HOME-BASED PSYCHIATRIC TREATMENT: 2000-2005

Ferentinos P, Zeikou E, Milonaki T, Kalabogia K, Fitsiou P, Tsitsopoulou M, Sakellaropoulos P 
Mental Health Institute for Children and Adults, Athens, Greece

Introduction

Home-based psychiatric treatment (HBPT), as applied by the Mental Health Institute for Children and Adults (MHICA), dates back to the 1970s. It was introduced by Professor P.Sakellaropoulos.

HBPT’s basic principle is that treatment is better provided in patients’ home, when possible.

Goals

• HBPT’s main goal is to avoid hospitalization, which often brings about regression, self-depreciation, stigmatization, family’s guilt and induces patients’ persecutory fantasies. Compliance, responsibility and active participation in therapy are, thus, facilitated.
• In parallel, the patient’s family is involved through consultation sessions. The patient and his family are dealt with as a whole even though the symptoms are not the same.
• Another main goal of HBPT is continuity in psychiatric care after the crisis intervention. When the acute phase is over, therapy is encouraged to continue in an integrated medical and psychosocial treatment program in MHCIA.
• Therefore, HBPT is not an isolated activity but it is incorporated in a treatment network, which combines medical and psychosocial therapies (drug therapy, psychotherapy, family therapy, Day Center services), in an attempt to respond continuously and cohesively to psychotic patients’ various needs.

Therapeutic team

The therapeutic team consists of mental health professionals of different specialties (psychiatrists, psychologists, nurses, social workers).

Eligible patients

HBPT is indicated for:

• acute psychiatric patients
• patients returning home after a long or short term hospitalization
• outpatients, who have never been hospitalized (Mobile Units of Fokida and Evros)
• stabilized patients with mobility problems

There can be combinations and modifications of technique according to psychopathology, family support, and risk issues.

Objective

This study presents findings regarding:

• Patients considered eligible for HBPT (Intakes) between 2000 and 2005
• Patients actually treated with HBPT between 2000 and 2005

Demographic Characteristics

• 71 patients
• 42 females (59.2%), 29 males (40.8%)
• age 41.5 (±19.6) years

HBPT intakes per month (2000-2005)

Diagnosis

Clinical characteristics

• 49 acute patients (69 %)
• Duration of disease 7.5±9.7 years (0-38 y)
• 18 patients (25.4%) had no former psychiatric treatment
• 24 patients (33.8%) had no drug therapy in the past
• 22 patients (31%) had 1-8 hospitalisations in the past

B. PATIENTS ACTUALLY TREATED WITH HBPT
(2000-2005)

Demographic characteristics

• 49 patients
• 29 females (59.2%), 20 males(40.8%)
• age 39.6 (±17.9) years

Diagnosis

Clinical characteristics

• 32 acute patients (65.3%)
• Duration of disease 7.6±9.8 years
• 11 patients (22.4%) had no former psychiatric treatment
• 16 patients (32.7%) had no drug therapy in the past
• 14 patients (28.6%) had 1-3 hospitalisations in the past

HBPT Features

• Drug therapy: 46 patients (93.9%)
• Psychotherapy: 49 patients (100%)
• Parental counseling: 15 patients (30.6%)

HBPT course

• 22 patients (44.9%) finalized treatment after 19.6 (±13.8) months;
• 19 patients (38.8%) dropped out after 2.3 (±2.4) months;
• 7 patients (14.3%) are still on treatment.

HBPT outcome

• In total, 71.4% of patients improved and 28.6% remained stagnant.

CONCLUSION

• Profile of the patient presenting for HBPT:
• female,
• around 40 years old,
• single,
• living with her family,
• well-educated,
• unemployed,
• currently unoccupied,
• psychotic,
• disease onset before 7.5 years
• in the acute phase
• not hospitalised in the past
• not improved with former treatment