Psychological interventions for housebound people with psychosis: service user and therapist perspectives in South East London

Abstract

Background: People with psychosis often have difficulty leaving their homes to perform tasks of daily living, which also limits their access to clinic-based interventions to support recovery. Home-based psychological therapy may offer a solution.

Aim: To examine service user and therapist perspectives on (i) houseboundness in psychosis and (ii) the value of home-based psychological interventions, as a first step towards a systematic evaluation.

Method: Semistructured interviews with 10 service users and 12 therapists from a large inner city mental health NHS Foundation Trust were thematically analysed.

Results: Houseboundness most commonly resulted from anxiety, paranoia and amotivation, indicating the potential usefulness of targeted psychological therapies. Home-based therapy was offered unsystematically, with variable goals. Although beneficial for engagement and assessment, little gain was reported from undertaking a full course of therapy at home.

Conclusion: Home visits could be offered by psychological therapists to engage and assess housebound service users, but home-based therapy may be best offered on a short-term basis, targeting paranoia, anxiety and amotivation to increase access to other resources. Given the increased cost associated with home-based psychological interventions, a systematic evaluation of their impact is warranted.

• Schizophrenia
• community mental health
• low-intensity
• engagement
• access

Declaration of interest

The authors declare that there is no conflict of interest. The authors alone are responsible for the content and writing of this article.

Notes

¹United Kingdom National Health Service mental health provision in our locality is organised by governmentally defined administrative areas (London boroughs), each of around 280 000 population.

²The recovery service worked with adults (aged 18–65 years) who had an established psychotic illness. At the time of the project, the typical therapist to service user ratio was 1:750.

³The Early Intervention Service worked with adults and young people (aged 14–35 years) who have experienced a first psychotic episode. Early intervention services are designed to provide high levels of support at an early stage in illness development in order to prevent relapse. At the time of project, the typical therapist to service user ratio was 1:200.