The Changing Roles of Psychiatric Day Hospitals in Hong Kong
Mak, K. Y., Hong Kong Journal of Psychiatry
Psychiatric day hospitals have existed in Hong Kong for over thirty years and psychiatric day-time activity centres have also been established within the last decade. Though in theory these two services cater for different categories of psychiatric patients, there are in practice some duplication of services. As activity centres are there economical to run, day hospitals therefore have to consider new roles in order to function efficiently.
Keywords: psychiatric, services, day hospitals, activity centres, history, roles
HISTORY OF PSYCHIATRIC DAY HOSPITAL
Psychiatric day hospitals have come into existence for over half a century. The first psychiatric day hospital (actually called 'half hospital') began in 1933 Dzhafgarov, 1937) in Moscow, Russia due to bed shortage and inadequate funding in a large mental hospital for the severely mentally ill. The programme consisted mainly of work therapy, with some 80 patients treated for an average duration of two months.
In 1947, a real experimental 'day hospital' was set ups at the Allen Memorial Institute of Psychiatry in Montreal, Canada with the purpose to stimulate community life by allowing the individual to attend treatment only during the day just as one might go to work (Cameron, 1947). Since then more and more day hospitals were set up throughout the world. The first one in the United States was set up in 1949 at the Menninger Clinic in Topeka, Kansas Marnard, et al 1952). The deinstitutionalisation movement since the 1950s and the community care movement in the 19805 have all facilitated the development of day hospitals further.
In the United Kingdom, the first day hospital started in 1948 (Bierer, 1951) for psychiatric patients shortly discharged from hospitals. During the 1950s, more and more day hospitals were set up by the Health Authorities (Farndale, 1961), with different degrees of staff provision, therapeutic emphases and management. Later on, day hospitals were given a unique role in the process of run-down of large mental hospitals (DHSS, 1962).
From the above description. It can be seen that psychiatric day hospitals are developed as an alternative service to traditional service (hospital care, out-patient care or borne care) of mental patients provided perhaps that they are not dangerous to themself or others. The scenario behind this development is that in the early stages, in-patient treatment in over-crowded mental asylums could be an awful experience, yet total homecare could be extremely stressful to family members. At one time, day hospital care was considered not only as good as but perhaps even better than inpatient care. In certain sense this is true, as day hospital care may prevent the regression and isolation characteristic of institutionalised patients, Bennett (1981) even called day hospital the 'corner-stone' of community care. Besides, day programmes can vary more easily to suit individual patient's needs than those at in-patient or outpatient settings. Using the milieu atmosphere. Guy and others (1969) found that day hospital care was more effective in reducing relapse rate compared with traditional outpatient care.
THE CHANGING WORLD SCENE
Since the 1960s, the scene has gradually changed. Firstly, many patients, especially acute cases, are now treated in inpatient psychiatric units within district general hospitals. The setting is less crowded. Secondly, even for mental institutions, the treatment is more humane and the care more decent. Furthermore, there is a trend for shorter term in-patent treatment, and more and more patients are now discharged back home and to the community. Day hospital has thus been regarded as part of the community psychiatric service (NIMH, 1967). Therefore, the functions of the day hospital have been evolving gradually. According to Astrachan et al (1970), the objectives of a day hospital are:
1. to present an alternative to 24-hour hospitalization;