Psychiatric Hospitalization

Psychiatric home hospitalization 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.

Composition of 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, 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 meeting. Over time, and stabilization of the patient’s condition, the patient can receive 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 entire duration of the hospitalization and to be partner in making and implementing therapeutic decisions.

As part of the home hospitalization, the patient can receive the treatments he needs at home or in a 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 Psychiatric Home Hospitalization

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 examplesleep difficulties, unrest, danger, difficulty in taking medication, etc.

What will actual hospitalization be like

The staff will create a therapeutic plan in conjunction with the patient and the primary caregiver, while empowering the patient, for example by encouraging and promoting independence and involvement in managing the disease, implementation of the therapeutic plan and the recovery process, to the extent possible.

The frequency of sessions with the professional staff will be determined according to a clinical assessment of the home hospitalization unit staff. The staff will determine the frequency based on the level of therapeutic intensity required, high or low. Ini general, at the start of hospitalization, the sessions will take place frequently and over time, the frequency of the sessions will decrease, based on the patient’s needs and decision of the attending staff.

The agenda in home hospitalization

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, 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 of home hospitalization

Home hospitalization 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 hospitalization 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 hospitalization, including a contraindication, that had not existed or was not known at the start of hospitalization.
• When the staff believes that under these and other circumstances, it is impossible to achieve the therapeutic goals in a home hospitalization 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.