Psychiatric hospital

This article is about modern psychiatric hospitals. For historical lunatic asylums, see history of psychiatric institutions.

Traverse City State Hospital, Traverse City, Michigan

Psychiatric hospitals, also known as mental hospitals, are hospitals specializing in the treatment of serious mental disorders. Psychiatric hospitals vary widely in their size and grading. Some hospitals may specialise only in short-term or outpatient therapy for low-risk patients. Others may specialise in the temporary or permanent care of residents who, as a result of a psychological disorder, require routine assistance, treatment, or a specialised and controlled environment. Patients are often admitted on a voluntary basis, but involuntary commitment is practiced when an individual may pose a significant danger to themselves or others.^[1]

History

Austin State Hospital - Austin, Texas

Main article: History of psychiatric institutions

Modern psychiatric hospitals evolved from, and eventually replaced the older lunatic asylums. The development of the modern psychiatric hospital is also the story of the rise of organised, institutional psychiatry. While there were earlier institutions that housed the "insane" the arrival of institutionalisation as a solution to the problem of madness was very much an event of the nineteenth century. To illustrate this with one regional example, in England at the beginning of the nineteenth century there were, perhaps, a few thousand "lunatics" housed in a variety of disparate institutions but by 1900 that figure had grown to about 100,000. That this growth coincided with the growth of alienism, later known as psychiatry, as a medical specialism is not coincidental.^[2]

The treatment of inmates in early lunatic asylums was sometimes brutal and focused on containment and restraint.^[3][4] With successive waves of reform, and the introduction of effective evidence-based treatments, modern psychiatric hospitals provide a primary emphasis on treatment, and attempt where possible to help patients control their own lives in the outside world, with the use of a combination of psychiatric drugs and psychotherapy.^[5] These treatments can be involuntary and are questioned by the Anti-Psychiatric movement. Most psychiatric hospitals now restrict internet access and any device that can take photos.^[6]

Types

There are a number of different types of modern psychiatric hospitals, but all of them house people with mental illnesses of widely variable severity.

Crisis stabilization

Main article: Emergency psychiatry

The crisis stabilization unit is in effect an emergency room for psychiatry, frequently dealing with suicidal, violent, or otherwise critical individuals.

Open units

Open units are psychiatric units that are not as secure as crisis stabilization units. They are not used for acutely suicidal persons; the focus in these units is to make life as normal as possible for patients while continuing treatment to the point where they can be discharged. However, patients are usually still not allowed to hold their own medications in their rooms, because of the risk of an impulsive overdose. While some open units are physically unlocked, other open units still use locked entrances and exits depending on the type of patients admitted.

Medium-term

Another type of psychiatric hospital is medium term, which provides 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 monitor the patient for the first few weeks of therapy to ensure the treatment is effective.

Juvenile wards

Juvenile wards are sections of psychiatric hospitals or psychiatric wards set aside for children and/or adolescents with mental illness. However, there are a number of institutions specializing only in the treatment of juveniles, particularly when dealing with drug abuse, self harm, eating disorders, anxiety, or other mental illness.

Long-term care facilities

In the UK long-term care facilities are now being replaced with smaller secure units (some within the hospitals listed above). Modern buildings, modern security and being locally sited to help with reintegration into society once medication has stabilized the condition^[7][8] are often features of such units. An example of this is the Three Bridges Unit, in the grounds of Hanwell Asylum in West London and the John Munroe Hospital in Staffordshire. However these modern units have the goal of treatment and rehabilitation back into society within a short time-frame (two or three years) and not all forensic patients' treatment can meet this criterion, so the large hospitals mentioned above often retain this role. These hospitals provide stabilization and rehabilitation for those who are having difficulties such as depression, eating disorders, mental disorders, and so on.

Halfway houses

One type of institution for the mentally ill is a community-based halfway house. These facilities provide assisted living^[9] for patients with mental illnesses for an extended period of time, and often aid in the transition to self-sufficiency. These institutions are considered to be one of the most important parts of a mental health system by many psychiatrists, although some localities lack sufficient funding.

Political imprisonment

In some countries the mental institution may be used for the incarceration of political prisoners, as a form of punishment. A notable historical example was the use of punitive psychiatry in the Soviet Union^[10] and China.^[11]

Secure Units

In the UK, criminal courts or the Home Secretary can refer people to what are known as psychiatric secure units, even though for many decades now, the term "criminally insane" is no longer legally or medically recognized. They are hospitals mostly run by the National Health Service, which undertake psychiatric assessments and can also provide treatment and accommodation in a safe, hospital environment where its patients can be prevented from harming themselves or others. They also run under clearly defined Home office rules. These secure hospital facilities are divided into three main categories and are referred to as High, Medium and Low Secure. Although it is a phrase often used by newspapers, there is no such classification as "Maximum Secure". Low Secure units are often referred to as "Local Secure" as patients are referred there frequently by local criminal courts for psychiatric assessment before sentencing.

