Home Treatment for acute mental disorders: challenges and opportunities for patients, families, and healthcare providers

Caiata Zufferey, Maria and Bernegger, Guenda and Mellacqua, Zefiro and Larghi, Giuseppina and Cordasco, Severino and Rossa, Simona and Crivelli, Luca (2022) Home Treatment for acute mental disorders: challenges and opportunities for patients, families, and healthcare providers. In: 11a Giornata della Ricerca e dell’Innovazione in Medicina Umana della Svizzera italiana, 3.6.2022, Lugano.

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Introduction. Home Treatment (HT) is a multidisciplinary community-based mental health service offered since 2016 by the Cantonal Psychiatric Clinic - as an alternative to hospitalization - to patients in Bellinzona and Valleys suffering from acute mental disorders. While some studies report a good degree of satisfaction among HT patients, little is known about the complex interactions that develop in this particular care setting. The aim of this study is to illustrate the challenges and opportunities of HT for acute mental crises, based on the experiences of patients, family members and caregivers. Methods. This Grounded Theory study is based on narrative data collected through semi-structured interviews and focus groups with a purposive and diversified sample of 22 patients and 11 family members, and with the entire HT team of 13 caregivers. Interviews and focus groups were audio-recorded, transcribed and analyzed by constant comparison. Results. Taking care of acute mental disorders at home implies the redistribution of power between the caregiver and the patient, the overexposure of the patient's intimacy, and the de-standardization of interactions. These peculiarities of HT constitute challenges that patients and caregivers manage by adopting specific fronetic postures. When these challenges are adequately managed, HT is experienced as good care. If not, experiences of subordination/prevarication, companionship/distance, or personalism/formalism may arise. Conclusions. The HT setting implies challenges that, if properly addressed, generate a participatory and empowering care experience for the patient, and a high degree of personalization and satisfaction for the caregivers.

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