Psychiatric home hospitalization: advanced and customized treatment in the home environment

Can a psychiatric hospitalization at home provided today by the HMOs help with this?

A new trend that has been developing in recent years offers a solution to the plight of the place in the psychiatric hospital institutions in Israel. Providing a full medical and nursing response at the patient’s home. “In July 2015, as part of the mental health reform, the Ministry of Health transferred responsibility from the institutional system to the community,” explains Prof. Arad Kodesh, director of the mental health system of United Health Services.

“This allowed the acceleration of mental health processes in the community and the nature of the HMOs’ treatment. Me personally as the director of the United HMO, and also at the national level, the state of psychiatric hospitalization is very disturbing. There are not enough beds today – there are 3,500 beds in Israel. “In terms of the per capita rate of beds, we are in a very low place compared to other OECD countries. In addition, we believe that in a psychiatric home hospitalization for appropriate mental health contenders, the meaning of a familiar environment, a normal life routine and return to normative community functioning are particularly important.”

Prof. Arad Kodesh, Director of the Mental Health System of the United Health Services (Photo: Courtesy of the United Health Services)

Density and overcrowding in psychiatric inpatient institutions have a major impact on the patient experience. According to Dr. Pazit Frenkel Leibowitz, a Central District psychiatrist at Leumit Health Services, a home hospitalization system provides a solution for both the patient and his family.

“The decision whether to admit a family member to a psychiatric hospital and actually leave him alone is a very difficult decision. The psychiatric hospitalization at home actually frees the family from this difficult dilemma, and is a convenient and effective solution for them over time. “How much profit they have. Home care provides great relief to both the patient and the family who feel they are not alone. And it is important to mention that we also accompany them in the bureaucratic process of exercising the patient’s rights.”

Comprehensive response available 24/7

The psychiatry department at Sabar Medical’s home, which was established two years ago in a pilot conducted with Leumit, has joined other inpatient wards that provide Sabra medicine funded by the HMOs, such as inpatient hospitalization, home hospice, intensive home rehabilitation and more. “In the past year, the psychiatric inpatient service at home has also been expanded for members of the United Health Insurance Fund, and we look forward to a dialogue with the additional funds to promote the issue,” says Dr. Itamar Ofer, chairman and president of Sabar Medicine.

“In-house hospitalization provides a comprehensive response to all the patient’s medical and mental needs, available 24/7,” explains Dr. Ofer. Mental Health”.

Dr. Itamar Ofer, President and Chairman of Sabar Medicine.  Founder and co-chair of the community and the International Conference on Home Hospitalization (Photo: Courtesy of Sabar Medicine)Dr. Itamar Ofer, President and Chairman of Sabar Medicine. Founder and co-chair of the community and the International Conference on Home Hospitalization (Photo: Courtesy of Sabar Medicine)

“The framework of psychiatry at home significantly improves the patient’s condition,” emphasizes Prof. Kodesh. “Among mental health contenders, the importance of a familiar environment, a normal life routine and a return to normative functioning within the community are especially important.”

The service, which is provided nationwide, is intended for people with chronic mental illnesses, such as severe clinical depression, schizophrenia or bipolar disorder (manic depression), and in fact for any adult (over the age of 18) who is suitable for hospitalization at home, who is not dangerous to himself or others. Medication. The hospitalization is done with the consent of the patient, his family and the treating staff and with their consent.

The department is headed by Dr. Oren Lebstein, a 14-year-old specialist psychiatrist in the public service. “Today, for an insured of a unified and national HMO who is referred to a psychiatric hospital, and his condition allows it, the treatment begins immediately, without waiting time or any additional stay.”

