Since their original conception, day hospitals for older people with mental illness have evolved and developed, frequently responding to the demands of local service configuration, vested interests and demands of service users. This has resulted in a wide variety of service provision throughout the UK as exemplified by the Royal College of Psychiatrists survey conducted 5-6 years ago.

Their relationships with local authority day care centres and centres provided by the voluntary sector have at times become blurred. A significant number of day hospitals provide long term day care for service users, often filling gaps in social service provision. This can be associated with considerable problems as NHS day hospital provision (in the absence of a clear rehabilitative program) may lead to inappropriate dependency and institutionalisation of service users who would otherwise benefit from more appropriate social support.

Likewise, as a consequence of lack of clarity relating to the great variety of  functions associated with the many day hospitals across the UK, it is very difficult to identify common standards, develop audit cycles and undertake research into the efficiency and effectiveness of day hospitals, their interventions and service delivery.

Reviewing the survey

As a consequence of the initial survey, The Royal College of Psychiatrists (Faculty of Old Age Psychiatry) mandated the Day Hospital Steering Group review the functions and character of Day Hospitals in England with view to generating a set of Clinical Standards and devise a clinical audit tool designed to inform and support clinical audit within day hospitals. Even though the work was confined to England (because of financial constraints) it may well offer some relevance to other countries within the British Isles.

The authors have been careful not to ‘define’ the role and nature of day hospitals for older people but have attempted to identify functions common to most day hospitals. It is apparent that day hospitals will vary in their emphasis in terms of the nature of the service provision and the functions that they carry out. Some day hospitals concentrate on one or two functions (for example; crisis intervention or psychotherapy) whilst others may be more eclectic, tailoring their functionality to a wide range of patient and carer needs. It is also evident that we have been unable to capture all possible functions of day hospitals and fully expect day hospitals to undergo further evolution and development, responding to national initiatives and local commissioning needs.

In summary: The Changing Face of Day Hospitals For Older People with Mental Illness is designed to inform the debate relating to the quality and performance of day hospitals through encouraging the adoption of standards and facilitating audit. The document is not proscriptive, does not attempt to determine how day hospitals should function but should be regarded as a potential aid to encourage debate, development and facilitate clinical audit and role definition.