I wish I’d been aware of in-home hospitalisation when I lived in Germany and had my first episode of what turned out to be psychosis. I think I would’ve avoided the trauma of inpatient admission, would’ve had my partner around to translate (and avoided a potential misdiagnosis of BPD and would’ve been correctly identified as prone to extreme somatisation of emotions), and may have never been overmedicated (two benzos at once is too much and borders on chemical restraints, even if I was a voluntary admission).
I don’t have direct experience with the at-home hospitalisation service in the UK, but I will say that the knowledge that there’s a clear escalation pathway for mental health crisis that may culminate in in-patient admission but won’t necessarily has made me a lot more willing to seek help during acute episodes. Last time was a couple of years ago — I ended up being able to terminate what might’ve become a manic episode in one day, after a GP visit to get something for acute insomnia and agitation, and with a friend to supervise me for half a day on my request. If I’d thought that letting on that I’m still experiencing occasional mood episodes would end up with any kind of admission to hospital, I would not have reached out.
So there’s that angle to consider — the knowledge that there’s a whole line of options before being stuck on a locked ward on so many benzos and neuroleptics that I can’t stay awake for longer than an hour at a time makes me open to the idea of treatment. In-home hospitalisation need not even come up explicitly, just the framework that allows it as an option already leads to at least some improved outcomes.
Now, I’ve also heard the requisite amount of horror stories from mental health crisis treatment in my city, and all things being equal, I’m still a white Anglophone man with an Irish passport and the ability to do a passable vaguely unplaceable British-or-Irish middle class accent, and people here aren’t dedicated to sniffing out “freeloading”, “unassimilated” Soviet Jews the way they are in rural Germany. All the patient-oriented structures in the world are not enough when structural racism and so on come into play. But that’s a somewhat separate issue from the question at hand. Just didn’t want to make it seem like the UK is some kind of psych treatment utopia — it isn’t, it’s just better than what I previously experienced.
Hi Isidore , in case you were not aware, Germany does have home treatment of the type described in our articles.
It is called stationär äquivalente behandlung - inpatient equivalent home treatment.
These were started in 2018 , there are now about 50, with 650 expected eventually.
The willingness of patients to seek timely treatment when symptoms emerge rather than delay through fear of hospitalization , has been noted in these programs
Good to know! I’m glad that it’s now an option, but either it wasn’t yet available in 2012 or I was simply not offered it for whatever reasons patients can fall through the cracks with no malice on part of the providers.
Thanks for posting this. I was thinking after I had sent off my article , that I should have included this research , which would, I hope , help decrease opposition to this treatment model.
This is super interesting. I've been wondering lately whether policymakers (and much of the general public) are fully aware of the potential trauma that comes with hospitalization--I think there might be a need for some education there. If this gains traction again I'd be inclined to ditch the term "hospitalization" and call it something generic like "home care" as a way to further distinguish this from inpatient.
Hi John, David Heath here. I agree that ' hospitalization" is best avoided. The reason that I use it my article that is linked to Awais article ,is that , to people unfamiliar with the concept , the meaning is clear.
The problem with this model, is that there is no generally recognized term -like Assertive Community Treatment.
The term used in the UK-the epicentre of this model, is Crisis Resolution and Home Treatment ( CRHT) the meaning of which would not be completely clear I suspect to US readers
I've agonized over this issue; I used one term in my book, and, subsequently, another one on my website -intensivehometreatment.com
I wish I’d been aware of in-home hospitalisation when I lived in Germany and had my first episode of what turned out to be psychosis. I think I would’ve avoided the trauma of inpatient admission, would’ve had my partner around to translate (and avoided a potential misdiagnosis of BPD and would’ve been correctly identified as prone to extreme somatisation of emotions), and may have never been overmedicated (two benzos at once is too much and borders on chemical restraints, even if I was a voluntary admission).
I don’t have direct experience with the at-home hospitalisation service in the UK, but I will say that the knowledge that there’s a clear escalation pathway for mental health crisis that may culminate in in-patient admission but won’t necessarily has made me a lot more willing to seek help during acute episodes. Last time was a couple of years ago — I ended up being able to terminate what might’ve become a manic episode in one day, after a GP visit to get something for acute insomnia and agitation, and with a friend to supervise me for half a day on my request. If I’d thought that letting on that I’m still experiencing occasional mood episodes would end up with any kind of admission to hospital, I would not have reached out.
So there’s that angle to consider — the knowledge that there’s a whole line of options before being stuck on a locked ward on so many benzos and neuroleptics that I can’t stay awake for longer than an hour at a time makes me open to the idea of treatment. In-home hospitalisation need not even come up explicitly, just the framework that allows it as an option already leads to at least some improved outcomes.
Now, I’ve also heard the requisite amount of horror stories from mental health crisis treatment in my city, and all things being equal, I’m still a white Anglophone man with an Irish passport and the ability to do a passable vaguely unplaceable British-or-Irish middle class accent, and people here aren’t dedicated to sniffing out “freeloading”, “unassimilated” Soviet Jews the way they are in rural Germany. All the patient-oriented structures in the world are not enough when structural racism and so on come into play. But that’s a somewhat separate issue from the question at hand. Just didn’t want to make it seem like the UK is some kind of psych treatment utopia — it isn’t, it’s just better than what I previously experienced.
Hi Isidore , in case you were not aware, Germany does have home treatment of the type described in our articles.
It is called stationär äquivalente behandlung - inpatient equivalent home treatment.
These were started in 2018 , there are now about 50, with 650 expected eventually.
The willingness of patients to seek timely treatment when symptoms emerge rather than delay through fear of hospitalization , has been noted in these programs
Good to know! I’m glad that it’s now an option, but either it wasn’t yet available in 2012 or I was simply not offered it for whatever reasons patients can fall through the cracks with no malice on part of the providers.
It would not have been available then; it only started in 2018
It's worth noting the strongest predictor of suicide within psychopathology research is involuntary admission to a hospital. E.g, https://www.frontiersin.org/journals/psychiatry/articles/10.3389/fpsyt.2025.1684927/full
Thanks for posting this. I was thinking after I had sent off my article , that I should have included this research , which would, I hope , help decrease opposition to this treatment model.
This is super interesting. I've been wondering lately whether policymakers (and much of the general public) are fully aware of the potential trauma that comes with hospitalization--I think there might be a need for some education there. If this gains traction again I'd be inclined to ditch the term "hospitalization" and call it something generic like "home care" as a way to further distinguish this from inpatient.
Hi John, David Heath here. I agree that ' hospitalization" is best avoided. The reason that I use it my article that is linked to Awais article ,is that , to people unfamiliar with the concept , the meaning is clear.
The problem with this model, is that there is no generally recognized term -like Assertive Community Treatment.
The term used in the UK-the epicentre of this model, is Crisis Resolution and Home Treatment ( CRHT) the meaning of which would not be completely clear I suspect to US readers
I've agonized over this issue; I used one term in my book, and, subsequently, another one on my website -intensivehometreatment.com
I see, that's great to know your thought process! Definitely important to have a term that resonates with the public.