Hospital in the home for mental health – insights from a former acute psychiatric consumer

Dr Jacqueline Kirkman’s first two encounters with psychosis saw her being admitted as an involuntary patient at an acute psychiatric ward.

Years later, during her third encounter, she felt a different treatment option was needed and became one of the first Australians to receive mental health care under ‘hospital in the home’.

“For me personally, it made good sense to embark on this program, because I had a three year old son at home and clearly neither of us wanted to be separated from eachother for a long period.

“Nor did I wish for my son to have to visit me at an acute mental health facility, where he would be exposed to an unfamiliar, potentially distressing environment,” said Dr Kirkman.

Under the program by Barwon Health, Dr Kirkman received extensive therapeutic intervention, with at least two daily home visits from a mental health professional.

“My care was in many ways not that different to what I had received as an inpatient on a physical ward. It incorporated strategies around meditation and mindfulness, as prescribed by an OT, in combination with traditional medication based interventions.

“A couple of times a week, a psychiatrist would come out, discuss with me my mood and sleep, and formulate a medication plan for me. In between, I would have nurses and social workers visit and make sure I was on track with taking my meds, check up on how I was feeling and how much sleep I was getting. They would monitor my levels of mental distress and determine whether I was regressing or heading down the recovery path.”

Conducive to recovery

From the comfort of her home, Dr Kirkman said these visits felt more personable than they had on a physical ward.

“It felt like I was being checked in with, rather than checked on, which is quite a different distinction. It was like I was part of the team, rather than a number being treated,” she said.

Dr Kirkman also found her home environment more therapeutic than a psychiatric ward and said maintaining her personal rhythms was conducive to recovery.

“Small things like being able to wake up in my own comfy bed and eat my preferred foods were really beneficial.

“My home is also a lot more calming than a hospital, which made a big difference to my state of mind and general ease. Just by their nature, acute psychiatric wards can be loud and disordered places, which at times can be distressing.”

By being treated at home from the outset, Dr Kirkman also forewent the stress of transitioning from hospital back to home.

“When you are discharged from hospital, it can be a big jump to go from the hospital rhythm, back to your self-driven, at-home rhythm. It’s quite a shock to the system and can set you back on your recovery journey.

“With hospital in the home, those in-home strategies were built in from the outset, so it was easier to maintain continuity in my recovery.”

A good fit

As well as being a good fit for her personal circumstances, Dr Kirkman believes the program is effective for treating psychosis and other acute vulnerabilities.

“I really believe it is suitable for a variety of healthcare consumers. There are lots of myths around conditions like psychosis, which may be fuelling doubt around the model,” she said.

“When I experienced psychosis, it was quite unlike how it is portrayed in the movies. Initially, I felt like I had complete clarity of my emotions and thoughts, and could access a different depth of memory. It was almost like I could drown out all sounds and only hear my breath and heartbeat.

“However, as I slipped deeper into the realms of disordered thought, I lacked clarity around what was real and what wasn’t.

“That was when my husband and family realised I needed support – and, for me, there was no uncertainty in terms of treatment path I wanted to take.”

Room for improvement

However, there are disadvantages to the hospital in the home program, Dr Kirkman says. Among the greatest is the lack of support for families and carers.

“My husband was very much involved in my treatment planning and spent a lot of time communicating with my mental health team. In between visits and phone calls from them, I also lent on him quite a bit – which meant he was having to balance work, parenting, and the care burden of looking after an acute psychiatric patient.

“I believe he may have underestimated the toll this would take and, as result, we had quite contrasting experiences with the program. While he did think it was good overall, there were times – especially when I was acutely unwell – when he needed some respite from me.”

Dr Kirkman believes further consideration may be needed to better support families and carers of people who use the program.

“Ideally, there should be a variety of support mechanisms on offer. Whilst this wasn’t an issue for us personally, I feel many families would benefit from financial or household support. Help with cooking, cleaning and grocery shopping could really help reduce the daily burden of care.”

A further drawback of the program is the lack of peer support that can be gained by the presence on a physical ward, she argued.

“In acute mental health facilities, there is a lot to gain from meeting and talking to fellow consumers. They can give you a sense of community and help you learn different coping strategies and help you feel less alone.

“Those of us who have experienced extreme mental health distress or psychosis have a knack for understanding what others are going through. So I definitely missed that interaction.”

Further insight

Talking more about her experience of managing psychosis from home, Dr Kirkman will present at the upcoming Hospital in the Home Conference, hosted by Informa Connect.

The conference is one of three to be delivered at Connect Virtual Care on 7-8 March 2024 at the Hilton Sydney.

Co-located at the event are the National Telehealth Conference 2024 and Medication Safety and Efficiency Conference 2024.

Learn more and register your place here.

About Dr Jacqueline Kirkman

Dr Jacqueline Kirkman has a background in clinical optometry, optometry education and research. Her life’s path was abruptly altered following the birth of son in 2019 when she experienced postnatal psychosis. She currently uses her knowledge as a service user in a lived experience project management role at Barwon Health.