Australia Pioneers ‘Hospital in the Home’ Model too Address Mental Health Crisis
Table of Contents
Australia is increasingly turning to innovative, community-based solutions to address a growing mental health crisis, with a focus on “hospital in the home” programs offering acute care outside traditional hospital settings. This shift comes as the nation grapples with a mental health system under immense pressure and a decades-long struggle to fully realize the promise of deinstitutionalization.
A regional New South Wales public hospital is set to close its acute mental health unit, with patients to be treated rather through a new ‘hospital in the home’ service covering an area of 55 kilometers.The NSW government believes that a successful rollout of this programme could serve as a model for the entire state.
The Strain on Australia’s Mental Health System
Australia’s mental health system is facing unsustainable pressure. Despite the burden of disease attributable to mental health and addictions rising to around 15% of the total disease burden, funding allocated to mental health has remained stagnant at approximately 7% of total health spending since 1992. This financial constraint has led to a system heavily reliant on hospital-based care, which accounts for nearly 80% of state and territory spending on mental health – and is also the most expensive form of care.
A History of Community-Based Care
Australia has a long history of pioneering alternatives to traditional hospitalization for mental illness. As early as 1907, organizations like the Aftercare Association were working to provide housing, care, and employment opportunities for patients outside of asylums. This movement gained momentum in the 1970s and 80s,spurred by inquiries such as the Richmond Report,leading to a shift towards a network of community-based services.
The “hospital in the home” model emerged as a key component of this approach, offering patients more options and helping to alleviate pressure on hospital beds.this model provides acute, hospital-level mental health care within a patient’s own home, offering a comparable level of care in a familiar environment. A dedicated team – including psychiatrists, psychologists, nurses, allied health professionals, and peer workers – develops a tailored treatment plan, often involving daily home visits or appointments at a clinic or online. Crucially, discharge planning begins upon admission, focusing on restoring the patient’s functionality within the community.
Evidence Supports the ‘Hospital in the Home’ Approach
Research indicates that “hospital in the home” is an effective alternative to traditional hospital-based care. Studies show it can shorten hospital stays and reduce the need for readmission.Moreover, it carries a reduced risk of adverse events like seclusion and restraint. Many patients find the experience more agreeable and prefer it to hospital admission. “Felt like I was being checked in with, rather than checked on, which is quite a different distinction. It was like I was part of the team, rather than a number being treated,” one individual shared. However,the model is not suitable for all patients,particularly those at vrey high risk of suicide.
Learning from New Zealand and Expanding Access
New Zealand offers a compelling comparison, allocating over 20% of its mental health funding to community-based services, compared to Australia’s 7%. Services like Tupu Ake, a consumer-run acute psychiatric “ward” in Auckland, demonstrate the potential of innovative community models to reduce hospital admissions. While successive reports in Australia have recommended expanding community mental health services, access to programs like Orygen @ Home – which provides acute care for young people in their homes – remains limited.
The Need for Sustainable Funding
The growing pressure on hospitals is driving a broader consideration of alternative care models. St Vincent’s Health Australia recently announced plans to shift half of its services to home-based or online care over the next five years, reserving hospitals for emergency and intensive care. This shift coincides with ongoing negotiations between federal and state/territory governments regarding the next five-year national health and hospital funding agreement.
Experts argue that alternatives like “hospital in the home” should be a central focus of this new agreement, as part of a extensive strategy to reduce the hospital-centric nature of the mental health system. However, they caution against simply replacing inadequate hospital care with substandard home-based care. Maintaining the integrity of the “hospital in the home” model – both in its ideology and execution – is paramount.
