Abstract.
Objective:
As the use of “day hospitals” increases, conceptual models of these services are changing dramatically across Europe. Therefore, the need arises for mental health services research to assess this process cross-nationally in a standardised and systematic way. Such research approaches should seek to maximise the generalisability of results from high-quality (e. g. randomised controlled) single- or multi-site trials assessing specific models of day hospital care.
Method:
Using a self-developed structured questionnaire, the European Day Hospital Evaluation (EDEN) study group carried out national surveys of the characteristics of day hospitals for general psychiatric patients in Germany, England, Poland, the Slovak Republic and the Czech Republic, during the period 2001–2002.
Results:
Response rates varied from 52 to 91%. Findings show that day hospitals have no consistent profile of structural and procedural features. Similarities across countries focus on three main issues: on average, consideration of concepts oriented toward providing acute treatment are equivalent; disorders associated with disabled functioning in everyday life, high risk of somatic complications, and need for behaviour control are excluded to a comparable degree; and some core therapeutic activities are consistent with the main approaches of social psychiatry. Identified according to self-rated conceptions and extended with data from individual hospital’s statistics on the clientele in 2000, three clusters of limited selectivity subdivide the services. One category focuses mainly on rehabilitative tasks; two categories are oriented toward providing acute treatment as an alternative to inpatient care, but combine this either with rehabilitative tasks or with equal additional functions of shortening inpatient treatment and providing psychotherapy. The distribution of services across these three clusters varies significantly in the five European countries.
Conclusion:
Future day hospital studies should always clarify the type of services being assessed. To fully consider the impact of their results, the current national and international health policy environment of these services should be taken into account. Such surveys require enhanced methodology, however, in order to identify clear, distinct categories of services characterised by overlapping programme functions, and to increase the generalisability of valid results from single- or multi-site trials.
Similar content being viewed by others
References
Zwerling J, Wilder JF (1964) An evaluation of the applicability of the day hospital in the treatment of acutely disturbed patients. Isr Ann Psychiatry Related Disciplines 2:162–185
Kris EB (1965) Day hospitals. Curr Ther Res 7:320–323
Herz MI, Endicott J, Spitzer RL, Mesnikoff A (1971) Day versus in-patient hospitalization: a controlled study. Am J Psychiatry 10:1371–1382
Dick P, Cameron L, Cohen D, Barlow M, Ince A (1985) Day and full time psychiatric treatment: A controlled comparison. Br J Psychiatry 147:246–250
Creed F, Black D, Anthony P, Osborn M, Thomas B, Tomenson B (1990) Randomised controlled trial of day patient versus in-patient psychiatric treatment. BMJ 300:1033–1037
Kluiter H, Giel R, Nienhuis FJ, Rüphan M, Wiersma D (1992) Predicting feasibility of day treatment for unselected patients referred for inpatient psychiatric treatment: Results from a randomized trial. Am J Psychiatry 149:1199–1205
Schene AH, van Wijngaarden B, Poelijoe NW, Gersons BPR (1993) The Utrecht comparative study on psychiatric day treatment and in-patient treatment. Acta Psychiatr Scand 87:427–436
