Psychiatric hospital

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A psychiatric hospital (also called a mental hospital or asylum) is a hospital specializing in the treatment of persons with mental illness. Psychiatric wards differ only in that they are a unit of a larger hospital.

Mental hospitals have a number of differences from other hospitals. First, they generally have elaborate procedures to prevent suicide by patients (for example, appliances with power cords are not allowed, and access to stairways and high, open windows is restricted). Second, they attempt to reduce the amount of sensory stimulation that the patients have. Contrary to popular belief, mental hospitals are generally quiet, even boring places. Third, mental hospitals often try to provide as normal an environment as possible. For example, unlike most other hospitals, many patients in mental hospitals wear street clothes rather than examination patient garments.

Since the 1960s, efforts have been made to improve mental health care. Nevertheless, many problems remain, especially for those with little money to pay for more expensive facilities. The use of restraints and medication for punishment rather than treatment, the lack of adequate staff and resources, the lack of documentation when it comes to forced treatment, as well as other serious deficencies remain all too common.

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Types of mental hospitals

There are a number of different types of mental hospital.

Crisis stabilization

One is the crisis stabilization unit, which is in effect an emergency room for mental situations. Because involuntary commitment laws in many jurisdictions require a judge to issue a commitment order within a short time (often 72 hours) of the patient's entry to the unit and because moving a severely ill mental patient can be extremely dangerous, especially as the patient may try to harm himself/herself or others, many of these stabilization units have conference rooms which are used as courtrooms for emergency commitment procedures.

Medium-term

Another type of mental hospital is used for medium term care lasting several weeks. Most drugs used for psychiatric purposes take several weeks to take effect and the main purpose of these hospitals is to watch over the patient while the drugs taken have their expected effect and the patient can be discharged.

Hospitals for prisoners with mental illness

One other type of mental hospital is designed for long-term care: a combination hospital and prison for the "criminally insane": typically, people with a personality disorder who have committed serious crimes. In the United States, these are generally operated by the state government and exist in a few centralized locations. In many cases, persons within these hospitals have been charged with serious crimes and have been found not guilty by reason of insanity. As a result, in addition to the precautions to prevent suicide there are also precautions against escape (such as are found in a prison). The treatment of persons within such institutions has been a subject of long-standing debate.

Half-way houses

One final type of mental institution which is not a hospital is a community-based half-way house which provides assisted living for mental patients for an extended period of time. These institutions are considered to be one of the most important parts of a mental health system by many psychiatrists, although many localities fail to provide sufficient funding for them.

Used as a form of prison

See Psikhushka

Anti-psychiatry objections to mental hospitals

Some observers, including Thomas Szasz, have objected to calling mental hospitals "hospitals" (see anti-psychiatry). Lawrence Stevens has described mental hospitals as "jails."

In particular, anti-psychiatry activists have advocated for the abolition of long-term hospitals for the criminally insane, on the grounds that the insanity defence should not be permitted and those confined to such institutions should be incarcerated in a regular prison instead, others on the grounds that the inmates' confinement to these "hospitals" punishes them for crimes of which they have been judged not guilty, and others on various other grounds.

History of psychiatric hospitals

The history of psychiatric hospitals is linked heavily with social and scientific attitudes towards mental health, and the attitudes of those afflicted with mental illness, both of which have changed greatly over the past centuries. File:HogarthBedlam.png Early asylums were little more than repositories for the mentally ill, removing them from mainstream society in the same manner as a jail would for criminals. Conditions were often extremely poor, and serious treatment was not yet an option. The first known psychiatric hospital, Bethlem Royal Hospital (Bedlam) was founded in London in 1247 and by 1403 had begun accepting "lunatics." It soon became (in)famous for its harsh treatment of the insane, and in the 18th century would allow visitors to pay a penny to observe their patients as a form of freak show. In 1700 it is recorded that the "lunatics" were called "patients" for the first time, and within twenty years separate wards for the "curable" and "incurable" patients had been established, representing the beginning of a clear shift in the attitude towards mental illness towards a disease of some form.

