«Therapy is less stigmatising for parents»

Mrs Braken-Portmann, does it make sense to leave the children out of it if a home treatment patient does not want her children to be involved in her treatment?

This decision is not up to us. We always recommend a conversation or counselling with our specialist centre for relatives. This allows the children to understand what is going on with mum or dad without them having to be regularly involved in the process. If there was a specific trigger for the depression that the children can understand very well, it makes sense for mum to talk to them herself.

How is the environment involved in the treatment?

This depends very much on what the patient and her relatives want. We offer the opportunity for couple and family discussions at an early stage. This gives us valuable information and allows everyone involved to have their say. That is very important. Of course, there are also patients or relatives who don't want this, but this is very rare. In most cases, the relatives are happy about the offer of help.

Under what conditions can a patient be treated at home?

Firstly, there must be a need for inpatient treatment. There must be a permanent place of residence that can be reached within 30 minutes from the main location of our psychiatric services. Relatives must also be in agreement, which is very important. And we do not treat patients with addiction disorders, as these require medical supervision, which we cannot guarantee in home treatment.

In the event of acute danger to themselves or others, treatment at our clinic is not possible, as patients must be hospitalised for their own protection and that of others. Patients must also have sufficient knowledge of German.

Are the personnel costs greater for home treatment than for an inpatient stay?

No, the personnel costs are even lower and at the same time more intensive. The fact that the same caregivers are always in daily contact with the patient means that the therapeutic relationship becomes very close. Patients and carers see this as positive.

What are the advantages of home treatment compared to inpatient treatment?

The patient remains in their familiar surroundings. Parents in particular have great difficulty with the idea of inpatient treatment that separates them from their children. They also find treatment at home less stigmatising than a stay in a clinic.

If you visit the patient at home, you understand the overall situation much better, can assess the situation better and react accordingly.

It is also economically more favourable, as it is billed as outpatient treatment without extending the duration of treatment compared to inpatient treatment.

Are there any disadvantages?

One disadvantage can be that you continue to be exposed to stress factors at home, for example relationship problems or overload in everyday life. However, this can also be addressed in discussions and used as therapy.

Read an experience report on home treatment here:

You offer home treatment for people aged 18 to 64. Why do they do this?

Our specialists all work in adult psychiatry. We would need different resources and specialist training for paediatric, adolescent and geriatric psychiatry. However, this is being planned.

The PDAG recently started offering home treatment for children and adolescents. How does this differ from the treatment of adults?

Apart from the legal particularities of dealing with minors, special developmental psychological and educational components must be included in the treatment of children and adolescents. For this reason, there is also a special specialist training programme in child and adolescent psychiatry in contrast to adult psychiatry.

What is your conclusion so far?

In the personal feedback from both our patients and our team, home treatment is perceived as successful. This has also been scientifically confirmed in the studies accompanying home treatment. When you visit the patient at home, you understand the overall situation much better and can better assess and respond to the situation.

Are there any negative experiences?

It is always difficult when someone is not transparent and hides problems. For example, if it turns out that the patient is using drugs, which can be dangerous in combination with the prescribed medication and can also lead to illness. We can only monitor this to a limited extent in home treatment.

As a rule, however, patients are very cooperative, motivated and transparent. Before treatment, we sign a treatment agreement which states that the consumption of drugs and alcohol is prohibited. This is also tested if necessary.

How does it work with dispensing medication?

After we have got to know the patient in a consultation and explained the medication, we dispense the medication for one week at a time. For new appointments, we can be contacted at any time via the on-call telephone in addition to the daily visits. If necessary, I also visit and advise patients on medication issues on site.

What can you say about the success of home treatment compared to inpatient treatment?

Our studies on home treatment have shown that the quality of treatment is equivalent to inpatient treatment and that the duration of treatment is even shorter. The relapse rate is also lower because, unlike after inpatient treatment, you don't have to leave a protected environment and enter everyday life where you first have to learn how to apply what you have learnt. In home treatment, this step happens parallel to treatment. We also endeavour to ensure that, towards the end of treatment, patients who were initially on 100 percent sick leave gradually find their way back into the world of work with our support.