In-Home Mental Health Care

In-home mental health care is intensive treatment provided to patients who are experiencing an acute mental crisis and is designed to replace psychiatric hospitalization in a hospital department. Hospitalization is in the patient’s home.

The multidisciplinary staff

The staff includes professionals from the psychiatry, psychology, nursing, and social work sectors. When necessary and with the approval of the Home Hospitalization Unit, professionals from other health sectors, such as occupational therapy, diet, speech pathology, art therapy, and other healthcare professions, may participate. The staff can also include "expert colleagues," mentally challenged people who are in recovery processes and have undergone professional training so that they can contribute from their experience and help and support the patient in the recovery process.

The staff is also responsible for establishing the proposed range of service: service providers and HMOs defined the range of service packages for the patient’s clinical purpose. In general, the service package initially is intensive and includes highly frequent meetings. Over time, and with stabilization of the patient’s condition, the patient can receive a less intense and less frequent package of services.

The primary caregiver

One of the key criteria is the presence of a person who will function as the primary caregiver for the patient. This can be a family member or any other significant person in the patient’s life who will live with the patient in the same house that will be used for home hospitalization. The primary caregiver must be capable of performing the task, agree to assume responsibility for accompanying the patient for the entire duration of the in-home care, and be a partner in making and implementing therapeutic decisions.

As part of the in-home care, the patient can receive the treatments he needs at home or in rehabilitative housing in which he lives, such as a hostel. The therapies are provided by a multidisciplinary staff that maintains intensive contact with the patient as well as with the primary caregiver.

Preparing for In-Home Mental Care

The process will include coordination of expectations and instruction of the patient and primary caregiver on the following topics:

• Familiarity with personnel on the therapeutic staff.
• Instruction on remote medicine methods, measurement tools, and other auxiliary tools available to the patient and primary caregiver.
• Establishing an expected timetable, staff availability, and contact methods for all hours.
• Defining interfaces with therapeutic practitioners such as primary medicine, welfare, rehabilitation, etc.
• Preparation for various scenarios and how to behave in each one, for example, sleep difficulties, unrest, danger, difficulty in taking medication, etc.

What is it really like to receive in-home care?

The staff will work with the patient and their primary caregiver to create a treatment plan that supports the patient. This includes encouraging the patient to be independent and involved in managing their illness and following the treatment plan during recovery as much as possible.

How often the professional staff visits will be decided based on an assessment by the home hospitalization team. They will determine the visit frequency depending on how intensive the treatment needs to be, whether it's high or low. Generally, at the beginning of the hospitalization, visits will happen frequently, and over time, the frequency will decrease based on the patient's needs and the staff's decisions.

In-home care agenda

The therapeutic staff creates an agenda as part of the therapeutic plan. The purpose of the agenda is to maintain, to the extent possible, psychological and functional continuity of the patient subject to his mental state and abilities. Members of the therapeutic staff regularly visit the patient’s home with a package of services and meet with the patient as well as with the primary caregiver, inter alia, to determine whether the established agenda corresponds with the patient’s current condition and advances and controls his mental state and daily function. Every time the patient leaves the home, the patient must be accompanied by an escort and must be approved by the attending psychiatrist. Prior to discharge and in accordance with the instructions of the attending staff, a decrease in the need for supervision until independent function will be allowed.

Conclusion

In-home care ends once the medical staff determines that the therapeutic objectives have been achieved. The staff will make sure that the patient’s mental state is stable and that he can continue to receive therapy as part of outpatient treatment or at the clinic, and home care has reached its end. The decision to end treatment will be made in conjunction, to the extent possible, with the patient, the primary caregiver, and the patient’s HMO to facilitate continuity of care in the transition between therapeutic frameworks.

The decision to end home hospitalization will also be considered in the following circumstances:

• If the patient or primary caregiver requested to end it.
• If a change in circumstances has occurred that prevents the continuation of home care, including a contraindication that had not existed or was not known at the start of in-home care.
• When the staff believes that under these and other circumstances, it is impossible to achieve the therapeutic goals in an in-home setting and that full hospitalization in a hospital is required, or transition to a Beit Mazen.

Instructions for further care

Upon conclusion of hospitalization, the attending staff will provide the patient and primary caregiver a letter of summary of the therapy that includes details on the reason for hospitalization, diagnoses, medication, physical and mental state upon discharge, etc. The staff will also issue instructions and recommendations for further care and recommendations such as: a continued therapeutic setting such as outpatient clinic, continued therapeutic intervention required, and continued supervision to utilization of benefits from National Insurance or as part of the rehabilitation basket.

Utilization of benefits following home hospitalization

The processes for utilization of benefits, including recognition of mental health disability by National Insurance and assistance in referrals to the Rehabilitation Basket Board can take time. Waiting for hospitalization to end is therefore not recommended but rather the process should begin, if possible, during hospitalization. Consult the service provider regarding this and rely on supervision and support of a mental health professional who knows the patient.