Are not in fashion, but evidence shows that they provide feasible and effective care

Acute day hospitals are among the earliest forms of psychiatric community care, but they are definitely not in fashion. In the NHS Plan they are not targeted for investment,1 whereas in the United States, under managed care, they have been in steady decline since the 1980s.2 Yet acute day hospitals did not fall from favour because they were ineffective, and emerging social trends may yet restore them to favour.

Day hospitals were invented in Russia in the 1930s, spread to America and Europe in the 1940s and 1950s, and reached their peak in the 1970s, when they provided the main alternative to hospital admission.3 Paradoxically, the success of acute day hospitals as an alternative to inpatient care was a major factor in their decline, since it begged the question of whether hospital care was necessary at all. In the 1980s new radical approaches to community care, such as assertive community …