Delay in discharge of psychiatric patients frequently is attributed to the lack of available community resources, or to the unwillingness of the patient or his family to accept discharge or transfer to another facility. The role of the psychiatric system itself rarely is mentioned as a factor. A study of 138 psychiatric patients in a Canadian community hospital in 1978 showed that 35 per cent were judged to be delayed in their discharge. By far the greatest source of delay was the administration of the various psychiatric services within the system. Delayed patients were found to be statistically similar to nondelayed patients, except for the delayed patients tendency to be poorer and to be overrepresented on two of the six wards studied. The cost implications of the delays in discharge are discussed, as are suggestions for solving the problems within the administrative framework.
The first modern psychiatric day hospital founded over 40 years ago has gone through a number of re-organizations which reflect utilization patterns representative of day hospitals in general. The author traces chronologically the dynamic movement from self-contained settings emphasizing group integration to expanded structures providing individualized treatment approaches. The day hospital's unique location at the interface of the institution and the community has important implications for today's mental health policy.
A report is given of a visit to an Indian village community project which is supported by a small Swedish foundation. The project was started about 40 years ago by a female relative of Mahatma Gandhi. The community is a small village of about 2000 inhabitants and consists of an irrigated agricultural project, a school through 10th grade, a small hospital, a home for 140 poor or orphan girls and a nursery. The program employs 12 community health workers who have some healthcare training. Each worker cares for 200-250 households and usually knows his/her families well. Primary emphasis is on care of children which includes help with nutrition and a vaccination program. For every 4 community health workers there is an auxiliary nurse midwife who has 3 years special training following 10th grade. The midwives check up on pregnant women once a month through the 7th month, 2 visits in the 8th month and once/week in the 9th month. Undernourishment and anemia are the most common problems of pregnancy. Children are often born in the parents' home without any trained obstetric help. In spite of this, maternal mortality is very low. Even infection from childbirth is extremely rare. The visitor was particularly impressed by the respect and affection everyone in the village showed for children and for each other.