This article evaluates how clients with severe and enduring mental illness in the USA and Eire are managed within the philosophy of 'partial hospitalisation', a total care package that is delivered part of the time in a mental health unit, instead of a traditional inpatient mental health service. The author visited McLean Hospital, Boston, which is a centre of excellence for the partial hospitalisation philosophy (Sederer, 1992), and Harvard Medical School, Massachusetts. This is compared with a visit to St Joseph's Hospital, County Limerick, and Newcastle Hospital, County Wicklow, which evolved from institutional care philosophies and sustained the highest bed population in the world for patients with mental illness (Commission of Inquiry, 1996).
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