Homebased Treatment In Early Psychosis Choice of Treatment Setting

Patients should be cared for in the least restrictive setting that is likely to be safe and to allow for effective treatment [11]. It should not be assumed that every patient with a first episode of psychosis will require admission to hospital.

Hospital admission is indicated for patients who are thought to pose a serious threat of harm to themselves or others, who are unable to care for themselves, or who have general medical or psychiatric problems that are not safely or effectively treated in a less intensive setting [11]. Even when psychotic patients are not at risk, the hospital may sometimes be the preferred setting, because patients can be carefully observed during a period of assessment, and then medication can be introduced while they are closely monitored for the development of any adverse side effects. This is much less likely and available than in previous eras.

The three most common reasons for admission to hospital in a first episode of psychosis [3] are:

• concerns about safety;

• sustained refusal to accept community assessment or treatment;

• lack of appropriate family and social support.

Alternative treatment settings such as partial hospitalization, home care, family crisis therapy, crisis residential care and assertive community treatment can be considered for patients who do not need formal hospitalization but require more intensive services than can be expected in a typical outpatient setting. If resources are available and the person's family or carers are coping, then treatment can be initiated safely in the community. This avoids the anxiety, loss of control, increased stigma and trauma which can all too frequently accompany hospitalization.

The first experience of treatment for early psychosis can strongly influence future attitudes to all types of therapy and the mental health system in general. Effective home-based care is likely to be regarded favourably by patients, enhance the therapeutic alliance, improve adherence with medication and other interventions, and facilitate follow-up care.

BiPolar Explained

BiPolar Explained

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