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| CONCEPT ARTICLE |
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| Year : 2016 | Volume
: 12
| Issue : 1 | Page : 41-42 |
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Home care services for mentally ill persons
R Rajalakshmi1, KN Jayanthi2
1 Clinical instructor, NIMHANS, Bangalore, India
2 Lecturer- College of nursing, NIMHANS, Bangalore, India
| Date of Web Publication | 17-Jun-2019 |
Correspondence Address:
K N Jayanthi
Lecturer- College of nursing, NIMHANS, Bangalore
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/2231-1505.260549
How to cite this article:
Rajalakshmi R, Jayanthi K N. Home care services for mentally ill persons. Indian J Psy Nsg 2016;12:41-2 |
| Introduction | |  |
Home care programs are changing rapidly in response to the increased number of individuals with psychiatric illnesses living in the community and the competitive health care market. Perhaps the best reason to advocate for psychiatric home care is that it is a humane and compassionate way to deliver health care and supportive services. Home care reinforces and supplements the care provided by family members and friends and maintains the recipient’s dignity and independence-qualities that are all too often lost in even the best institutions[1].
| Definition | | |
The community home based care (CHBC) is defined as “any form of care given to sick people in their homes. Such care includes physical, psychosocial and spiritual activities[1].”
| Factors Contributing to the Development of Home Care Services | | |
- Continued trend of deinstitutionalization.
- Growth of managed care, which focuses on cost, outcomes, and earlier hospital discharges.
- In order to find less restrictive and more humane ways of delivering care to people with mental illness[2].
| Aim | | |
To assist the persons, who are unable to live independent life outside the hospital due to their illness, in everyday activities and in social contacts regardless of pharmacological treatment
| Principles | | |
- Services and treatments must be patient and family centered.
- Care must focus on increasing patients ability to successfully cope with life’s challenges, on facilitating recovery, and on building resilience[1]
| The Advantages of Home Care in Relation to Inpatient Treatment : | | |
- An alternative to hospitalization by maintaining a patient in the community
- A facilitator of an impending hospital admission through preadmission assessment.
- A way to shorten inpatient stays while keeping the patient engaged in active treatment[4].
Examples of other gains are outreach capacity and emphasis on patient and family participation, responsibility, autonomy, and satisfaction, easy Accessibility, greater user satisfaction, identify and treat early relapses, increase adherence to treatment, protect human rights, and prevent stigmatization[2].
| CHBC Team | | |
The CHBC team consists of patients with mental sickness, family caregivers, health and social welfare personnel, Psychiatrist, Psychologists, Educators, Social Workers, Psychiatric Nurses, Occupational Therapists, community health workers and community volunteers. Other key stakeholders in the team are community and spiritual leaders, traditional healers, pharmacists, community health committees, neighbours, other community agencies or organizations[3]
| A Policy Framework for CHBC | | |
Framework is a systematic approach for policy-makers, senior administrators and government decision-makers to follow in developing the overall policies and guidelines for CHBC. The discrete categories include the nature of the programme, Eligibility criteria & assessment, Benefits, Programme operation, Financing and Coverage[3].
| Essential Elements of CHBC | | |
Provision of care, Continuum of care, Education, Supplies and equipment, Staffing, Financing and sustainability, Monitoring and evaluation &Strategies for action in establishing and maintaining CHBC[1],[3]
| Characteristics of Home Based Care | | |
- Teaching and help in the development of skills indispensable for independent life, especially development of social functioning skills, motivating the patients to being active, undertake treatment and rehabilitation, finding employment, conducting self-help and social skills trainings.
- Crisis interventions, psychological support, therapeutic talks, assistance in settling a business in the office, such as obtaining social benefit or pensions as well as assistance in filling in the legal documents.
- Supporting treatment process: setting and monitoring of patients’ appointments and diagnostic examinations[5].
| Issues in Home Based Mental Health Care | | |
- ▪Psychiatric home care provides unique challenges and opportunities to the mental health professionals. In an inpatient clinic or office setting, the provider has the control and power that come with ownership. The patient is a guest, and the mental health professionals are the host. It is vice versa in CHBC
- ▪Cultural competence. Awareness of the patient’s ethnic and cultural background is critical to give effective care in all settings. It is important that an understanding of one’s own cultural background and the prejudices related to socioeconomic status, gender, family structure, and ways of dealing with emotion emanating from that background
- ▪Boundary issues. Closely related to cultural issues are that differences in boundary issues. Trust becomes a vital part of the health care workers-patient relationship as the patient and health care workers work together to solve problems and achieve goals.
- ▪Safety. Strategies must be identified for dealing with suicidal or aggressive behavior. In this way, home based care does have its limitations[5].
| Nursing Activities | | |
Psychiatric home care nurses are providing many skilled nursing services. They act as case managers, coordinating an array of services, including physical therapy, occupational therapy, social work, and community services. They collaborate with all the patient’s health care providers and often facilitate communication among members of the multidisciplinary team[6].
| Conclusion | | |
“Home-based care is taking us back to the root of human coexistence. It reminds us that we all have the responsibility to one another. If we hold hands collectively … we will be able to retain our humanity and will come out of this wave as a stronger community.” The health care workers and patient must work together to develop and acceptable plan. If the situation becomes unsafe, the health care workers must leave the home. Patients’ families, caregivers, and other community resources should be urged to notify the police or take the patient to the hospital for and evaluation if the patient becomes dangerous.
| References | | |
| 1. | WHO. Home-based and long-term care: home care issues at the approach of the 21st century from a World Health Organization perspective: annotated bibliography. Geneva, World Health Organization, 1999 (document WHO/HSC/LTH 99/1).  |
| 2. | Jose Miguel Caldas de Almeida and Helen Killaspy, LONG-TERM MENTAL HEALTH CARE FOR PEOPLE WITH SEVERE MENTAL DISORDERS .European Union, 2011 |
| 3. | WHO 2002 Community home-based care in resource-limited settings: a framework for action. |
| 4. | Burns T, Raftery J, Beadsmoore A, McGuigan S, Dickson M.A controlled trial of home-based acute psychiatric services. II: Treatment patterns and costs. Br J Psychiatry. 1993 Jul;163:55-61. |
| 5. | PawelBronowski, MarylaSawicka, KatarzynaCharzynska. Home care services in the community treatment of mentally ill persons. Archives of Psychiatry and Psychotherapy, 2011; 3 : 31-40 |
| 6. | Kudless MW, White JH.Competencies and roles of community mental health nurses. J PsychosocNursMent Health Serv. 2007 May;45(5):36-44. |
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