DAY HOSPITAL (Day Care Program)

A mental hospital program organized on a daytime basis. The patients come to the hospital in the morning, receive practically all the care and treatment ordinarily provided, and return to their homes in the late afternoon or evening.The day hospital concept was first outlined by D. Ewen Cameron in 1947 and is now widely utilized to counteract the seclusion of the mental institution and to keep patients in contact with their families and social groups. During the day patients receive individual or group psychotherapy and engage in the hospital’s activity program according to their needs and interests, but during the evening they are cared for by their family or foster family. In some institutions the program is set up in conjunction with an outpatient clinic or as a separate center; in others, the day patients receive care and treatment along with the residential patients. Those who require rehabilitation rather than definitive treatment often engage in such a program on a day-care basis, since remaining in the hospital overnight might tend to overemphasize their sickness or handicap.Day care has a number of advantages. It gives the family a respite during the day. It reduces the costs of hospital treatment. It enables the staff to observe the behavior of patients within the hospital environment in a way that is not possible with outpatients. It can serve as a gradual transition from the community to the hospital, enabling the patient to become acquainted with the staff and to overcome the fear of hospitalization. Or, after a hospital stay, it can be used to facilitate the transition to fulltime community life, since it helps the patient to gain self-confidence at his own pace.When patients return home every night the staff is given an additional opportunity to study the effects of the family environment upon them. And when the family transports the patient to and from the hospital every day, they have a chance to get acquainted with the personnel, to learn about hospital activities, and to discover how they can collaborate in the treatment process. They are also likely to be drawn into hospital social events and thereby help to bring the “outside world” into the institution and thus bridge the gap between the hospital and the community.The day program also helps to prevent the dependent patient from using the hospital as a refuge from life. When he goes back to the home or community at night, he comes to regard the hospital as merely a center for temporary treatment rather than permanent care. This helps to maintain his morale and in many cases keeps him from becoming a residential patient. Moreover, he will not have to learn to “readjust” to the community because he has not left it in the first place.A promising variation on the day hospital approach has been developed in Africa. Since 1953, Dr. Thomas A. Lambo, a Nigerian psychiatrist trained in America and Britain, has conducted an experimental program in which psychotic as well as neurotic patients are placed in homes near a modem mental hospital built by the government (Lambo, 1968). In each case a member of the patient’s own family takes care of him, markets for him, cooks his food, and escorts him to the hospital for treatment every morning and afternoon. All modem therapeutic procedures are used—drug therapy, electro- shock therapy, group therapy—but in addition two native healers are also used, since they are directly acquainted with the culture and philosophy of the people, and are especially adept at interpreting the patient’s dreams.This combination of traditional with modem treatment, and of day care with home living, has been remarkably successful. A two-year study conducted by the National Institute of Mental Health has compared the village plan with ordinary hospitalization: fifteen times as many patients were treated on the village plan, at roughly fifteen times less cost; four out of five were discharged after six months, as contrasted with two out of five; and only one out of twenty had to be returned for treatment within a year of discharge, as contrasted with three out of seven of the hospitalized patients. Though skeptical at first, the villagers gradually came to accept their sick neighbors, and no cases were reported of patients involved in violence of any kind. The treatment plan, which recalls the family care system used in Gheel, Belgium, is now spreading to many other points in Africa. See FAMILY CARE, SOCIAL BREAKDOWN SYNDROME, MENTAL HOSPITAL.