In pursuit of the added value of Intensive Home Treatment: The effects and costs of outpatient care for patients experiencing an acute psychiatric crisis

Mental disorders are of concern because of their high prevalence rate, the burden of the disease and the attendant high social expenditure. Hospitalisation has been the standard care modality for people with mental disorders who experience an acute psychiatric crisis, a situation in which the severity of someone’s current clinical problems, social problems, and associated risk factors necessitates acute admission to a psychiatric ward. Nevertheless, there is an extensive history of attempting to avoid hospitalising patients when treating an acute psychiatric crisis. Intensive Home Treatment (IHT) is one of the more recent care modalities that focuses on stabilising acute psychiatric crises in order to either prevent hospitalisation or facilitate early discharge from hospital. In order to widely implement IHT as an alternative to acute hospital care, high-quality evidence from randomised controlled trials (RCTs) was needed to evaluate both its therapeutic effectiveness and cost-effectiveness. Therefore, it is important to assess both the effects and costs of IHT in comparison to care as usual (CAU), and evaluate the added value of IHT for both patients and mental healthcare. Patients experiencing an acute psychiatric crisis severe enough to be considered for hospital admission by a psychiatrist, were pre-randomised to the treatment group IHT or CAU. Between November 2016 and November 2018, patients were recruited from either the psychiatric emergency service or inpatient wards in Amsterdam. In total, 246 patients participated in the RCT, which resulted in the several studies that are presented in this thesis.