Hostname: page-component-78c5997874-fbnjt Total loading time: 0 Render date: 2024-11-05T13:45:57.941Z Has data issue: false hasContentIssue false

Randomised Controlled Trial of Day and In-patient Psychiatric Treatment. 2: Comparison of Two Hospitals

Published online by Cambridge University Press:  02 January 2018

Francis Creed*
Affiliation:
Department of Psychiatry, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL
Dawn Black
Affiliation:
Department of Psychiatry, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL
Phil Anthony
Affiliation:
Department of Psychiatry, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL
Madeline Osborn
Affiliation:
Department of Psychiatry, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL
Phil Thomas
Affiliation:
Department of Psychiatry, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL
David Franks
Affiliation:
Department of Psychiatry, Queen's Park Hospital, Blackburn
Richard Polley
Affiliation:
Department of Psychiatry, Queen's Park Hospital, Blackburn
Stuart Lancashire
Affiliation:
Department of Psychiatry, Queen's Park Hospital, Blackburn
Packeerrowther Saleem
Affiliation:
Department of Psychiatry, Queen's Park Hospital, Blackburn
Barbara Tomenson
Affiliation:
Manchester Royal Infirmary
*
Correspondence

Abstract

Acutely ill patients presenting for admission in two district psychiatric services were randomly allocated to day-hospital or in-patient care. In both services a quarter of all admissions could not be allocated because they were too ill (half of these were compulsory admissions); these patients were predominantly manic and schizophrenic patients with pronounced psychotic symptoms and disturbed behaviour. In one service 80% (41/51) of patients randomly allocated to day-hospital treatment were successfully engaged in treatment compared with 54% (19/35) in the other service. This difference arose because only patients with mildly disturbed behaviour could be treated at the second day hospital. For patients who were successfully allocated, the outcome of treatment was similar in terms of psychiatric symptoms and social functioning. The results of a treatment trial for acutely ill patients in one district service cannot be generalised to other district services without due attention to the factors, such as staffing levels, which determine the degree of disturbed behaviour that can be tolerated in the day hospital.

Type
Research Article
Copyright
Copyright © Royal College of Psychiatrists, 1991 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Creed, F. H. Black, D. & Anthony, P. (1989 a) Day hospital treatment for acute psychiatric illness: a critical appraisal. British Journal of Psychiatry, 154, 300310.Google Scholar
Creed, F. H. Anthony, P. Godbert, K. et al (1989 b) Treatment of severe psychiatric illness in a day hospital. British Journal of Psychiatry, 154, 341347.Google Scholar
Creed, F. H. Black, D. Anthony, P. et al (1990) Randomised controlled trial comparing day and in-patient psychiatric treatment. British Medical Journal, 300, 10331037.Google Scholar
Department of Health and Social Security. (1975) Better Services for the Mentally Ill. Cmnd 6233. London: HMSO.Google Scholar
Dick, P. Cameron, L. Cohen, D. et al (1985) Day and full time psychiatric treatment: a controlled comparison. British Journal of Psychiatry, 147, 246250.Google Scholar
Fenton, F. R. Tessier, L. & Struening, E. L. (1979) A comparative trial of home and hospital psychiatric care. Archives of General Psychiatry, 36, 10731079.Google Scholar
Hertz, M. I. Endicott, J. Spitzer, R. L. et al (1971) Day versus in-patient hospitalization: a controlled study. American Journal of Psychiatry, 10, 13711382.Google Scholar
Hertz, M. I. Endicott, J. & Spitzer, R. L. (1975) Brief hospitalization of patients with families: initial results. American Journal of Psychiatry, 132, 413417.Google Scholar
Hoult, J. (1986) Community care of the mentally ill. British Journal of Psychiatry, 149, 137144.CrossRefGoogle Scholar
Lancet (1987) Drop-outs from clinical trials. Lancet, ii, 892893.Google Scholar
McGrath, G. & Tantam, D. (1987) Long-stay patients in a psychiatric day hospital. British Journal of Psychiatry, 150, 836840.Google Scholar
Platt, D. P. 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. Journal Psychiatric Research, 3, 123132.CrossRefGoogle ScholarPubMed
Platt, E. P. Hirsch, S. R. & Knights, A. C. (1981) Effects of brief hospitalisation on psychiatric patients' behaviour and social functioning. Acta Psychiatrica Scandinavica, 63, 117128.Google Scholar
Pryce, I. G. (1982) An expanding “stage army” of long-stay psychiatric day patients. British Journal of Psychiatry, 141, 595601.Google Scholar
Stein, L. I. & Test, M. A. (1980) Alternative to mental hospital treatment: 1. Conceptual model, treatment program, and clinical evaluation. Archives of General Psychiatry, 37, 392397.Google Scholar
Vaughan, P. (1985) Developments in psychiatric care. British Journal of Psychiatry, 147, 14.Google Scholar
Weisbrod, B. A. Test, M. A. & Stein, L. I. (1980) Alternatives to mental hospital treatment; economic cost-benefit analysis. Archives of General Psychiatry, 37, 400405.Google Scholar
Wilkinson, G. (1984) Day care for patients with psychiatric disorders. British Medical Journal, 288, 17101711.Google Scholar
Wing, J. K. Cooper, J. E. & Sartorius, N. (1974) The Measurement and Classification of Psychiatric Symptoms: An Instruction Manual for the Present State Examination and CATEGO Programme. London: Cambridge University Press.Google Scholar
Wykes, T. & Sturt, E. (1986) The measurement of social behaviour in psychiatric patients: an assessment of the reliability and validity of the SBS schedule. British Journal of Psychiatry, 148, 111.Google Scholar
Zwerling, I. & Wilder, J. F. (1964) An evaluation of the applicability of the day hospital treatment of acutely disturbed patients. Israeli Annals of Psychiatry and Related Disciplines, 2, 162185.Google Scholar
Submit a response

eLetters

No eLetters have been published for this article.