View report page

While the rate of admission and the overall distribution of diagnosis
have altered little, and the factor of social isolation remains
important in nearly every case, the proportion of patients suffering
from little more than loneliness has been reduced.
"In spite of the encouraging improvement in the discharge figures,
by comparison with Day Hospitals for younger patients, the turnover is
low and the numbers returned to the community perhaps unimpressive.
However, when mental illness is superimposed on ageing, with such
factors as social isolation and diminished resistance with greater
incapacitation by illness, perhaps our figures cannot be much improved.
In the more severely ill patients, Dundee Ward is the place of choice
as the first stage of treatment. Later, the Day Hospital is used for
rehabilitation. The Day Hospital serves best the convalescent and
those whose illness is moderately incapacitating, often insidious in
onset and chronic in course. In such cases the Day Hospital supplies
an alternative to permanent in-patient treatment. Response is fairly
rapid to full-time attendance but reduction may lead to difficulties,
and to cut down too much may be to see a return of symptoms. The
service given by the Day Hospital, even supposing not more than 50 per
cent of its patients are returnable to the community, can also be gauged
by those it mahages to keep out of hospital, general or psychiatric, as
permanent residents. This is in line with the idea that the aged
should be kept in community care as long as possible. Our capacity to
do this more effectively, and on a larger scale, will depend on the
development of. club facilities in the community of a kind different
from those well established for persons without psychiatric disability,
usually in the first decade after retirement. This aspect of after-care
deserves to receive much more urgent consideration; we ourselves have
taken the following steps to develop our own ideas.
"Late in the year we formed a social club within the Day Hospital
itself which on two afternoons a week is open to any ex-patients living
nearby and prepared to attend without provision of transport. The
work of the Social Department has been extended but still more has to
be done, especially in the community in conjunction with the welfare
officers of the Local Authority and Voluntary Associations. Relations
with such bodies have been fostered through the bi-monthly meetings of
our committee and by the routine forwarding of information about
patients to the Medical Officers of' Health and their welfare staffs,
as well as to Practitioners, when patients are admitted and discharged.
Having been enlarged the membership of the Day Hospital Committee has
become more representative and useful."
23