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Day-Hospital and Community Treatment for Acute Psychiatric Illness: A Critical Appraisal

  • Francis Creed (a1), Dawn Black (a1) and Philip Anthony (a1)


Findings on the efficacy of day-hospital and community treatment for acutely ill psychiatric patients have been contradictory. This review confirms the methodological problems previously noted, but highlights the variation in feasibility of day care: staffing levels and the attitudes of staff appear to have been responsible, along with the severity and chronicity of illness. The comparison of day and in-patient care to see which is 'superior’ has been unrewarding, and further research is needed. Day-hospital treatment is unlikely to be more widely used for acutely ill patients until: (a) there is clear evidence that certain patients are best treated in this way; (b) the social and clinical characteristics of such patients are defined; (c) adequate staffing is achieved (i.e. day care is not regarded as a cheap option); and (d) day centres are available for chronic patients.


Corresponding author

Department of Psychiatry, Rawnsley Building, Manchester Royal Infirmary, Oxford Road, Manchester M13


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Avison, W. R. & Speechley, K. N. (1987) The discharged psychiatric patient: a review of social-psychological and psychiatric correlates of outcome. American Journal of Psychiatry, 144, 1.
Bowman, E. P., Shelley, R. K., Sheehy-Skeffington, A., et al (1983) Day patient versus in-patient: factors determining selection of acutely ill patients for hospital treatment. British Journal of Psychiatry, 142, 584587.
Braun, P., Kochansky, G., Greenberg, S., et al (1981) Overview: deinstitutionalization of psychiatric patients, a critical review of outcome studies. American Journal of Psychiatry, 138, 736749.
Carney, M. W. P., Ferguson, R. S. & Sheffield, B. F. (1970) Psychiatric day hospital and community. Lancet, i, 12181220.
Cowen, E. L. (1978) Some problems in community program evaluation research. Journal of Consulting and Clinical Psychology, 46, 792805.
Creed, F. H., Anthony, P., Godbert, K., et al (1989) Treatment of severe psychiatric illness in a day hospital. British Journal of Psychiatry, 154, 341347.
Department of Health and Social Security (1969) A pilot survey of patients attending day hospitals. DHSS Statistical Reports No. 7. London: DHSS.
Department of Health and Social Security (1975) Better Services for the Mentally Ill. Cmnd 6233. London: HMSO.
Dick, P., Cameron, L., Cohen, D., et al (1985a) Day and full time psychiatric treatment: a controlled comparison. British Journal of Psychiatry, 147, 246250.
Dick, P., Ince, A. & Barlow, M. (1985b) Day treatment: suitability and referral procedure. British Journal of Psychiatry, 147, 250253.
Endicott, J., Cohen, J., Nee, J., et al (1979) Brief versus standard hospitalization. For whom? Archives of General Psychiatry, 36, 706712.
Fadden, G., Bebbington, P. & Kuipers, L. (1987) The burden of care: the impact of functional psychiatric illness on the patient's family. British Journal of Psychiatry, 150, 285292.
Fenton, F. R., Tessier, L. & Struening, E. L. (1979) A comparative trial of home and hospital psychiatric care. Archives of General Psychiatry, 36, 10731079.
Fink, E. B., Longabaugh, R. & Stout, R. (1978) The paradoxical underutilization of partial hospitalization. American Journal of Psychiatry, 135, 713716.
Gath, D., Hassal, C. & Cross, K. W. (1973) Whither psychotic day patients? A study of day patients in Birmingham. British Medical Journal, i, 9498.
Glick, I. D., Fleming, L., DeChillo, N., et al (1986) A controlled study of transitional day care for non-chronically-ill patients. American Journal of Psychiatry, 143, 15511556.
Greene, L. R. & de la Cruz, A. (1981) Psychiatric day treatment as alternative to and transition from full time hospitalization. Community Mental Health Journal, 17, 191202.
Gudeman, J. E., Shore, M. F. & Dickey, B. (1983) Day hospitalization and an inn instead of in-patient care for psychiatric patients. New England Journal of Medicine, 308, 749753.
Gudeman, J. E., Dickey, B., Evans, A., et al (1985) Four-year assessment of a day hospital–inn program as an alternative to in-patient hospitalization. American Journal of Psychiatry, 142, 13301333.
Guy, W. & Gross, G. W. (1967) Problems in the evaluation of day hospitals. Community Mental Health Journal, 3, 111118.
Herz, M. I., Endicott, J., Spitzer, R. L., et al (1971) Day versus in-patient hospitalization, a controlled study. American Journal of Psychiatry, 127, 13711381.
Herz, M. I., Endicott, J. & Spitzer, R. L. (1975) Brief hospitalization of patients with families: initial results. American Journal of Psychiatry, 132, 413417.
Hogarty, G. E., Dennis, H., Guy, W., et al (1968) “Who goes there?” – A critical evaluation of admissions to a psychiatric day hospital. American Journal of Psychiatry, 124, 9341003.
Hoult, J. (1986) Community care of the acutely mentally ill. British Journal of Psychiatry, 149, 137144.
