpatients — including newly admitted patients — on a given day could theoretically be treated in one or more alternative services.

Less than a third, only 29 per cent of the sampling of acute care psychiatric patients, were found unsuitable for an alternative to hospital care, said the article.

"A confusing variety of terms have been used to describe psychiatric hospital-at home programs, including crisis resolution and home treatment (in England and Australia) and, a term I prefer, intensive home treatment," Heath wrote.

He said he started Canada's first IHT program — the Hazelglen Program — in 1989 in Kitchener–Waterloo. 

Canada’s first IHT program, the Hazelglen Program, was started by Heath in 1989 in Kitchener–Waterloo, he said..

"The program was able to treat patients with severe acute schizophrenia, bipolar disorder, or depression without admitting them. A multidisciplinary team makes frequent home visits, provides all the treatment that the hospital provides, helps figure out the social factors contributing to the crisis, and provides 24/7 clinical coverage," he said.

Heath said intensive home treatment has been shown to be as safe and effective as hospital treatment; was preferred by patients and their families, and was found to be cheaper, in a study from the United Kingdom.

"Intensive home treatment can reduce pressure on beds by around a third, as indicated by a 2022 study from the Netherlands, and 40 per cent of patients can be discharged early to IHT, according to a report from the UK’s national audit office," he said

Heath argued that more IHT programs are needed in Canada, would be cheaper to run and more useful to the patients.

"The IHT model of treatment has been disseminated to 11 countries but, in Canada, is available in only three provinces, including three programs in Quebec, four in British Columbia, and still only one — Kitchener–Waterloo — in Ontario. Creating IHT teams in Canada would likely be cheaper and as effective as creating new mental health beds, and is a solution that may be more appealing to government funding bodies."

A full text copy of Heath's commentary is available online here.