When psychiatric nurse Alexandre Boisvert arrives at Tina-Maria Sirois's home, Sirois is waiting. The door to the large bungalow in a middle-class neighbourhood opens the instant Boisvert knocks.
Face to face at the large kitchen table, Boisvert checks in with the 41-year-old mother of three.
How is she sleeping? Is she feeling sad? Has she been having delusions or hallucinations?
Sirois, who suffers from a schizoaffective disorder, struggles with depression, and she's been hearing voices for the past eight years. She says it's always her father's voice telling her "very negative and domineering" things.
"They say that I'm not a good person, that I should commit suicide, that my kids don't love me. That I'm just a big zero," she says. "It's really, really not easy to deal with."
In recent months, Sirois has started having visual hallucinations as well: an intimidating, faceless man appears in her bedroom at night.
Most of the time now, she's able to make the man go away. She "puts him in the closet."
That's something she's learning from Boisvert and the other clinicians who come to her home, under a program called Traitement intensif bref à domicile (TIBD) – or "brief intensive home treatment."
Up to 4 visits a day
Usually, patients with problems as severe as Sirois's would be in a hospital psychiatric ward, but through TIBD, even very sick patients are treated at home.
Boisvert and his colleagues will make up to four house calls per day to see a single patient.
Sirois said she's been in hospital a number of times and received all kinds of treatment, including electroshock therapy. She said the home-based treatment has been the most helpful she's ever received.
"They used to come every day, twice per day, so there was always some help," Sirois said. "I knew I wasn't alone any more. I knew they were there to help me out."
"I really needed the program. Otherwise, I'm not sure I would be here today."
At-home care is better, psychiatrist says
Karine Paquet, the team's psychiatrist, says like Tina-Maria Sirois, some of her patients have a history of psychotic episodes. Others are getting psychiatric care for the first time.
She said the kind of home treatment her team offers is more "normalizing and non-stigmatizing" than hospital in-patient care.
She said her patients are more likely to follow treatment plans during and after their time in the program.
She's found because patients have a more positive experience with the mental health care system, they are more likely to ask for help again if they need it.
In addition, Paquet says, seeing her patients where they live helps her give them better care
"You see them functioning in their environment, interacting with the people around them. So you get way more information that you wouldn't have otherwise," Paquet said.
Trained to manage risk
Paquet and her team assess the risk patients pose to the themselves and others before agreeing to treat them at home.
She said if they believe someone is safer in the hospital, they'll admit that patient.
Alexandre Boisvert, the psychiatric nurse who makes house calls, said he has never felt scared while with a patient, although he has felt at risk.
He said he feels well trained to assess the risks the patients pose.
He said on rare occasions, he's had to call the police and an ambulance to transport an unwilling patient to the hospital.
Halving the cost of care
The TIBD team's annual budget is $1.3 million, most of which goes to pay salaries.
Jean-François Beaulieu, the team's administrator, estimates it would cost the health care system at least twice as much if patients in the team's care were to be treated in hospital instead of at home.
Beaulieu said the team of 13 people treats about 120 patients per year, and on average, each patient is in the program for six to eight weeks.