Patients struggling with mental health issues in Montreal are now hospitalized in the comfort of their own homes. La Presse accompanied the medical team for a day.

“They could have lost me if I hadn’t had this follow-up,” says Mathieu*, sitting by the window of a café in Plateau Mont-Royal. He is one of the first patients to benefit from Montreal’s mental health home hospitalization program, a model that Quebec wants to introduce across the province.

It’s a Wednesday afternoon in August. Clinical nurse Janie Bouchard arranges to meet Mathieu at their regular café, as she does several times a week. The other café patrons don’t know it, but Mathieu is “hospitalized” for mental health issues, meaning he’s receiving close medical monitoring at home.

Since June 12, the CIUSSS du Centre-Sud-de-l’Île-de-Montréal has been offering home hospitalization for mental health. The team is made up of about fifteen health professionals who travel several times a day to meet with the 14 patients they are following, including Mathieu. La Presse benefited from privileged access to the program.

For several years, the man in his thirties has been dealing with intrusive thoughts, obsessive-compulsive disorder, phobias and anxiety. “It stopped me from functioning completely. Imagine your worst fear and imagine it’s there all the time,” he says.

By June, his condition had deteriorated and it became impossible to carry out his daily activities. “The alarm in my brain never stopped. My thoughts were racing. There’s nothing you can do to make it stop,” he says.

Exhausted, he went to Notre-Dame Hospital, where he was admitted for a week’s stay. “I went into the hospital thinking, ‘If they don’t give me follow-up, I’m going to kill myself.'”

After a few days, he was informed that there was a new home hospitalization program. “At first, I wasn’t sure, because I’m sharing an apartment,” he said. A social worker and a nurse suggested they meet at a coffee shop or a park, rather than at his apartment.

A model that will soon be widespread

The home hospitalization program brings together around fifteen health professionals: nurses, administrative staff, psychiatrists, social workers.

“We’ve wanted this service for a long time. To offer an [alternative] to traditional hospital service,” says Nathalie Lefrançois, head of program administration, alternatives to hospitalization. The service is offered to people aged 18 and over whose mental state is sufficiently unstable that emergency room or hospitalization is required.

But here, there are no blue hospital gowns or curfews. “The person can receive care equivalent [to what they would receive] in the hospital, but while remaining in their living environment,” says Ms. ^Lefrançois  .

Home hospitalization generally lasts for a period of six to eight weeks. “The goal is to mimic the hospital episode and then have someone else take over for long-term follow-up,” says psychiatrist Marianne Genest.

This model has already been implemented in the Capitale-Nationale region since 2009. A separate home hospitalization program has also existed since 2015 at the Institut universitaire en santé mentale de Montréal for elderly patients with mental health problems. The Capitale-Nationale model is also being rolled out in Mauricie and Centre-du-Québec, in Outaouais, in Laval, as well as in the west of Montreal.

“We want to continue to expand this model throughout Quebec,” the office of the Minister responsible for Social Services, Lionel Carmant, told La Presse . The goal is to bring “mental health services closer to the community.” “This will allow us not only to avoid revolving doors, but also to keep the family more involved in care and services.”

“I was so reassured”

For the first few weeks, Mathieu had meetings every day, then the frequency decreased to once a week. During the sessions, the team monitors his medication, assesses his needs and identifies factors that may impact his mental health.

“The medication and follow-up have had a big effect,” he rejoices, noting a decrease in the intensity of his symptoms over the past few weeks. Mathieu will finish his home hospitalization at the end of August and will continue his external follow-up through a separate program.

One of the program’s principles is to support and equip loved ones, emphasizes clinical nurse Janie Bouchard. Julie* has experienced it. Her daughter Béatrice* has been part of the home hospitalization program since June.

“My daughter was always in a good mood, had a good lifestyle, she was a good trainer, thrifty, in her business, she has lots of friends,” explains Julie, sitting in her living room. Her behavior completely changed this winter. “From one day to the next, she was talkative, her vocabulary was different, her facial expressions were different, we thought she was high . We didn’t recognize her.”

The family tried to take her to the hospital, but Beatrice refused. “It was hell. She was fine,” says Julie, who had to get a court order to have her hospitalized. During her week-long hospital stay, Beatrice was diagnosed with bipolar disorder. She was eventually offered to enter the home hospitalization program in June.

At first, the team visited her three times a day. Separate meetings were held with Beatrice’s parents to offer advice and provide them with informational materials. “It took a ton of bricks off my shoulders,” Julie says. “I really hope this program will spread. I wish that for everyone.”

* Names have been changed to protect patient anonymity.