Skip to main content Accessibility help

Home treatment for acute mental healthcare: randomised controlled trial

  • Niklaus Stulz (a1), Lea Wyder (a2), Lienhard Maeck (a3), Matthias Hilpert (a4), Helmut Lerzer (a5), Eduard Zander (a3), Wolfram Kawohl (a6), Martin grosse Holtforth (a7), Ulrich Schnyder (a8) and Urs Hepp (a9)...

Home treatment has been proposed as an alternative to acute in-patient care for mentally ill patients. However, there is only moderate evidence in support of home treatment.


To test whether and to what degree home treatment services would enable a reduction (substitution) of hospital use.


A total of 707 consecutively admitted adult patients with a broad spectrum of mental disorders (ICD-10: F2–F6, F8–F9, Z) experiencing crises that necessitated immediate admission to hospital, were randomly allocated to either a service model including a home treatment alternative to hospital care (experimental group) or a conventional service model that lacked a home treatment alternative to in-patient care (control group) (trial registration at NCT02322437).


The mean number of hospital days per patient within 24 months after the index crisis necessitating hospital admission (primary outcome) was reduced by 30.4% (mean 41.3 v. 59.3, P<0.001) when a home treatment team was available (intention-to-treat analysis). Regarding secondary outcomes, average overall treatment duration (hospital days + home treatment days) per patient (mean 50.4 v. 59.3, P = 0.969) and mean number of hospital admissions per patient (mean 1.86 v. 1.93, P = 0.885) did not differ statistically significantly between the experimental and control groups within 24 months after the index crisis. There were no significant between-group differences regarding clinical and social outcomes (Health of the Nation Outcome Scales: mean 9.9 v. 9.7, P = 0.652) or patient satisfaction with care (Perception of Care questionnaire: mean 0.78 v. 0.80, P = 0.242).


Home treatment services can reduce hospital use among severely ill patients in acute crises and seem to result in comparable clinical/social outcomes and patient satisfaction as standard in-patient care.

Declaration of interest

U.H. reports grants from the Hugo and Elsa Isler Foundation during the performance of the study.

