Abstract
Background: Portugal has a high burden of mental health disorders and a relatively low bed density compared to most EU countries (1), highlighting the need for comprehensive, integrated, and community-based mental health services. Evidence suggests that innovative strategies can reduce coercive treatment, address trauma, broaden treatment options, enhance professional expertise, and foster collaborative care. Research also indicates that intensive home treatment, acute day units, and community crisis services can help prevent hospitalisation for some individuals (2). The increasing prevalence of mental illness (3), calls for innovative care models like Psychiatric Home Hospitalisation (PHH), which offers intensive, home-based care as an alternative to traditional psychiatric hospitalisation (4). Although PHH models have been adopted in various countries (4,5), substantial differences in components and implementation practices have emerged. This variability underscores the need for more clearly defined guidelines and reliable tools to measure model fidelity, ultimately aiming to improve their effectiveness (4).
Approach: This study protocol aims to co-design a sustainable psychiatric home hospitalisation model by actively involving stakeholders to ensure equitable and person-centred care. The project focuses on developing a PHH model tailored to the Portuguese context, serving as a strategic pillar for community-based mental health care. Stakeholders—including users, caregivers, health professionals, policymakers, and community leaders—participate in three key phases. First, a systematic literature review maps existing PHH models to identify their core components and outcomes. Second, user profiling is conducted using validated tools to characterise eligible users and caregivers within a specific care setting. Finally, the PHH model is developed through stakeholder workshops, incorporating focus groups with users and caregivers, and an e-Delphi method involving professionals and community representatives. This participatory approach ensures that the resulting model reflects the needs, values, and priorities of all stakeholders.
Results: The HOME-ENGAGE project delivers a comprehensive psychiatric home hospitalisation (PHH) model tailored to Portugal, detailing key components such as eligibility criteria, team structure, therapeutic interventions, safety protocols, and mechanisms for inter-professional communication. It also provides operational guidelines covering admission, assessment, care planning, monitoring, crisis management, discharge, and follow-up, alongside implementation strategies that address integration within the Portuguese health system, resource allocation, infrastructure, professional training, and coordination with other mental health services.
By decentralising mental health care, PHH promotes autonomy, social reintegration, and continuity of therapeutic follow-up while potentially reducing hospitalisations, optimising resources, and lowering costs. The model is designed to enhance service accessibility, ensuring a person-centred approach by actively involving users and caregivers in its development. Furthermore, HOME-ENGAGE aligns with the 9 Pillars of Integrated Care by fostering user engagement and interdisciplinary collaboration and supports the Sustainable Development Goals (SDGs) by promoting accessible and equitable mental health care (SDG 3 and SDG 10), strengthening community-based care (SDG 11), and reinforcing multi-stakeholder partnerships for sustainability (SDG 17).
By involving care providers, service users, and policymakers in the co-design process, this project ensures that the PHH model reflects their needs, priorities, and values, addressing service gaps and fostering more holistic, responsive, and person-centred mental health care. This study protocol forms part of a doctoral research project.