Caution and conservatism in the use of a psychiatric day hospital: evidence from a research project that failed

A randomized trial to evaluate day hospital care as an alternative to inpatient treatment in the acute phase of psychiatric illness was abandoned when too few patients were admitted to the trial to enable any valid generalization to be made concerning the total at-risk population. In accounting for the failure of the experimental design, attention is drawn to the inability of the research team to influence either the organization of the unit, whereby junior staff had no contact with the day hospital, or the prevailing belief among senior staff that the two treatment settings serve distinctive, not alternative, functions. The implications of our failure for the feasibility of conducting a successful and externally valid controlled trial in this research setting are explored.