Home treatment as an alternative to hospital admission for mothers in a mental health crisis: a qualitative study.
OBJECTIVE
This study explored the experiences, treatment preferences, and needs of mothers of dependent children who were treated at home as an alternative to hospital admission for an acute severe mental health crisis.


METHODS
In this qualitative study, mothers were recruited who were treated by one of four crisis resolution teams in two inner London boroughs. Semistructured interviews were conducted with 18 mothers and five of their children. Transcripts were coded by thematic analysis to extract relevant themes.


RESULTS
Home treatment provided good patient care, but most participants felt that they struggled to parent adequately and to meet their children's needs. Common difficulties included meeting the children's physical needs, feeling emotionally distant, being dependent on children during the crisis, and struggling to protect the children from exposure to symptoms or distress. Most mothers preferred home treatment to hospital admission, because they felt safer and better looked after at home. However, most children preferred parental hospital admission, because it relieved the children of distress and responsibility. Mothers were reluctant to seek help with parenting from professionals because of fears of custody loss.


CONCLUSIONS
Home treatment for female patients with child care responsibility meets patients' needs, but their children may be exposed to additional risks and currently lack appropriate support. The needs of children should be considered in the planning of home treatment for psychiatric crises.
Department of Mental Health Sciences, University College London, Level 2, Pond St., London NW32QG, United Kingdom. h.khalifeh@medsch.ucl.ac.uk
Hind
H
Khalifeh
Catherine
C
Murgatroyd
Mona
M
Freeman
Sonia
S
Johnson
Helen
H
Killaspy
D000293:Adolescent; D000328:Adult; D002648:Child; D005190:Family / Q000523:psychology; D005260:Female; D006301:Health Services Needs and Demand; D006699:Home Care Services / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology* / Q000628:therapy*; D009034:Mother-Child Relations; D009035:Mothers / Q000523:psychology* / Q000706:statistics & numerical data*; D010287:Parent-Child Relations; D010343:Patient Admission / Q000706:statistics & numerical data*; D011618:Psychotic Disorders / Q000453:epidemiology / Q000628:therapy; D012931:Social Environment; D012947:Social Work; D011795:Surveys and Questionnaires; D013637:Tape Recording; D055815:Young Adult