9.Intensive home treatment for first episode psychosis

Of all the psychiatric disorders , first episode psychosis is one of the most suited to intensive home treatment. It’s the treatment of choice for severe acute episodes in England  and Australia. Entry into the psychiatric system is often very traumatic for young people with first episode psychosis; McGorry in Australia has found a high rate of post-traumatic stress disorder as a residue of in-patient treatment of these individuals. They are hard to engage, and coercion is often needed to get them into hospital. The first study of home treatment for this condition was by P.Fitzgerald and J.Kulkarni in Australia; a study of the HOMES program ( Home Oriented Management of Early Psychosis) found that 22 out of 31 people were managed without hospital admission. Illness severity was not related to the ability to manage the illness at home;but level of social support and duration of untreated psychosis was  ( British Journal of Psychiatry , 172 ( suppl 33), 39-44.