103
SOCIAL AND PSYCHIATRIC PROBLEMS IN DAY HOSPITAL MANAGEMENT AT HILL END
by AGGREY W. BURKE, B.SG., M.B., D.P.M., M.R.C.PSYCH. Senior Lecturer/Consultant Psychiatrist St.
Department ofPsychiatry George’s Hospital, Blackshaw Road, London, SW17 OQT
for persons who have been inbelief that the day hospital can the mental In Britain the plan for populations of 200,000 is to provide a psychiatric department of 100 - 200 beds with a closely linked day hospital of 160 - 180 places(6). Although it has been shown that re-admission rates to in-patient care are related to the level of onganization in the day hospital(15), little progress has been made in efforts to provide adequate facilities in many areas. Furthermore, those that exist vary according to whether psychogeriatric(15,18) or schizophrenic 16) services are provided at units of large mental hospitals or, instead, a psychoneurotic orientation at general hospital units (13) and newer small mental
HE
of continuous community mental disorders has led
prospect by Tcapacitated replace hospital(1).
care
to
a
hospitals(9).
The purpose of the present study is to describe the operation of the Hill End Day Hospital. There, attempts have been made to provide a comprehensive service. Since 1958, when the unit was planned as a pilot scheme, it has been housed in the limited space of the ’Superintendent’s House’ at the entrance to the mental hospital (760 beds) in St. Albans. The hospital has a catchment area of 300,000 persons and there is no other in-patient or day-patient provision for them. After-care is often provided by general practitioners as well as psychiatric out-patient domiciliary personnel who work in conjunction with the mental hospital and its day hospital. The day hospital provides a service on five days (9 am - 5 pm, Monday to Friday) only, and most patients from the large semi-rural area reach there by ambulances. At the time of the study the full-time staffing at the day hospital consisted of a psychiatrist (the author), a nurse-in-charge, a staff nurse, three student nurses, a secretary-receptionist and three domestic assistants. The building also housed the domiciliary workers (four specially trained former mental health nurses) and social workers of the hospital. In effect, these workers were active members of the day hospital staff. METHOD
The study was carried out during the six-month period ending 30th June 1972 and includes all 133 patients who received day care (the day care cohort) in that period. The author assessed and treated all these patients and made a record of family, personal and illness data in each case. For the study, an episode of illness isdefined as any consultation with overt psychiatric symptomatology of a duration of one week or more. Data concerning unhappy childhood (recalled unhappiness or parental loss before the age of 15), family history of mental disorder (any illness in parents, siblings, children, uncles, aunts and grandparents, that was known to the patient to have received therapy) and mental disorder in the spouse which had received or needed therapy, were spcifically asked for. For each patient a careful study was made of all available case-notes concerning in-patient care at any Downloaded from isp.sagepub.com at Mount Royal University on April 30, 2015
104
careful assessment of the social, psychological and personality history. and past and present clinical state each patient was allocated to a diagnostic group. Four major diagnostic groups were used organic, schizophrenia, primary affective disorder, and affective psychoneurosis. In this latter group, patients may have had clinical depression at some time, but they had significant neurotic features and no clear bipolar affective ones. Three groups were identified by time of referral. Any period of attendance which had been broken by admission to the main hospital or by non-attendance for more than three months, but which was then followed by renewed day care, was defined as an admission. Referral during the study was called ’new’, in the preceeding year ’recent’ and previous to that ‘old’.
hospital. By
-
.-
I
RESULTS
The
mean daily attendance during the six-month period was 31 (20 female, and 80 different persons attended each week. Thirty patients lived in their own home (26) or in rented accommodation (4), whereas 103 lived in local authority (council) accommodation (75), or with their parents on whom they were dependent (21), or in lodgings (7). It is evident that more than three-quarters of the cohort were of a low socio-economic background. Table I shows the distribution of the day-care cohort. The female/male ratio was 5 :2 and more than half the cohort was made up of women past the childbearing period. The difference in the distribution of the sexes among groups younger and older than 45 is statistically significant (xz=6,231, p
SOCIAL AND PSYCHIATRIC PROBLEMS IN DAY HOSPITAL MANAGEMENT AT HILL END
by AGGREY W. BURKE, B.SG., M.B., D.P.M., M.R.C.PSYCH. Senior Lecturer/Consultant Psychiatrist St.
