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Home Treatment as an Alternative to Hospital Admission for Mothers in a Mental Health Crisis: A Qualitative Study

Dr. Khalifeh, Dr. Killaspy, and Dr. Johnson are affiliated with the Department of Mental Health Sciences, University College London, Level 2, Pond St., London NW3 2QG United Kingdom (e-mail: h.khalifeh{at}medsch.ucl.ac.uk). Dr. Khalifeh, Dr. Johnson, and Dr. Killaspy are also with the Camden and Islington NHS (National Health Service) Foundation Trust, London, with which Dr. Murgatroyd is affiliated. Dr. Freeman is with the Child and Family Department, Tavistock and Portman NHS Foundation Trust, London.

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.

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