A naturalistic study of outcomes in a general psychiatry day hospital

In the last few years, day hospitals have received renewed interest in European mental health services because of their potential advantages compared with inpatient and/or outpatient treatment [1]. How ever, results are inconsistent and thus their use is contro versial. Day hospitals pursue several aims, the most common being a reduction in inpatient treat ment, and the promotion of social integration or re habilitation by keeping patients in contact with real life conditions [2]. Day hospitals appear to be an adequate alternative to a substantial proportion of in patient admissions [3], and accumulating evidence shows the advantages of partial hospitalisation. In a recent systematic review, Marshall and colleagues [4] showed that the outcomes are comparable to those of inpatient wards; other studies indicated that they can be even better in terms of social adjustment [5, 6] and treatment satisfaction [7, 8]. Reviews and metaanaly ses have shown that treatments in acute day hospitals were effective in reducing symptoms [9] and global levels of psychopathology [7, 8]. Furthermore, the costbenefit ratio is often better in day hospitals than with inpatient care [7, 10]. The benefits of day hospitali sation compared with an inpatient stay appear to be more salient regarding social functioning [6, 9, 11]. Life quality has been shown to improve to a similar degree as in an inpatient ward [8], even in acutely ill patients [6]. However, these promising advantages are not uni versal. The models, goals, theoretical orientations, populations and contexts of day hospitals vary greatly. Accordingly, results concerning psychiatric day hos pitals are sometimes contradictory [2, 12]. Moreover, data available for Swiss psychiatric day clinics are very limited and concern specific approaches or diagnoses [13, 14]. A few years ago, in Canton Fribourg, Switzer land, a day hospital that aimed to provide an inter mediate structure between outpatient and inpatient general adult mental healthcare was opened. The pre sent study aims to (a) provide a picture of the popula tion treated at this day hospital, (b) assess the treat ment outcomes and (c) identify predictors of treatment outcomes.