L’hôpital de jour ou la métaphore des essuie-glaces…

In Belgium, in the era of « evidence based psychiatry », mental health care is on the cusp of a major reform related to the Hospital Act ("art.107").
But care for people with psychic disorders does not lend itself to therapeutic rules based on « evidence ». Despite this antinomy, the field of psychiatry is confronted with the budgetary res-trictions imposed by health care policies. As well as other somatic pathologies, psychiatry does not escape the process of « human body » and medicine in general, commercialization.

The day hospital, because of its polymorphism and its innovative character, has always been able to adapt to various societal crisis so far as to become, for some, a « day hospital 2.0 ».
Its current evolution deviates far from the initial models devised by the pioneers of institutional therapy.

The creation of a new link between hospital and home is one of the innovative aspects of this reform. The introduction of mobile teams and the development of home care should help to treat psychiatric patients who would never have gone out for help and care, whether in-hospital or as an outpatient. Support of the existing links with the entourage and communication between the different partners of the network should thus be reinforced.

After a historical reminder about the evolutions of psychiatry and of the legal reforms related to the mode of operation of day hospitals, we will develop the singular aspect and the specificity of our Day Hospital, « La Clé ».
As an avant-garde structure, our care protocol immediately assumed that group psychotherapy effectively supplements individual psychotherapy and psychosocial rehabilitation.

Institutional therapy, adapted on a part-time basis, significantly reduces the risk of chronicity and mass regression while stimulating the psychic progress of the individual in a benevolent community setting.

A good metaphor for the concept of day hospital could be « windshield wipers » : through changes that may get stormy, they do not stop the rain but they allow to move forward ...