Department ofPsychiatry George’s Hospital, Blackshaw Road, London, SW17 OQT
for persons who have been inbelief that the day hospital can the mental In Britain the plan for populations of 200,000 is to provide a psychiatric department of 100 - 200 beds with a closely linked day hospital of 160 - 180 places(6). Although it has been shown that re-admission rates to in-patient care are related to the level of onganization in the day hospital(15), little progress has been made in efforts to provide adequate facilities in many areas. Furthermore, those that exist vary according to whether psychogeriatric(15,18) or schizophrenic 16) services are provided at units of large mental hospitals or, instead, a psychoneurotic orientation at general hospital units (13) and newer small mental
HE
of continuous community mental disorders has led
prospect by Tcapacitated replace hospital(1).
care
to
a
hospitals(9).
The purpose of the present study is to describe the operation of the Hill End Day Hospital. There, attempts have been made to provide a comprehensive service. Since 1958, when the unit was planned as a pilot scheme, it has been housed in the limited space of the ’Superintendent’s House’ at the entrance to the mental hospital (760 beds) in St. Albans. The hospital has a catchment area of 300,000 persons and there is no other in-patient or day-patient provision for them. After-care is often provided by general practitioners as well as psychiatric out-patient domiciliary personnel who work in conjunction with the mental hospital and its day hospital. The day hospital provides a service on five days (9 am - 5 pm, Monday to Friday) only, and most patients from the large semi-rural area reach there by ambulances. At the time of the study the full-time staffing at the day hospital consisted of a psychiatrist (the author), a nurse-in-charge, a staff nurse, three student nurses, a secretary-receptionist and three domestic assistants. The building also housed the domiciliary workers (four specially trained former mental health nurses) and social workers of the hospital. In effect, these workers were active members of the day hospital staff. METHOD
The study was carried out during the six-month period ending 30th June 1972 and includes all 133 patients who received day care (the day care cohort) in that period. The author assessed and treated all these patients and made a record of family, personal and illness data in each case. For the study, an episode of illness isdefined as any consultation with overt psychiatric symptomatology of a duration of one week or more. Data concerning unhappy childhood (recalled unhappiness or parental loss before the age of 15), family history of mental disorder (any illness in parents, siblings, children, uncles, aunts and grandparents, that was known to the patient to have received therapy) and mental disorder in the spouse which had received or needed therapy, were spcifically asked for. For each patient a careful study was made of all available case-notes concerning in-patient care at any Downloaded from isp.sagepub.com at Mount Royal University on April 30, 2015
104
careful assessment of the social, psychological and personality history. and past and present clinical state each patient was allocated to a diagnostic group. Four major diagnostic groups were used organic, schizophrenia, primary affective disorder, and affective psychoneurosis. In this latter group, patients may have had clinical depression at some time, but they had significant neurotic features and no clear bipolar affective ones. Three groups were identified by time of referral. Any period of attendance which had been broken by admission to the main hospital or by non-attendance for more than three months, but which was then followed by renewed day care, was defined as an admission. Referral during the study was called ’new’, in the preceeding year ’recent’ and previous to that ‘old’.
hospital. By
-
.-
I
RESULTS
The
mean daily attendance during the six-month period was 31 (20 female, and 80 different persons attended each week. Thirty patients lived in their own home (26) or in rented accommodation (4), whereas 103 lived in local authority (council) accommodation (75), or with their parents on whom they were dependent (21), or in lodgings (7). It is evident that more than three-quarters of the cohort were of a low socio-economic background. Table I shows the distribution of the day-care cohort. The female/male ratio was 5 :2 and more than half the cohort was made up of women past the childbearing period. The difference in the distribution of the sexes among groups younger and older than 45 is statistically significant (xz=6,231, p
