Home Treatment: trattamento psichiatrico a domicilio

Home Treatment (HT) psychiatric care at home is an innovative and pioneering model for managing patients during the acute phase of a psychiatric crisis. It was developed starting in the 1980s as an alternative to hospitalization and institutionalization. This new model is based on an intensive, multimodal approach delivered directly at the patient’s home by a multidisciplinary team specialized in mental health care. The goal of HT is to keep the person in their own living environment, reduce stigma, and promote social reintegration. This thesis topic stems from my personal internship experience within the HT service of the Canton of Ticino, made possible through the “Swiss European Mobility Programme” (SEMP). During this experience, I had the opportunity to closely observe the differences between this approach and conventional hospitalization, as well as the positive impact of this model on the patients’ care pathways and their families. The paper aims to illustrate the origins of the HT model, its founding principles, and its spread at both international and Swiss levels, with a particular focus on the organization and functioning of the service in the Canton of Ticino. In Ticino, HT represents a unique example, as an acute inpatient unit of the Cantonal Psychiatric Clinic (CPC) has been transformed into a fully community-based, home-only service that provides 24-hour continuous care. The thesis specifically analyzes the nursing role, which is fundamental in establishing the therapeutic alliance with the patient, managing daily symptoms, and supporting families. Additionally, the paper presents the operational characteristics of the model: inclusion and exclusion criteria, procedures for activating the service, pharmacological management, and organization of home visits. This allows for the identification of HT's strengths: timely intervention, intensity of care, active involvement of family members, organizational flexibility, and the ability to reduce repeated hospital admissions. To demonstrate the model’s concrete effectiveness, two complex clinical cases have been analyzed. The first concerns a young patient diagnosed with disorganized schizophrenia, with a history of involuntary hospitalizations and hetero-aggressive behavior. In this context, the implementation of HT led to a significant improvement in medication compliance, management of family conflicts, and personal autonomy, facilitating social reintegration and continuity of care with community services. The second case involves a young woman diagnosed with bipolar affective disorder, with a history of traumatic bereavements and substance abuse. Here too, HT helped reduce depressive symptoms, strengthen the support network, and promote a personalized therapeutic path, thus encouraging the patient’s social reintegration. The case analyses show that, compared to traditional hospitalization, HT allows for a type of care that is more closely aligned with the patient’s actual needs, reduces the risks associated with institutionalization syndrome, and positions the patient as the protagonist of their own care journey. In conclusion, the HT model proves to be an innovative and sustainable strategy for managing acute psychiatric crises, effectively combining clinical efficacy, reduced healthcare costs, and a person-centered approach. The direct experience I gained in the Canton of Ticino, together with the analysis of international literature and the presented clinical cases, highlights the importance of promoting and further developing home treatment services as an alternative to traditional hospitalization—toward a modern, integrated psychiatry that is attentive to the needs of both patients and the community.

Il trattamento psichiatrico domiciliare denominato Home Treatment (HT) si configura come un modello innovativo e pionieristico di presa a carico del paziente in fase acuta di uno scompenso psichico. È stato sviluppato a partire dagli anni ’80 come alternativa al ricovero ospedaliero e all’istituzionalizzazione. Questo nuovo modello prevede un approccio caratterizzato da un’assistenza intensiva e multimodale erogata direttamente al domicilio dell’utente da parte di un’equipe multidisciplinare specializzata in ambito di salute mentale. L’obiettivo di HT è quello di mantenere la persona nel proprio contesto di vita, ridurre lo stigma e favorire il reinserimento sociale. Questo argomento di tesi nasce dalla mia personale esperienza di tirocinio svolto presso il servizio di HT del Canton Ticino favorito dal programma “Swiss European Mobility Programme” (SEMP), durante il quale mi è stato possibile osservare da vicino le differenze rispetto all’ospedalizzazione convenzionale e l’impatto positivo di tale modello sul percorso di cura dei pazienti e sulle famiglie. L’elaborato si propone di illustrare le origini del modello di HT, i suoi principi fondanti e la sua diffusione a livello internazionale e svizzero, con particolare attenzione all’organizzazione e al funzionamento del servizio nel Canton Ticino. Nel Ticino HT rappresenta un esempio singolare in quanto, un reparto ospedaliero acuto della Clinica psichiatrica cantonale (CPC), è stato trasformato in un servizio territoriale esclusivamente domiciliare, che garantisce continuità assistenziale 24 ore su 24. Viene analizzato in particolare il ruolo infermieristico, fondamentale per l’instaurazione dell’alleanza terapeutica con il paziente, la gestione quotidiana della sintomatologia e il supporto alle famiglie.