Nienhuis FJ, Giel R, Kluiter H, Rüphan M, Wiersma D (1994) Efficacy of psychiatric day treatment. Course and outcome of psychiatric disorders in a randomised trial. Eur Arch Psychiatry Clin Neurosci 244:73–80
Wiersma D, Kluiter H, Nienhuis FJ, Rüphan M, Giel R (1995) Costs and benefits of hospital and day treatment with community care of affective and schizophrenic disorders. Br J Psychiatry 166(Suppl 27):52–59
Sledge WH, Tebes J, Rakfeldt J, Davidson L, Lyons L, Druss R (1996) Day hospital/crisis respite care versus inpatient care, Part I: Clinical outcomes. Am J Psychiatry 153:1065–1073
Sledge WH, Tebes J, Wolff N, Helminiak TW (1996) Day hospital/crisis respite care versus inpatient care, Part II: Service utilization and costs. Am J Psychiatry 153:1074–1083
Creed F, Mbaya P, Lancashire S, Tomenson B, Williams B, Holme S (1997) Cost effectiveness of day and inpatient psychiatric treatment: results of a randomised controlled trial. BMJ 14:1381–1385
Marshall M, Crowther R, Almaraz-Serrano A, Creed F, Sledge W, Kluiter H, Roberts C, Hill E, Wiersma D, Bond GR, Huxley P, Typrer P (2001) Systematic reviews of effectiveness of day care for people with severe mental disorders. (1) Acute day hospital versus admission; (2) Vocational rehabilitation; (3) Day hospital versus outpatient care. Health Technol Assess 5(21)
Marshall M, Crowther R, Almaraz-Serrano A, Creed F, Sledge W, Kluiter H, Roberts C, Hill E, Wiersma D (2003) Day hospital versus admission for acute psychiatric disorders (Cochrane Review). In: The Cochrane Library, Issue 3. Oxford: Update Software
Schene AH (2001) Partial hospitalisation. In: Thornicroft G, Szmukler G (eds) Textbook of Community Psychiatry. Oxford University Press, Oxford, pp 283–289
Horvitz-Lennon M, Normand SLT, Gaccione P, Frank RG (2001) Partial versus full hospitalization for adults in psychiatric distress: A systematic review of the published literature. Am J Psychiatry 158:676–685
Kallert TW, Schützwohl M (2002) Clientele, assessment and efficacy of psychiatric day hospital treatment: implications resulting from existing research findings (in German). Schwz Arch Neurol Psychiatr 153:144–152
Johnson S, Kuhlmann R, and the EPCAT Group (2000) The European Service Mapping Schedule (ESMS): development of an instrument for the description and classification of mental health service. Acta Psychiatr Scand 102(Suppl 405):14–23
De Girolamo G, Picardi A, Micciolo R, Falloon I, Fioritti A, Morosini P (2002) Residential care in Italy. Br J Psychiatry 181:220–225
Bosch G, Steinhart I (1983) Entwicklung und gegenwärtiger Stand der tagesklinischen Behandlung in der Bundesrepublik Deutschland. In: Bosch G, Veltin A, Aktion Psychisch Kranke (eds) Die Tagesklinik als Teil der psychiatrischen Versorgung. Rheinland-Verlag, Köln, pp 11–36
Schene AH, van Lieshout PAH, Mastboom JCM (1988) Different types of partial hospitalization programs: results of a nationwide survey in the Netherlands. Acta Psychiatr Scand 78:515–522
Mbaya P, Creed F, Tomenson B (1998) The different uses of day hospitals. Acta Psychiatr Scand 98:283–287
Wancata J, Rittmannsberger H, Winkler J, Berner J (1999) Strukturmerkmale, Leistungen und organisatorische Probleme psychiatrischer Tageskliniken. Wien
Becker T, Vázquez-Barquero JL (2001) The European perspective of psychiatric reform. Acta Psychiatr Scand 104(Suppl 410):8–14
Johnson S, Zinkler M, Priebe S (2001) Mental health service provision in England. Acta Psychiatr Scand 104(Suppl 410):47–55
Balicki M, Leder S, Piotrowski A (2000) Focus on psychiatry in Poland. Br J Psychiatry 177:375–381