Prof. Kodesh adds and emphasizes the importance of responding to a multidisciplinary team: “Home hospitalization compared to community care is more intensive, and includes a greater number of sessions, availability of 24/7 drives and ongoing response from a whole basket of services and treatments that includes not only psychiatrists but Also a nursing response, a social and nutritional service, the use of which varies according to the patient’s needs. ”

“The treating psychiatrist and all the treating factors, including the Osim nursing staff and the dietitians of Zabar Refuah, systematically transfer all the details to the patient’s medical file at the HMO,” explains Eli Geffen, director of the National Health Services’ control system. And synchronization between all caregivers. It is important to understand that this is not just a technical matter, but the very existence of a therapeutic sequence and synchronization between all the treating factors is significant for providing accurate and correct treatment to the patient, during the hospitalization of the psychiatric home, and later in the treatment procedure. “

Dr. Oren Levstein, Director of the Department of Psychiatry at Home (Photo: Courtesy of Sabar Medicine)Dr. Oren Levstein, Director of the Department of Psychiatry at Home (Photo: Courtesy of Sabar Medicine)

By the time Corona began to realize – it was time for home hospitalization

The benefits of home hospitalization in general and psychiatric hospitalization in particular, stood out more than any Corona epidemic, as Dr. Frenkel Leibowitz points out: “During the Corona period, the treatment of psychiatry at home is a very significant advantage. After all, we have all experienced and still experience the difficulty of living within the plague. Certainly for contestants in mental health institutions this is a significant difficulty, in addition to the challenges added for the staffs caring for these institutions. In addition, a psychiatric hospitalization at home reduces the fear of being infected with Corona during the hospitalization. “

The corona plague has of course also led to an increase in the need for a quality response to mental health. “The psychiatric hospitalization framework in the home is designed to prevent hospitalizations, shorten the duration of hospitalization and even help prevent the phenomenon of re-hospitalizations,” notes Prof. Kodesh, “so that a continuum of treatment can be maintained more effectively compared to hospitalization. The patient in the electronic file, and update us for the benefit of continued treatment in the community. “

Eli Geffen, Director of the National Control Services for Health Services (Photo: Courtesy of Leumit Health Services)Eli Geffen, Director of the National Control Services for Health Services (Photo: Courtesy of Leumit Health Services)

Home hospitalization has a decisive effect on the response to treatment, according to A.’s wife, a United insured from the center of the country who was treated in a closed ward at one of the mental health institutions in the country. “His condition was not good, and the treating staff was unable to stabilize him and each time he was re-hospitalized.” After several hospitalizations, the doctor at Meuhedet referred them to the hospitalization solution.

“This is exactly what we needed, a complete answer – the psychiatrist of Zabar Medicine who contacted my husband’s previous doctors, studied the case and adapted the treatment, psychiatrist and nurse who come to our home several times a week and social worker. First the visits were frequent and then, as the situation improved “It was also possible to reduce the intensity of the visits. For the first time in a very long time, I felt that his condition was stabilizing and balancing.”

According to Dr. Levstein, there is great importance in the arrival of the treatment staff at the patient’s home. “.

“This is a revolution in the way mental health is treated in the world”

“In total, there are thousands of patients who are suitable for receiving the service,” claims Eli Geffen from Leumit Health Services. At home. ”

The benefits of the home hospitalization system were also emphasized in the State Comptroller’s report on the state’s conduct in the corona crisis. “Given the workload that has existed for years in psychiatric hospitals, in institutional inpatient settings, there are all the right reasons why we have translated the knowledge and experience we have accumulated in various areas of home hospitalization into the field of home psychiatry,” says Dr. Ofer. “For hospitalization of psychiatry at home, we have seen that psychiatry at home was for many of them an accurate and beneficial solution that prevents hospitalization.”

The next step, according to Dr. Levstein, is to make the public aware of his right to apply for home hospitalization under the National Health Insurance Law. “The Ministry of Health must work to increase public awareness. “There is a need to sharpen the recognition of policy makers in the medical system that everyone who does not have to be hospitalized must be allowed to receive the treatment at home, so that it will be possible to realize the full potential of the psychiatric hospital system.”

Psychiatry at home (Photo: Courtesy of Sabar Medicine)Psychiatry at home (Photo: Courtesy of Sabar Medicine)

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