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Acute psychiatric day hospitals are no longer in fashion, but evidence shows that they provide feasible and effective care. More ideas seem to be returning from the 1960's and 1970's. In an editorial in the BMJ, Max Marshall, Professor of Psychiary, University of Manchester UK, points out that they fell from favor not because they were ineffective
Currently, in the United Kingdom and elsewhere, "the preferred alternative to hospital admission is acute home based care delivered by a specialised crisis team. According to a recent systematic review, home based care is thought to be feasible for about 55% of patients who would otherwise be admitted and seems to reduce costs and increase satisfaction."
A recent Cochrane review of nine randomized controlled trials of acute day hospital treatment includes 2268 patients. The review found that treatment in day hospitals was not only feasible for about 23-38% of the patients who were currently admitted to an inpatient service but that day hospitals led to cost reductions ranging from 20.9% to 36.9% over the inpatient care. An unexpected outcome was that patients at day hospitals showed a more rapid improvement in mental state than patients randomised to inpatient care, a finding not shown for any other alternative to admission. There was also evidence of increased satisfaction of patients and no evidence of an increased burden on caregivers.
This review also highlights some recent changes of practice in acute day hospitals, with more emphasis on community follow up of non-attendees and the use of respite facilities for people temporarily too ill to return home at night.
The editorial reminds us that day hospitals were invented in Russia in the 1930s, spread to America and Europe in the 1940s and 1950s, and reached their peak in the 1970s, when they provided the main alternative to hospital admission. Paradoxically, 'the success of acute day hospitals as an alternative to inpatient care was a major factor in their decline, since it begged the question of whether hospital care was necessary at all.'
Will this begin to replace ACT teams or home based care? Will it catch on, again, in the US and other countries? If the data is good, the economics feasible and it represents increased treatment options and patient satisfaction, then maybe more people will ask why they really ever fell from grace.
5:18:35 PM 
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