Home treatment for acute mental healthcare: protocol of the Financial Outputs, Risks, Efficacy, Satisfaction Index and Gatekeeping of Home Treatment (FORESIGHT) study

Levati, Sara and Mellacqua, Zefiro Benedetto and Caiata Zufferey, Maria and Soldini, Emiliano and Albanese, Emiliano and Alippi, Maddalena and Bolla, Emilio and Colombo, Raffaella Ada and Kawohl, Wolfram and Cordasco, Severino and Larghi, Giuseppina and Lisi, Angela and Lucchini, Mario and Rossa, Simona and Traber, Rafael and Crivelli, Luca (2021) Home treatment for acute mental healthcare: protocol of the Financial Outputs, Risks, Efficacy, Satisfaction Index and Gatekeeping of Home Treatment (FORESIGHT) study. JMIR Research Protocols, 10 (11). e28191. ISSN 1929-0748

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BACKGROUND Crisis Resolution and Home Treatment (CRHT) teams represent a community-based mental health service offering a valid alternative to hospitalisation. CRHT teams have been widely implemented in various mental health systems worldwide and their goal is to take care of people with severe acute mental disorders that would be considered for admission to acute psychiatric wards. The evaluation of several home-treatment experiences shows promising results; however, it remains unclear which specific elements and characteristics of CRHT are more effective and acceptable. OBJECTIVE This study aims to assess the acceptability, effectiveness and cost-effectiveness of a new CRHT intervention in Ticino, Southern Switzerland. METHODS The study includes an interventional non-randomised quasi-experimental study combined with a qualitative study and an economic evaluation over a 48-month period. The quasi-experimental evaluation will involve two groups: patients in the northern area of the region will be offered with the CRHT service and be defined as the intervention group; patients in the southern area of the region will act as the control group and receive care as usual. Individual interviews with patients receiving the home treatment intervention and their family members will be conducted. CRHT members will be asked to take part in a focus group. The economic evaluation will include a cost-effectiveness analysis. RESULTS As of February 2021, data for the non-randomised quasi-experimental study have been collected and results are expected to be published by the end of the year. Data are currently being collected for the qualitative study and the economic evaluation, and the results will be disseminated through publication when the analysis is complete. CONCLUSIONS Compared to other Swiss CRHT experiences, the CRHT intervention in Ticino represents a unique case, as the introduction of the service is backed by the closing of one of its acute wards. The proposed study will address several areas where there are evidence gaps or contradictory findings relating to the home treatment of acute mental crisis. Findings from this study will allow local services to improve their effectiveness in a challenging domain of public health and contribute to improving access to more effective care for people with severe mental disorders. CLINICALTRIAL Trial registration ISRCTN38472626 (ISRCTN registry)

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