Perspectives

Kaleidoscope of the Heart: What we can learn from home care

Rika Kayama

Imagine that one day you thought to yourself, "I'm not feeling well. Could it be depression?" and visited a psychiatrist. Imagine that the psychiatrist told you, "You'll need to stay at a hospital for treatment." What would you do?

Say you went along and entered the hospital, thinking to yourself, "Well, it will probably only be for a week or so," but instead you remain there for a half-year, then a year. You're let go from your job, your family complains, "We can't wait forever," and starts to drift away.

Though psychiatrists recommend hospitalization thinking it's for the good of their patients, the actual result can be that the patients' lives are changed dramatically for the worse.

In order to avoid such a tragic situation, there has been a large shift in recent times from inpatient-based care to outpatient-based care. Even today, however, many people being treated for psychological disorders remain in long-term hospital stays. Against this background, one person, believing that care for psychological disorders ought to be done in the same place that we live our everyday lives, has started Japan's first treatment service specializing in at-home care. That person is Shunsuke Takagi, M.D., of Kyoto University.

Dr. Takagi has released a book describing the experiences of care staff who, attached to a local area, fight alongside families and patients to overcome psychological disorders. The name of the book is "Kokoro no Iryo, Takuhaibin" or "Treatment for the Heart, Home-Delivered."

In the home-care system, there is no hospitalization or even any hospital visits. Caregivers visit the homes of patients, who needn't feel like "patients" at all. When doctors visit, they don't just ask the standard set of questions like in a hospital's examination room and leave; they stay for a chat. Of course, when necessary, patients may have to take prescribed drugs, but after the symptoms abate, caregivers, family, and patients continue spending time together. They go for walks, shop together, and otherwise socialize. Patients can keep wearing the clothes they want and listening to the music they like. In recovery, "fighting the disorder" needn't be all-consuming.

When people find out they have psychological disorders, even serious ones, they shouldn't have to leave their home for a hospital away from their loved ones, nor should they have to live shut away in their home, an outcast from the world. As much as possible, they should be able to live just as they always have and receive the understanding and acceptance of their community. To bring this about, a tremendous amount of patience is required on the part of caregivers, but a society where those with psychological disorders can live normal lives is, surely, also a society that will give a sense of security and hope to those of us fortunate enough not to have disorders.

When I introduced Dr. Takagi's ideas at a university lecture, I saw the students' eyes light up with enthusiasm.

"It's hard work for the caregivers, but if I were to need help, I'd definitely want to try this kind of care."

"We should tell more and more people about this idea and spread it around the country!"

Already, there are young people who have been so inspired. Home care will help in moving away from the traditional "patient-and-doctor" relationship to one where those receiving treatment are respected as individuals with names, personalities and lives. There are many things we people of the current age should learn from that. (By Rika Kayama, psychiatrist)

Click here for the original Japanese story