Former psychiatric nurse vouches for home-based care for psychotic son

When Michele Martel talks about caring for patients suffering from acute psychotic episodes, she talks from professional experience and from two decades of personal experience, looking after her adult son.

• Unique mental health team in Quebec City treats psychotic patients at home

Richard Poulin, 42, has had psychotic episodes and periods of depression since he was in his early 20s. Until he began taking bi-weekly injections for his illness seven years ago, he spent an average of a month or two in hospital every year.

Martel, a retired nurse who worked in psychiatric care for 37 years, has been there for her son each time he relapsed.

Martel says as a parent, she doesn't feel she was taken seriously by her son's doctors.

Only twice in 20 years did her son's psychiatrist ask to meet her. Martel says when she asked to meet with the doctors, she was always told they were too busy.

"Well, I'm sorry, but the families have to be involved," she says.

This time, things are different.

Psychiatric team that makes house calls

Poulin is being treated under a unique program in Quebec which allows him to stay at home.

Traitement intensif bref domicile (TIBD) is an award-winning initiative of the Institut universitaire en sant mentale de Qubec, based in Quebec City. It provides intensive home care for patients in acute psychotic crisis as an alternative to in-patient treatment on a hospital psychiatric ward.

There's nothing therapeutic about being stuck between four walls with other people who are going through a crisis,- Richard Poulin, 42, psychiatric patient

The team, made up of 13 people, includingnurses and social workers and one psychiatrist, goes to each patient's home up to four times a day15 hours a day, seven days a week.

Before this latest round of treatment, Poulin feared being attacked. He would barricade his bedroom door at night and sleep with a knife.

He ended up in hospital, again. As a condition ofhis release, he agreed to be treated by the TIBD team.

Five weeks into the program, he's ready to swear by it.

"They [did a] miracle with my situation," he said, adding he's never responded so well to treatment before.

"I feel free," he says, "I feel cured now. I feel very good."

Poulin said if he'd had to stay in hospital to get through this latest acute psychotic episode, he doesn't think he would be well enough to be released yet. Being at home, with his catand surrounded by his own possessions, is key.

Quebec AM13:47Unique mental health team in Quebec City treats psychotic patients at home

A psychiatric team in Quebec City that pays home visits to patients in acute psychotic crisis up to four times a day finds the program works for the patients - and saves the health care system a bundle, too.

Model that should be copied, mother says

"There's nothing therapeuticabout being stuck between four walls with other people who are going through a crisis," Poulin said.

On the other hand, "there's nothing more therapeutic than being [among] your own things."

The program's annual budget is $1.3 million most of that earmarked for salaries for the 13 staff.

Jean-Francois Beaulieu, the team's administrator, says it would cost at least twice as much if the patient's treated by the team were in hospital instead.

"In the last two years, we proved ...that this is a good way to treat people," Beaulieu said.

Within five years, he'd like to seetwo more intensive home-based treatment teams like this one set up in the Quebec City region.

Michele Martel, Poulin's mother, says if she were still working as a psychiatric nurse, she would want to work on a team with this home-based approach.

"This program should be put in place everywhere." she said. "People feel good about themselves in this program. They feel, 'Someone is thinking of me, someone is there to support me.'"

"On top of that," she adds, "they ask parents for their opinions."

For Martel,that's of utmost importance.