A Renewed Interest in Day Treatment

Abstract

Dear Editor: Day treatment, a form of partial hospitalization, can be helpful for patients who do not require inpatient care but who may benefit from more intensive care than is possible for outpatients. It differs from other forms of partial hospitalization (that is, day hospital and day care) in that it emphasizes both treatment and rehabilitation. Treatment is concerned with alleviating symptoms and recovery from illness. Rehabilitation focuses on the patient's adapting to a disability and facilitates adaptive functioning in the community. Historically, day treatment programs were offered to patients who were in some degree of remission from acute psychotic illness or to patients who suffered from long-term disorders (for example, personality disorders). Day treatment was viewed as superior to outpatient care because it provides more intensive treatment and rehabilitation. It experienced considerable use from the 1950s to the late 1980s. However, day treatment declined in the 1990s owing to inadequate funding arrangements and a move toward assertive community treatments. Recently, this trend has reversed. Contributing to the renewed growth of day treatment is the recognition that, while many currently available treatments effectively reduce symptomatology, they often have minimal impact on functional impairments. This has contributed to high rates of relapse and recurrence. Multimodal treatments that focus on reducing illness and enhancing functional capacity are believed to offer an optimal intervention approach. Day treatment is seen as satisfying this need. It offers intensive and structured clinical services within a stable therapeutic milieu that typically incorporates group psychotherapy, biological psychiatry, milieu principles, and a systems orientation. Many of the day treatment programs that have recently evolved differ from those used in the past. The newer day treatment programs are short-term (ranging from 3 to 12 weeks), whereas historically, day treatment lasted for several months. In addition, rather than being psychodynamically based, many of the new programs are guided by the principals of cognitive-behavioural therapy; nearly all new programs incorporate some insight-oriented interventions. Finally, the application of day treatment has expanded beyond the patient populations it served in the past. It is now being used for mood disorders (1), obsessive-compulsive disorder (2), postnatal depression (3), eating disorders (4), and substance abuse disorders (5). …