The U.S. behavioral health care system is facing a capacity crisis. The country currently has 13% fewer state psychiatric beds than it did in 2010; in Massachusetts alone, more than 700 patients await inpatient psychiatric care every day. Many patients wait for psychiatric care in the emergency department, sometimes for days, delaying their treatment and potentially worsening their symptoms.
In response to this crisis, Ariadne Labs’ Home Hospital program will begin work to consider whether there is a subset of patients for whom home-based behavioral health care may be an appropriate substitute for an inpatient psychiatric stay.
“Our home hospital program has successfully designed and rigorously tested a model of care that allows patients to receive acute care for medical conditions like chronic obstructive pulmonary disease and pneumonia from the comfort of their homes,” said David Levine, MD, MPH, MA, who leads Ariadne Labs’ Home Hospital program. “We now want to explore whether it would be feasible to apply a similar model in patients requiring acute psychiatric care.”
To begin to answer this question, the team has convened an advisory board of leaders in inpatient and outpatient psychiatric care, psychology, multimodal therapy, social work, case management, and more. The advisory board currently includes:
- Dana Im, MD, MPP, MPhil
Director of Quality and Safety, Director of Behavioral Health, Brigham and Women’s Hospital/Brigham and Women’s Faulkner Hospital - Martie Carnie
Senior Patient Experience Advisor, Center for Patients and Families, Brigham and Women’s Hospital; PCORI Ambassador - Sejal B. Shah, MD
Chief, Division of Medical Psychiatry, Associate Vice Chair, Clinical Consultation Services Department of Psychiatry, Brigham and Women’s Hospital; Assistant Professor, Harvard Medical School - David Kroll, MD
Associate Vice Chair, Department of Psychiatry, Brigham and Women’s Hospital; Director of Ambulatory Programs, Systems Behavioral Mental Health, Mass General Brigham - Alisa B. Busch, MD, MS
Chief Medical Information Officer, McLean Hospital; Associate Professor of Psychiatry and Health Care Policy, Harvard Medical School - Naomi A Schmelzer, MD, MPH
Director of Medical Psychiatry, Brigham and Women’s Faulkner Hospital - Carlos Fernandez Robles, MD, MBA
Chief of Psychiatry, Brigham and Women’s Faulkner Hospital; Professor, Harvard Medical School - Christina Reynolds, LICSW
Clinical Operations Manager, Department of Psychiatry, Brigham and Women’s Faulkner Hospital
Combined with the Home Hospital team’s expertise in home-based acute care, this multidisciplinary stakeholder group will consider which types of diagnoses could potentially be treated at home, which characteristics may make a patient an appropriate candidate for home hospital care, and which circumstances might exclude a patient. The group will also consider which equipment, technology, and personnel would be needed to treat patients at home.
The findings of this first, year-long phase of work will be used to determine whether a model of home hospital care can be developed to deliver safe and effective acute behavioral health care in patients’ homes. If successful, the team would next focus on testing the model in a simulated care setting.
“We are very much in an exploratory phase with this work,” said Levine. “We’ve seen the benefits home hospital can provide in other areas of medicine, and, if we determine there is an effective model that could help patients in need of high-quality acute behavioral health care, we see huge potential to alleviate some of the system strain that currently prevents patients from accessing care.”
This work is being funded by the Thompson Family Foundation.