Puzybski S, Moskalewicz J (2001) Evolution of the mental health care system in Poland. Acta Psychiatr Scand 104(Suppl 410):69–73
Pfeiffer J, Probstova J, Pec O, et al. (1997) Conception of psychiatric care in Czech republic (Proposal). Mental health care policy. Ceska a slovenska psychiatrie (Suppl 2):3–81
Tomov T (2001) Mental health reforms in Eastern Europe. Acta Psychiatr Scand 104(Suppl 410):21–26
Kallert TW, Schützwohl M, Kiejna A, Nawka P, Priebe S, Raboch J (2002) Efficacy of psychiatric day hospital treatment: Review of research findings and design of a European multi-centre study. Arch Psychiatry Psychother 2:55–71
Kallert TW, Priebe S, Schützwohl M, Glöckner M, Briscoe J, and the EDEN study group (2004) The role of acute day hospital treatment for mental health care: Research context and practical problems of carrying out the international multi-centre EDEN-study. In: Kirch W (ed) Public Health in Europe. Springer, Berlin, pp 153–171
Kunze H, Kaltenbach L (1996) Psychiatrie-Personalverordnung, 3. erweiterte Auflage. Kohlhammer, Stuttgart Berlin Köln
Kallert TW, Kiejna A, Howardova A, Nawka P (2000) Psychiatric day hospitals in Eastern European countries. Psychiat Danub 12(1–2):93–94
Erlemeier N (2001) Stand und Perspektiven ambulanter Krisenhilfe bei Suizidgefährdung im Alter—Ergebnisse einer Befragung. Suizidprophylaxe 28:158–164
Kallert TW, Schützwohl M, Matthes C (2003) Current structural and procedural quality markers of psychiatric day hospitals in Germany (in German). Psychiat Prax 30:72–82
Briscoe J, McCabe R, Kallert TW, Priebe S (in press) A national survey of psychiatric day hospitals in England. Psychiat Bull
Rymaszewska J, Kiejna A, Adamowski T, Szurmiñska M, Hadryś T, Małyszczak K, Trypka E, Zając J, Jarosz J (2003) Characteristics of psychiatric day hospitals in Poland—results of questionnaire survey. Psychiatr Pol 37:1037–1048
Nawka P, Borosova D, Reguliova H, Korpova D, Ocvar O (2002) Comparison of selected data of Slovak day hospitals in EDEN study. 20th Congress of the Danubian Psychiatric Association. Abstract book, p 23
Kitzlerová E, Raboch J, Pěč O, Stárková L, Baková N, Sekot M, Howardová A, Peichlová J (2003) Survey of day hospitals in Czech republic. Czech and Slovak Psychiatry 99:299–305
Pec O, Howardova A, Kitzlerova E (2002) Vysledky mapovani dennich stacionaru v CR. In: Raboch J, Doubek P, Zrazavecka I (eds) Psychiatrie v Medicine a Medicina v Psychiatrii. Galen, Prague, pp 178–117
Bauer M, Kunze H, von Cranach M, Fritze J,Becker T (2001) Psychiatric reform in Germany. Acta Psychiatr Scand 104(Suppl 410):27–34
Kallert TW (2000) Versorgungsbedarf und subjektive Sichtweisen schizophrener Patienten in gemeindepsychiatrischer Betreuung. —Evaluationsstudie im Jahr nach Klinikentlassung in der Versorgungsregion Dresden—. (Monographien aus dem Gesamtgebiete der Psychiatrie, Band 101) Steinkopff, Darmstadt
Eikelmann B (1999) Zur Geschichte der psychiatrischen Tagesklinik. In: Eikelmann B, Reker T, Albers M (eds) Die psychiatrische Tagesklinik. Thieme, Stuttgart, pp 35–40
Dick PH, Sweeney ML, Crombie IK (1991) Controlled comparison of day-patient and out-patient treatment for persistent anxiety and depression. Br J Psychiatry 158:24–27
Tyrer P, Remington M, Alexander J (1987) The outcome of neurotic disorders after out-patient and day hospital care. Br J Psychiatry 151:57–62
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Kallert, T.W., Glöckner, M., Priebe, S. et al. A comparison of psychiatric day hospitals in five European countries. Soc Psychiatry Psychiatr Epidemiol 39, 777–788 (2004). https://doi.org/10.1007/s00127-004-0813-x
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00127-004-0813-x