Exploring lived experiences in home-based psychiatric care: A qualitative study of service users, families, and professionals in Spain

Ana Maria Besoain-Cornejo^1,2,3Montserrat Gil-Girbau^2,4,5Mariam Alouali-Moussakhkhar⁵Luisa Baladón Higueras^2,5Josefina Sáez⁶Maria Rubio-Valera^1,5,7,8*

• ¹Health Technology Assessment in Primary Care and Mental Health (PRISMA) Research Group, Teaching, Research & Innovation Unit, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
• ²Research Network on Chronicity, Primary Health Care and Health Promotion (RICAPPS), Barcelona, Spain
• ³School of Pharmacy and Food Sciences, Universitat de Barcelona, Barcelona, Spain
• ⁴Health Technology Assessment in Primary Care and Mental Health (PRISMA) Research Group, Teaching, Research & Innovation Unit, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat,, Esplugues de Llobregat, Spain
• ⁵Parc Sanitari Sant Joan de Deu, Sant Boi de Llobregat, Spain
• ⁶Patient Research Partner, Sant Pere de Ribes, Barcelona, Spain
• ⁷Center for Biomedical Research Network in Epidemiology and Public Health (CIBERESP), Madrid, Spain
• ⁸Medicine and life sciences, Universitat Pompeu Fabra, Barcelona, Spain

Introduction. Psychiatric home care provides a wide range of multidisciplinary, user-centered, high-intensity psychiatric interventions to manage mental health crises. Previous studies have found high satisfaction with care, but only assessed user and nurse perspectives. This study aimed to understand the experience of a psychiatric home hospitalization program in Spain from the perspective of all involved (users, families and healthcare professionals). Materials and Methods. A qualitative study with a phenomenological approach was conducted to assess "Crisis Resolution and Home Treatment" (CRHT), a psychiatric home care program. Semi-structured individual and group interviews were held between 2021 and 2022. The final sample size was determined by saturation and data were analyzed thematically. Analyses were performed by a multidisciplinary team and externally reviewed by a mental health user and an experienced CRHT manager. Results. Four main themes summarizing CRHT experiences emerged: (1) Organizing and operating CRHT programs; (2) Receiving care at home; (3) Caregiver and family involvement and (4) Consequences of the home-based care model. CRHT allows individualized and contextualized treatment. Users and families valued home care and felt safe, although unprepared for the post-discharge situation, especially as care intensity decreases. While home care strengthens family bonds, some caregivers may need additional support to manage a crisis. Along with personalized care, CRHT allows for the development of a comprehensive lifelong treatment plan, although the care burden (for oneself and others) must be considered. Conclusion. CRHT was rated positively as a flexible intervention, facilitating person-centered care and strengthening trust between users, their families, and the CRHT team. It offers personalized treatment and connects individuals to further support, enabling better treatment experiences and strengthening family relationships.