Experts are calling for the implementation of mental health home hospitalization care during the coronavirus disease (COVID-19) pandemic. A letter to the editor published in Acta Psychiatrica Scandinavica by Marina Garriga, MD, of the Clinical and Provincial Hospital of Barcelona in Spain, and colleagues emphasized that an intensive, home-based approach will be essential for patients with severe mental illness in the coming months.
In general, patients with mental disorders are at higher risk of death due to COVID-19 given elevated rates of somatic comorbidities and socioeconomic disparities. The pandemic has also worsened access to necessary care and increased anxiety and stress. In this context, telepsychiatry consultations have been adopted to meet patients’ needs.
Among most outpatient psychiatry clinics in Spain, services are now conducted remotely, and many inpatient wards have discharged their patients early to avoid in-hospital contact with COVID-19 cases. Even among patients not experiencing “immediate, life-threatening risk,” early discharge could increase risk for psychiatric relapse, suicidal ideation, self-harm, and other adverse outcomes. As such, Garriga et al suggested that Spain implement a home hospitalization program for patients with severe mental illness. Home hospitalization is already utilized by other specialties, such as palliative care, and has been demonstrated to reduce psychiatric hospitalization rates among adults and adolescents with moderate-to-severe mental illness.
In the home hospitalization model, a team of psychiatric specialists visit the home to confer care at regular intervals. In addition to reducing risk for poor psychiatric outcomes, the in-home model prevents nosocomial exposure to COVID-19. Furthermore, in-home care reduces strain on hospitals and may free up beds in psychiatry wards for use in emergencies.
For patients with mild-to-moderate mental illness, home intensive community teams can provide needed care, whereas home hospitalization teams can handle the demands of those with moderate-to-severe mental illness. The authors highlighted the importance of “adequate and necessary holistic care for these patients during the COVID-19 pandemic, not just for the short-term, but beyond as well.”
The COVID-19 pandemic necessitates alternative approaches to psychiatric care, according to the perspective letter. The in-home care model could prevent adverse psychiatric outcomes while also mitigating infection risk during the pandemic.
Disclosure: Several study authors declared affiliations with the pharmaceutical industry.
Please see the original reference for a full list of authors’ disclosures.
Garriga M1, Agasi I, Fedida E, et al. The role of mental health home hospitalization care during the COVID-19 pandemic [published online April 11, 2020]. Acta Psychiatr Scand. doi: 10.1111/acps.13173