SUMMARYThe day hospital in old age psychiatry has many supporters and is widely felt to be a 'good thing'. This article suggests there is an opposing view and that more hard data are required before the argument is resolved. Other models of care are mentioned which may be equally valid-comparison between different models is needed.KEY WORDS-Day hospital, results, alternatives, cost effectiveness.In the UK the Marlborough Day Hospital in London was the first psychiatric day hospital opened (Farndale, 1961). This was in 1946. Other psychiatric, geriatric and psychogeriatric day care facilities followed and grew dramatically in numbers in the 1960s and 1970s. As old age psychiatry developed as a specialty in the UK, the day hospital became central to many local services and was strongly advocated by professional leaders (Arie and Jolley, 1982;Jolley and Arie, 1992; Royal College of Physicians and Royal College of Psychiatrists, 1989). On March 31, 1990 there were over 20 000 regular attenders on the register of National Health Service (NHS) psychogeriatric day care facilities and over 1.7 million annual available place days recorded (Department of Health, 1991).The roles claimed for psychiatric day hospitals are many and varied. These include the management of patients with neurotic disorders, depression and late life psychoses, where they provide the environment in which assessment, monitoring, treatmentltherapy, rehabilitation and maintenance take place. They are said to be an alternative to inpatient treatment (Creed et al., 1990) and to promote earlier inpatient discharge, being especially helpful for people with chronic or relapsing conditions. In old age psychiatry, however, patients with dementia comprise the main users of the service. Direct physical care may be provided, also assessment and treatment of behavioural and emotional disturbance, but their main role is to provide day time respite for family carers. It is claimed that this can delay or prevent admission to institutional care.A survey of the day care services provided by local authority social services departments (SSD) and district health authorities (Tester, 1989) highlighted the difference in objectives between day hospitals (NHS) and day centres (SSD). Social services' stated aims, in order of priority, were: Day hospitals (NHS) had similar objectives but emphasized that rehabilitation was the most important aim and relief for relatives and respite care were less important objectives. Tester expressed doubt as to whether this distinction was real, and questioned how closely practice reflected the objectives in reality. The day hospital may be no more than a day centre providing respite care for people with dementia who are considered 'too severe' for day centres because of the level of their dependence and the presence of behavioural probin the community skills dual 'packages of care'
