The therapeutic milieu and the older depressed patient

A team screening referrals for admission to a state hospital evaluated 434 consecutive cases. Over 51% had a diagnosis of depression. By treating patients in the community, including brief local hospitalization where indicated, total geriatric admission were reduced by 50% per annum. In the final phase of the program, only 10% of admissions to the state hospital were for a primary diagnosis of depression. Almost half of the evaluations required only examination and recommendations, treatment being undertaken by the referring source or another community agency. A further 22% required but one visit to initiate therapy. 17.6% were admitted to treatment, which included drug and group therapy and also milieu therapy by means of transfer, environmental manipulation, and attitude therapy. Only 11.3% needed to be seen weekly or oftener. The program results in considerable savings by reducing unnecessary hospitalization.