Corresponding author
Correspondence: Urs Hepp, Integrated Psychiatric Services Winterthur – Zurcher Unterland, P.O. Box 144, CH-8408 Winterthur, Switzerland. Email:
Hide All
1Johnson, S, Needle, J, Bindman, JP, Thornicroft, G. Crisis Resolution and Home Treatment in Mental Health. Cambridge University Press, 2008.
2Smyth, MG, Hoult, J. The home treatment enigma. BMJ 2000; 320: 305–8.
3National Collaborating Centre for Mental Health (UK). Psychosis and Schizophrenia in Adults: Prevention and Management. National Institute for Health and Care Excellence, 2014.
4Hasselberg, N, Grawe, RW, Johnson, S, Ruud, T. An implementation study of the crisis resolution team model in Norway: are the crisis resolution teams fulfilling their role? BMC Health Serv Res 2011; 11: 96.
5Hubbeling, D, Bertram, R. Crisis resolution teams in the UK and elsewhere. J Ment Health 2012; 21: 285–95.
6Wheeler, C, Lloyd-Evans, B, Churchard, A, Fitzgerald, C, Fullarton, K, Mosse, L, et al. Implementation of the Crisis Resolution Team model in adult mental health settings: a systematic review. BMC Psychiatry 2015; 15: 74.
7Murphy, SM, Irving, CB, Adams, CE, Waqar, M. Crisis intervention for people with severe mental illnesses. Cochrane Database Syst Rev 2015; 12: CD001087.
8Fenton, FR, Tessier, L, Struening, EL. A comparative trial of home and hospital psychiatric care. One-year follow-up. Arch Gen Psychiatry 1979; 36: 1073–9.
9Hoult, J. Community care of the acutely mentally ill. Br J Psychiatry 1986; 149: 137–44.
10Pasamanick, B, Scarpitti, FR, Lefton, M, Dinitz, S, Wernert, JJ, McPheeters, H. Home vs hospital care for schizophrenics. JAMA 1964; 187: 177–81.
11Stein, LI, Test, MA, Marx, AJ. Alternative to the hospital: a controlled study. Am J Psychiatry 1975; 132: 517–22.
12Muijen, M, Marks, I, Connolly, J, Audini, B. Home based care and standard hospital care for patients with severe mental illness: a randomised controlled trial. BMJ 1992; 304: 749–54.
13Fenton, WS, Mosher, LR, Herrell, JM, Blyler, CR. Randomized trial of general hospital and residential alternative care for patients with severe and persistent mental illness. Am J Psychiatry 1998; 155: 516–22.
14Howard, L, Flach, C, Leese, M, Byford, S, Killaspy, H, Cole, L, et al. Effectiveness and cost-effectiveness of admissions to women's crisis houses compared with traditional psychiatric wards: pilot patient-preference randomised controlled trial. Br J Psychiatry 2010; 197 (suppl 53): s32–40.
15Johnson, S, Nolan, F, Pilling, S, Sandor, A, Hoult, J, McKenzie, N, et al. Randomised controlled trial of acute mental health care by a crisis resolution team: the north Islington crisis study. BMJ 2005; 331: 599.
16Jacobs, R, Barrenho, E. Impact of crisis resolution and home treatment teams on psychiatric admissions in England. Br J Psychiatry 2011; 199: 71–6.
17Gruber, J, Knie, B, Lippitsch, S. Spitalplanung 2012. Versorgungsbericht Kanton Aargau. [Planning of Hospital Services 2012. Health Services Report of the Federal State of Aargau.] Department Gesundheit und Soziales Kanton Aargau, 2010.
18Stulz, N, Nevely, A, Hilpert, M, Bielinski, D, Spisla, C, Maeck, L, et al. Referral to inpatient treatment does not necessarily imply a need for inpatient treatment. Adm Policy Ment Health 2015; 42: 474–83.
19World Health Organization. The ICD-10 Classification of Mental and Behavioural Disorders. World Health Organization, 1992.
20Zelen, M. A new design for randomized clinical trials. N Engl J Med 1979; 300: 1242–5.
21Torgerson, DJ, Roland, M. What is Zelen's design? BMJ 1998; 316: 606.
22 Wittchen, H-U, Wunderlich, U, Gruschwitz, S, Zaudig, M. SKID I. Strukturiertes Klinisches Interview für DSM-IV. Achse I: Psychische Störungen. [SCID I. Structured Clinical Interview for DSM-IV Axis I Disorders.] Hogrefe, 1997.
23Zander, E, Wyder, L, Holtforth, MG, Schnyder, U, Hepp, U, Stulz, N. Validity of routine clinical diagnoses in acute psychiatric inpatients. Psychiatry Res 2018; 259: 482–7.
24ANQ. National Quality Assessment of Inpatient Psychiatry. ANQ, 2017 (
25Wing, JK, Beevor, AS, Curtis, RH, Park, SB, Hadden, S, Burns, A. Health of the Nation Outcome Scales (HoNOS). Research and development. Br J Psychiatry 1998; 172: 11–8.
26Derogatis, LR. BSI. Brief Symptom Inventory. Administration, Scoring, and Procedures Manual. National Computer Systems, 1993.
27Junghan, U, Kraan, K. Abschlussbericht: Modellprojekt Gemeindeintegrierte Akutversorgung (GiA) für die Versorgungsregion Luzern-Stadt und Agglomeration. [Final Report: Pilot Project Community-Integrated Acute Care (GiA) for the Catchment Area Lucerne City and Agglomeration.] Psychiatric Services of Lucerne, 2011.
28Barber, JA, Thompson, SG. Analysis of cost data in randomized trials: an application of the non-parametric bootstrap. Stat Med 2000; 19: 3219–36.
29Thompson, SG, Barber, JA. How should cost data in pragmatic randomised trials be analysed? BMJ 2000; 320: 1197–200.
30Lloyd-Evans, B, Bond, GR, Ruud, T, Ivanecka, A, Gray, R, Osborn, D, et al. Development of a measure of model fidelity for mental health Crisis Resolution Teams. BMC Psychiatry 2016; 16: 427.
31Pelosi, AJ, Jackson, GA. Home treatment–engimas and fantasies. BMJ 2000; 320: 308–9.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

The British Journal of Psychiatry
  • ISSN: 0007-1250
  • EISSN: 1472-1465
  • URL: /core/journals/the-british-journal-of-psychiatry
Please enter your name
Please enter a valid email address
Who would you like to send this to? *


Type Description Title
Supplementary materials

Stulz et al. supplementary material
Stulz et al. supplementary material 1

 Word (223 KB)
223 KB


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed

Home treatment for acute mental healthcare: randomised controlled trial

  • Niklaus Stulz (a1), Lea Wyder (a2), Lienhard Maeck (a3), Matthias Hilpert (a4), Helmut Lerzer (a5), Eduard Zander (a3), Wolfram Kawohl (a6), Martin grosse Holtforth (a7), Ulrich Schnyder (a8) and Urs Hepp (a9)...
Submit a response


No eLetters have been published for this article.


Reply to: Submit a response

Your details

Conflicting interests

Do you have any conflicting interests? *