Day hospital care

Over the past 50 years, day hospitals have emerged and developed in Western psychiatric services in the process of deinstitutionalization. There is now great diversity in the aims and uses of services that fit under the umbrella term of ‘day hospital care’. The research literature has identified four models of day hospitals, varying from acute or crisis services as an alternative to traditional inpatient psychiatric care, to longer-term rehabilitative services to bolster ongoing outpatient treatment. A recent survey of English day hospitals found that most individual day hospitals aim to provide an array of functions and services, which suggests that the different day hospital models may not be mutually exclusive. Over the past 20 years a robust evidence base has developed to support the use of acute day hospitals, with a recent randomized controlled trial in London suggesting that service users may make significantly more improvement in symptom change in this treatment setting than on traditional wards. There is a dearth of research investigating the efficacy of other day-hospital models, including those with multiple aims and functions. There is thus a real gap between evidence and practice in this area. The range of day hospital uses may reflect the flexibility of day hospitals in adapting to local service needs, but may also suggest that, despite their lengthy history, day hospitals have not carved out a distinct identity within modern community service provision.