Here the soul can heal at home

Mirjana* will never forget the shocked looks on the girls' faces. The 34-year-old had shouted at her daughters, once again. Then she broke down. «Hana and Leonora were scared of me,» she says quietly. And: «That was the moment when I knew: you need help.»

«You have a major depressive disorder,» she was told a few weeks later. A shock for Mirjana. Not because of the diagnosis itself, but because treatment in a clinic would mean months of separation from her three children. Unimaginable for Mirjana. She has now been undergoing treatment in her own four walls for some time. With success.

Anger, sadness, sleeplessness and total overload in everyday life

Mirjana has known for a long time that something is wrong. «I'm generally someone who can hardly switch off,» she explains, «and when something throws me off, I don't sleep. I function during the day, but in the evening my head just won't switch off.» Then she is thin-skinned and explodes over every little thing. «I don't know how to deal with you any more,» says her husband. «Mummy's crying again,» Leonora says to her older sister more or less every day. «It's not normal for a child to say that,» says Mirjana.

She can pinpoint the day when it all began: It is 12 December 2021 and Mirjana suffers a miscarriage at 12 weeks. It is the second in six months. It happened in front of her three children Hana, 9, Leonora, 7, and Luan, who is now almost two years old. Mirjana loses a lot of blood, needs a curettage and it takes a long time for her to recover physically. Mentally, the events left a lasting impression on her. Anger, deep sadness, insomnia, total overload in everyday life follow.

One week after Mirjana contacted the emergency service of the Psychiatric Services Aargau (PDAG), she was diagnosed with major depressive disorder. The trained pharmacist once worked on a psychiatric ward herself and knows: «It can happen to anyone.» But she also knows what her diagnosis usually means: a stay in hospital for months. That is out of the question for the mother of three.

A third of all mental illnesses remain untreated because those affected do not want to seek therapy.

Fortunately for her, a week later a place becomes available in the home treatment programme that PDAG has been offering since 2015. Initially as a pilot project, the model, in which patients who actually require inpatient treatment are treated at home, has been fully established since 2018 and is also covered by health insurance.

The service kills two birds with one stone, so to speak: on the one hand, it relieves the burden on wards, and on the other, the prospect of being able to stay in their familiar surroundings lowers the inhibition threshold for parents in particular to seek therapy at all.

Carer and psychologist arrive in unlabelled cars

According to a report by the Swiss Association of Psychiatric Clinics and Services Swiss Mental Healthcare, a good third of all mental illnesses remain untreated because those affected do not want to seek treatment. The PDAG offers fourteen home treatment places a year, two thirds of these treatments take place in households with children.

Six days a week, Mirjana is visited for one to one and a half hours by a trained therapeutic carer. A psychologist also visits once a week. They always drive up in unlabelled cars.

The home treatment staff are available to Mirjana all week round the clock with an on-call service. If a telephone call is not enough, an extraordinary home visit will take place.

In an emergency, she would be accompanied to the clinic. That hasn't been necessary so far. «The conversations help with processing,» says Mirjana. The antidepressants help her cope with everyday life. She receives a ration for a week at a time.

When the «friend who talks to mummy» comes round, Hana and Leonora are at school, on Saturday mornings they stay in their rooms. Little Luan plays or sits on mummy's lap. «He's a very quiet child, it works really well that way,» says Mirjana.

People don't know how to react and I don't feel like explaining myself all the time, says Mirjana.

Most parents do not want their children to be involved in the process, says Karen Braken-Portmann, a psychiatrist at the PDAG. However, relatives can contact the specialist centre for relatives, which is part of the service. They explain to children in an age-appropriate way what is going on with their mum or dad. Mirjana has done this herself and explained to her daughters that she is sad about the loss of her baby and needs time to become happy again.

She also doesn't want her husband present at the therapy sessions. However, her relationship with him has changed thanks to the therapy. «I was angry with him for a long time because I thought he wasn't grieving for the baby. I've now accepted that everyone grieves differently and that someone doesn't always externalise their grief.»

Only the husband and brother know about the therapy

Apart from her husband, only Mirjana's brother knows that she is undergoing psychotherapeutic treatment. Why doesn't she tell anyone else? Mirjana shrugs her shoulders. «There's no reason. People don't know how to react to a confession like that, and I don't feel like explaining myself all the time.»

After just two or three weeks of home treatment, she felt better, says Mirjana. The most important thing is that she can sleep at night again. And she is no longer holed up at home, she is socialising, even going on family outings. «The children are also much more relaxed,» says Mirjana. She found the energy to tackle her cancelled job search again and has recently found a job. She shares housework and childcare with her husband. «Going to work does me a lot of good,» says Mirjana.

I know that I can do it.

Mirjana

Home treatment is now being gradually reduced and will soon be completely replaced by outpatient follow-up treatment. The dose of medication will then also be gradually reduced. Mirjana is not afraid of returning to life without therapeutic help.

«I've never been away from everyday life. I know that I can do it.» She has also come to terms with the miscarriage. Does she still want a fourth child after everything it has caused? «Yes, even if I expose myself to the risk of another miscarriage. I could deal with it differently today, I'm sure of it.»

* Names changed