Kennedy, P. & Hird, F. (1980) Description and evaluation of a short-stay admission ward. British Journal of Psychiatry, 136, 205215.
Kiesler, C. A. (1982) Mental hospitals and alternative care – noninstitutionalization as potential public policy for mental patients. American Psychologist, 37, 349360.
Knights, A., Hirsch, S. R. & Platt, S. D. (1980) Clinical change as a function of brief admission to hospital in a controlled study using the present state examination. British Journal of Psychiatry, 137, 170180.
Lancet (1985) Day hospitals for psychiatric care. Lancet, ii, 11061107.
Lancet (1987) Psychiatric day hospitals for all? Lancet, ii, 11841185.
Lavik, N. J. (1983) Utilization of mental health services over a given period. Acta Psychiatrica Scandinavica, 67, 404413.
Lipsius, S. H. (1973) Judgements of alternatives to hospitalization. American Journal of Psychiatry, 130, 892896.
McGrath, G. & Tantam, D. (1987) Long-stay patients in a psychiatric day hospital: a case note review. British Journal of Psychiatry, 150, 836870.
Michaux, M. H., Chelst, M. R., Foster, S. A., et al (1973) Postrelease adjustment of day and full-time psychiatric patients. Archives of General Psychiatry, 29, 647651.
Mosher, L. (1983) Alternatives to psychiatric hospitalization – why has research failed to be translated into practice. New England Journal of Medicine, 399, 15791580.
Penk, W. E., Charles, H. L. & Van Hoose, T. A. (1978) Comparative effectiveness of day hospital and in-patient psychiatric treatment. Journal of Consulting and Clinical Psychology, 46, 94101.
Platt, S. (1985) Measuring the burden of psychiatric illness on the family: an evaluation of some rating scales. Psychological Medicine, 15, 383393.
Platt, S., Knights, A. C. & Hirsch, S. R. (1980) Caution and conservatism in the use of a psychiatric day hospital: evidence from a research project that failed. Psychiatric Research, 3, 123132.
Potomianos, G., North, W. R. S., Meade, T. W., et al (1986) Randomised trial of community-based centre versus conventional hospital management in treatment of alcoholism. Lancet, ii, 797799.
Rosie, J. S. (1987) Partial hospitalization: a review of recent literature. Hospital and Community Psychiatry, 38, 12911299.
Schene, A. H. & Gersons, B. P. R. (1986) Effectiveness and application of partial hospitalization. Acta Psychiatrica Scandinavica, 74, 335340.
Stein, L. I. & Test, M. A. (1980) Alternatives to mental hospital treatment. 1. Conceptual model, treatment programme and clinical evaluation. Archives of General Psychiatry, 37, 392397.
Szmukler, G. I., Bird, A. S. & Button, E. J. (1981) Compulsory admissions in a London borough. 1. Social and clinical features and a follow-up. Psychological Medicine, 11, 617636.
Tantam, D. (1985) Alternatives to psychiatric hospitalisation. British Journal of Psychiatry, 146, 14.
Tyrer, P. J. & Remington, M. (1979) Controlled comparison of day-hospital and outpatient treatment for neurotic disorders. Lancet, i, 714716.
Tyrer, P. J., Remington, M. & Alexander, J. (1987) The outcome of neurotic disorders after outpatient and day hospital care. British Journal of Psychiatry, 151, 5762.
Vaughan, P. J. (1983) The disordered development of day care in psychiatry. Health Trends, 15, 9194.
Vaughan, P. J. (1985) Developments in psychiatric day care. British Journal of Psychiatry, 147, 14.
Washburn, S. & Vannicelli, M. (1976) A controlled comparison of psychiatric day treatment and in-patient hospitalization. Journal of Consulting and Clinical Psychology, 44, 665675.
Washburn, S., Vannicelli, M. & Scheff, B. (1976) Irrational determinants of the place of psychiatric treatment. Hospital and Community Psychiatry, 27, 179182.
Weisbrod, B. A., Test, M. A. & Stein, L. I. (1980) Alternative to mental hospital II: economic cost-benefit analysis. Archives of General Psychiatry, 37, 400405.
Wilder, J. F., Levin, G. & Zwerling, I. (1966) A two year follow up evaluation of acute psychotic patients treated in a day hospital. American Journal of Psychiatry, 122, 10951101.
Wilkinson, G. (1984) Day care for patients with psychiatric disorders. British Medical Journal, 288, 17101711.
Wing, L., Wing, J. K., Stevens, B., et al (1972) An epidemiological and experimental evaluation of industrial rehabilitation of chronic psychotic patients in the community. In Evaluating a Community Psychiatric Service (eds Wing, J. K. & Hailey, A. M.). Oxford: Oxford University Press.
Zwerling, I. & Wilder, J. F. (1964) An evaluation of the applicability of the day hospital in treatment of acutely disturbed patients. Israel Journal of Psychiatry and Related Disciplines, 2, 162185.

Day-Hospital and Community Treatment for Acute Psychiatric Illness: A Critical Appraisal

  • Francis Creed (a1), Dawn Black (a1) and Philip Anthony (a1)


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Day-Hospital and Community Treatment for Acute Psychiatric Illness: A Critical Appraisal

  • Francis Creed (a1), Dawn Black (a1) and Philip Anthony (a1)
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