Psychogeriatric day hospitals should be more widespread than they currently are, say Canterbury District Health Board experts running the only hospital of its kind in the country.
A psychogeriatric day hospital is a an outpatient hospital for older people with mental health needs. A study run by one of the Canterbury DHB Old Person’s Health clinical psychologist’s showed a reduction in day patients’ symptoms of depression and anxiety.
In the study, just published in the New Zealand Medical Journal, patients were surveyed on arrival and on discharge, and showed a modest improvement in their depression anxiety symptoms and in their quality of life
Author of the study, Dr Petra Ann Hogarth, said that considering our ageing population, more psychiatric day hospitals should be considered as an alternative to costly and overstretched inpatient services.
Dr Matthew J Croucher, a Canterbury DHB Psychiatrist of Old Age and Senior Clinical Lecturer, University of Otago, Christchurch said in an accompanying NZMJ editorial that he had had a change of heart when it came to Psychiatric Day Hospitals. His previous ambivalence to the approach stems from the resource cost of maintaining such an outpatient facility.
“My impression has changed in the face of the facts,” said Croucher. “I have seen for myself that with older persons anxiety and depressive disorders in particular, but also with cognitive impairment and psychosis at the milder end of the spectrum, being part of a community of care is not just a nice-to-have but is critical for some folk to gain the trust required to form a meaningful therapeutic alliance.”
Patients are referred to the Burwood Day Clinic when their acuity is believed to be higher than can be managed well with community team outpatient appointments but lower than required for an inpatient admission.
Day clinic admission is often used to clarify diagnosis (including that of cognitive impairment), to provide treatment in an interdisciplinary team environment and to determine what assistance the person requires to successfully live in the community or whether they want, or need, to move to aged residential care.
The clinic is part of a larger older adult mental health service, and the current interdisciplinary team staffing for the clinic includes a clinical manager, three registered nurses, a clinical psychologist (shared with two inpatient wards), a social worker, an occupational therapist, a physiotherapist and an occupational therapist assistant and an administrator. The medical cover for the unit (during the time of the study) was always a consultant psychiatrist (mostly psychiatrists of old age), an experienced senior medical officer or a supervised registrar doing advanced training in psychiatry of old age.
The Burwood Hospital-based clinic operates five days a week from 10am to 3pm. Patients are provided with transport, lunch, and morning and afternoon teas. Most patients attend one day per week, with flexibility to increase the number of days in response to symptom exacerbations or increased risk level. Patients take part in a range of planned group activities and meet individually with members of the interdisciplinary team, depending on their individualised treatment plan.
The day hospital was first introduced as a pilot in 1987 at Sunnyside Hospital in Christchurch (now Hillmorton Hospital) before shifting to The Princess Margaret Hospital and then in 2016, it was moved to purpose-built facilities at Burwood Hospital and renamed the Burwood Day Clinic.