15 - Acute day hospital care

Summary

Introduction

This chapter will examine the use of the day hospital for acute psychiatric illness. There are several questions to be addressed. Is it really feasible to treat acutely ill patients in a day hospital? What is the outcome of treatment? Can the findings of the few experimental studies be generalised? If so, can others develop acute day hospital treatment? Finally, is day hospital treatment for acute illness really cheaper than in-patient care? This chapter will examine these questions; there is increasing consensus in the literature about the answers, except, possibly, that concerning cost.

The major problem in trying to tackle these questions is the fact that day hospitals have been used predominantly for support and rehabilitation of patients with chronic disorders rather than as a primary treatment strategy for acute illness (Pryce 1982; McGrath & Tantam 1987); this means that evaluation of their use for acute illness is difficult. The reasons why day hospitals have not changed their role to the care of acute illness are discussed below, they include lack of alternative provision (e.g. day centres) for the chronically ill but also include staff attitudes – acutely ill patients may be perceived as ‘demanding and disruptive’ in a traditional rehabilitation day hospital (Creed et al., 1989b; Anthony et al., 1991). This resistance to change encourages the attitude that only selected patients are suitable for day hospital treatment.

Some would view day hospitals as having a very limited contribution to make towards the care of acute illness.