Education And Debate

The home treatment enigmaHome treatment—enigmas and fantasies

BMJ 2000; 320 doi: https://doi.org/10.1136/bmj.320.7230.305 (Published 29 January 2000) Cite this as: BMJ 2000;320:305

The home treatment enigma

  1. M G Smyth, honorary senior lecturer,
  2. J Hoult, consultant
  1. Department of Psychiatry, Northern Birmingham Mental Health (NHS) Trust, Birmingham B23 6AL
  2. a Lanarkshire Primary Care NHS Trust, East Kilbride G75 8RG
  3. b Greater Glasgow Primary Care NHS Trust, Leverndale Hospital, Glasgow G52 7TU
  1. Correspondence to: M G Smyth
  • Accepted 22 March 1999

Why is home treatment for acute psychiatric illness generally ignored as an alternative to conventional admission to hospital in the United Kingdom? Despite evidence showing that home treatment is feasible, effective, and generally preferred by patients and relatives, its widespread implementation is still awaited. Furthermore, no study has shown that hospital treatment is better than home treatment for any measure of improvement. In general, patients are denied the option of home treatment as a realistic, less restrictive alternative to formal admission under the Mental Health Act 1983, although the recent white paper Modernising Mental Health Services recommends that it should be provided.1

In any economic analysis, hospital admission remains the most expensive element of psychiatric care. Although the pressure on acute beds in inner city psychiatric hospitals in the United Kingdom is increasing—and it has reached breaking point in some areas 2 3 —it is claimed that managing these patients outside hospital would be out of the question.4 The pressure on hospital beds has been linked indirectly with the practice of discharging psychiatric patients too early and with well publicised reports of official inquiries into “psychiatric scandals.” In a recent article that was critical of the current state of British psychiatry, it was alleged that the Department of Health and health authorities had misconstrued research into home treatment and that this had resulted in a reduction in the provision of acute beds.4 We aim to examine the issues, real and imagined, that are behind the resistance to treatment at home.

Summary points

Home treatment is a safe and feasible alternative to hospital care for patients with acute psychiatric disorder, and one that they and their carers generally prefer

Hospital treatment has not been shown to have major advantages over home treatment and is more expensive

Home treatment has not …

Correspondence to: A Pelosi

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