It was not until the mid-19th century that attitudes towards the treatment of the mentally ill began to drastically improve. Reformers, such as Dorothy Dix in the United States, began to advocate a more human and progressive attitudes towards the mentally ill. In the United States, for example, numerous states established state mental health systems paid for by taxpayer money (and often money from the relatives of those institutionalized inside them). These centralized institutions were often linked with loose governmental bodies, though in general oversight was not high and quality subsequently varied.

While many of those in state hospitals were voluntarily admitted, many more were involuntarily committed by courts. For this reason, state hospital patients were usually from the lower class, as the mentally ill from families with money often had enough private care to avoid being labeled a public menace.

In the United States, state hospitals in some states began to overflow by the beginning of the 20th century. As state populations increased, so did the amount of the mentally ill, and so did the cost of housing them in centralized institutions. During wartime, state mental hospitals became even more overburdened, often serving as hospitals for returning servicemen as well as for their regular clientelle. The incentive to discharge patients was high, however there were still no adequate treatments or therapies for the mentally ill.

Stockton State Hospital, Stockton, California, c. 1920.

This provided a fruitful environment for the popularity of quick-fix solutions, like the eugenic compulsory sterilization programs undertaken in over 30 US states (and, later, in Nazi Germany), which allowed institutions to discharge patients while still claiming to be serving the public interest. These new treatments of mental illness -- which was now seen as a "defect," and likely a hereditary one -- were seen less as therapeutic for the individual patient than as preventative for the society as a whole.

By the mid-1940s, treatment of the mentally ill became effective for the first time with the advent of electroshock and insulin shock therapy, and the use of the lobotomy technique. In modern times, these techniques are viewed as being almost as barbaric as the Bedlam "treatments," though in their own context they were seen as the first options which produced any noticeable effect on their patients. The effect of a lobotomy on an overly excitable patient often allowed them to be discharged to their homes, which was seen by administrators (and often guardians) as a preferable solution than institutionalization. Nonetheless, these new therapies became a horrific part of popular understanding of the mental hospital, helping their popularity very little, to say the least.

By the mid-1950s, the first psychiatric drugs became available for the treatment of mental illness, such as thorazine, which revolutionized psychiatric care and provided for the first time ways for many of the severely mentally ill to return to normal society.

In some nations, mental hospitals were used as sites for the stifling of political dissidence or even genocide. Under Nazi Germany, a euthanasia program began which resulted in the killings of tens of thousands mentally ill housed in state institutions, and the killing techniques perfected at these sites became later implemented in the Holocaust (see T-4 Euthanasia Program). In the Soviet Union, dissidents were often put into asylums and kept on a variety of destabilizing medications, with the hope of not simply removing them from society, but making them unreliable in the eyes of others (see Psikhushka). Both of the attitudes in these cases -- that the mentally ill were a scourge and needed to be eliminated, and that the line between 'patient' and 'prisoner' is incredibly blurry -- have their precedents in the history of mental hospitals, though were taken to extremes by totalitarian regimes.

In the early 1960s USA, amid public images of mental hospitals as sites for horror movies, a deinstitutionalization movement caught hold in many states. California, for example, began to scale back its large mental health system in favor of community-based care, whereby smaller clinics would attempt to aid those suffering from early signs of mental illness before they got to the stage where they would be institutionalized in a mental hospital. At the time, mental hospitals were viewed as the least desireable solution to the problem of mental illness, both from a humane point of view and an economic one. The point of view continued to promulgate and went even further in the backlash against social welfare policies in the 1980s, which lead to massive deinstitutionalization and funding cuts. These changes lead to the closing of many mental hospitals and the further reliance on local community care.

Mental hospitals in film and television

Mental hospitals are often depicted as frightening places in fiction, where treatments are forced upon inmates by uncaring staff, or inmates themselves are either violently deranged or sinister. Although there have been cases of abuse of patients in real life, and some conditions do occasionally result in violent behavior, this stereotype of mental hospitals is misleading.

Some recent depictions of mental hospitals in fiction include:

See also

External links


References

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