Ariadne Labs’ Home Hospital team is exploring whether, for eligible patients, home-based psychiatric care may offer an alternative for inpatient psychiatric stays.
The U.S. behavioral health care system is facing a capacity crisis. The country has 13% fewer state psychiatric beds in 2023 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.
Providing safe, effective care at home could help alleviate these strains and connect more patients with the care they need.
Convening Experts in Psychiatric Care
To begin to consider home-based solutions, Ariadne Labs has convened an advisory board of leaders in inpatient and outpatient psychiatric care, social workers, nurses, and patient advocates.
The advisory board 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
This advisory board will work with Ariadne Labs’ team of experts in home hospital care to explore the potential of a model of home-based care that could bring patients safe, effective behavioral health care in their homes.
Current Phase: Scoping
In the first year of work, Ariadne Labs will work with the advisory board to consider key questions such as:
- Which diagnoses have the potential to be treated at home?
- Which characteristics may make a patient an appropriate candidate for home-based care?
- Which circumstances might exclude a patient from home-based care?
- What would be an effective care team structure?
- What equipment, technology, and personnel would be needed to treat patients at home?
Using findings from Phase I, the team will determine whether a model of home hospital care can be developed to deliver safe and effective acute behavioral health care in patients’ homes.
Future Work
In the next phase of work, the team will test the model in a simulated care setting, using patient actors and a rapid cycle feedback process to improve on the model. Following the simulation the advisory board will review the findings to ensure that the approach is safe for patients. If the simulation is successful, the team will begin work to launch a pilot trial with local hospitals.
This work is being funded by the Thompson Family Foundation.