“Hospital at home” mental health psychiatric hospital return to the community transition support: impact on self-reported wellbeing

Abstract

Background: People who are discharged from mental health psychiatric hospitals often have low average levels of wellbeing and require support to improve wellbeing, enable mental health recovery, and facilitate successful transition back into the community to prevent mental health crisis and readmission. Low levels of wellbeing are linked to worse mental health symptoms, anxiety, and depression. Intervention: Hospital at Home is a two-week intervention that provides at-home support for people who are discharged from a mental health hospital or who are at risk of a mental health crisis and hospital admission. It is a trauma-informed, behaviour-change, and strengths-based approach; staff provide individualised practical and emotional support, identifying needs and goals to help individuals stabilise, build confidence, develop and apply coping strategies, recover, self-manage, connect with community-based services and resources, and reconnect with previous social contacts and activities. Purpose/aim: This study investigated the impact of Hospital at Home on wellbeing. The study addressed the question: “What is the impact of Hospital at Home transition support on self-reported psychological wellbeing?” Methods: An open-label patient cohort design with no control group was used. Pre- and post-intervention assessments were conducted using the self-report measure, the Short Warwick–Edinburgh Mental WellBeing Scale (WEMWBS). Participants were 102 Hospital at Home clients, 28 (27.5%) males and 74 (72.5%) females. The average age of the participants was 50.1 years (range 25 to 95 years; SD = 14.8). Results: Prior to the start of participation in Hospital at Home, 89% of participants reported low wellbeing, with only 11% reporting in the normal range of wellbeing. At the end of participation in Hospital at Home, 54% reported in the normal range of wellbeing and 2% in the high range of wellbeing. SWEMWBS scores significantly improved by 5.52 points (SD = 4.05) with a very large effect size (Cohen’s d = −1.36). SWEMWBS scores significantly improved in participants with a primary diagnosis of anxiety by 5.44 points (SD = 4.14) with a very large effect size (Cohen’s d = −1.31). SWEMWBS scores significantly improved in participants with a primary diagnosis of depression by 5.28 points (SD = 3.76) with a very large effect size (Cohen’s d = −1.40). SWEMWBS scores significantly improved in participants with a primary diagnosis of schizophrenia by 6.60 points (SD = 3.79) with a very large effect size (Cohen’s d = −1.74). Conclusion: Hospital at Home was found to be beneficial in terms of improving wellbeing, which is linked to improvements in mental health. The SWEMWBS results indicate improvements in optimism, self-efficacy, calmness, coping, clarity of thinking, closer connections with others, and personal agency, which can enhance a successful return to the community, mental health recovery, and reduce the risk of relapse and readmission. Hospital at Home is relatively low-cost and can be offered by all mental health providers. Further research is justified to support roll-out.