Some units have been opened in recent years with the specific purpose of providing Therapeutically Enhanced Treatment and so form a subcategory to the three main ones.

The general public are familiar with the names of the High Secure Hospitals due to the frequency that they are mentioned in the news reports about the people who are sent there. Those in England include, Ashworth Hospital in Merseyside;^[12] Broadmoor Hospital in Crowthorne, Berkshire and Rampton Secure Hospital in Retford, Nottinghamshire and in Scotland is The State Hospital, Carstairs.^[13] Northern Ireland and the Isle of Man have their own Medium and Low Secure units but use the mainland faculties for High Secure, which smaller Channel Islands also transfer their patients to as Out of Area Referrals under the Mental Health Act 1983.

Of the Medium Secure units, there are many more of these in number scattered throughout the UK. As of 2009 there were 27 women only units in England alone.^[14] Irish units include those at prisons in Portlaise, Castelrea and Cork.

Anti-psychiatry objections

Some critics, notably psychiatrist Dr. Thomas Szasz, have objected to calling mental hospitals "hospitals" (see anti-psychiatry).

The French historian Michel Foucault is widely known for his comprehensive critique of the use and abuse of the mental hospital system in Madness and Civilization. He argued that Tuke and Pinel's asylum was a symbolic recreation of the condition of a child under a bourgeoisie family. It was a microcosm symbolizing the massive structures of bourgeois society and its values: relations of Family-Children (paternal authority), Fault-Punishment (immediate justice), Madness-Disorder (social and moral order).^[15][16]

Erving Goffman coined the term "Total Institution" for mental hospitals and similar places which took over and confined a person's whole life.^{[17]:150[18]:9} Goffman placed psychiatric hospitals in the same category as concentration camps, prisons, military organizations, orphanages, and monasteries.^[19] In Asylums Goffman describes how the institutionalisation process socialises people into the role of a good patient, someone "dull, harmless and inconspicuous"; it in turn reinforces notions of chronicity in severe mental illness.^[20]

Franco Basaglia, a leading Italian psychiatrist who inspired and was the architect of the psychiatric reform in Italy, also defined mental hospital as an oppressive, locked and total institution in which prison-like, punitive rules are applied, in order to gradually eliminate its own contents, and patients, doctors and nurses are all subjected (at different levels) to the same process of institutionalism.^[21]

American psychiatrist Loren Mosher noticed that the psychiatric institution itself gave him master classes in the art of the "total institution": labeling, unnecessary dependency, the induction and perpetuation of powerlessness, the degradation ceremony, authoritarianism, and the primacy of institutional needs over those of the persons it was ostensibly there to serve-the patients.^[22]

The anti-psychiatry movement coming to the fore in the 1960s oppose many of the practices, conditions, or existence of mental hospitals. The psychiatric consumer/survivor movement has often objected to or campaigned against conditions in mental hospitals or their use, voluntarily or involuntarily.

Some anti-psychiatry activists have advocated for the abolition of long-term hospitals for the criminally insane, including on the grounds that those judged not guilty by reason of insanity should not then be indefinitely confined with potentially fewer legal rights, or on the converse grounds that insanity is not a coherent concept and so should not be a basis for different treatment.

See also

Health and fitness portal

• Deinstitutionalisation
• History of mental illness
• History of psychiatric institutions
• Institutional syndrome
• Kirkbride Plan
• Mental health law
• MindFreedom International
• New Freedom Commission on Mental Health
• Psychiatric survivors movement
• Punitive psychiatry in the Soviet Union
• Salutogenesis, a best-practice methodology for the design of psychiatric facilities.
• Treatment Advocacy Center, involuntary treatment proponent group

To see lists of individual establishments: view the categorical index for Psychiatric hospitals; which appears at the very bottom of this article.

References

1. ^ "White House Intruder Put in Mental Ward". New York Times. June 1, 1995. http://www.nytimes.com/1995/06/01/us/white-house-intruder-put-in-mental-ward.html. 
2. ^ Porter, Roy (2006). Madmen: A Social History of Madhouses, Mad-Doctors & Lunatics. Tempus: p. 14.
3. ^ Life Magazine
4. ^ Life Magazine
5. ^ Surgeongeneral.gov
6. ^ Cqc.org.uk
7. ^ Medscape.com
8. ^ Hospital.com
9. ^ Vaslamatzis, G.; Katsouyanni, K.; Markidis, M. (1997). "The efficacy of a psychiatric halfway house: a study of hospital recidivism and global outcome measure". European Psychiatry 12 (2): 94–97. doi:10.1016/S0924-9338(97)89647-2. 
10. ^ Matvejević, Predrag (2004). Between exile and asylum: an eastern epistolary. Central European University Press. pp. 32. ISBN 9639241857. http://books.google.ru/books?id=qRrv8MqXMxYC&printsec=frontcover#PPA32,M1. 
11. ^ New York Times
12. ^ Official site, Accessed 2010-06-02
13. ^ Official site, Accessed 2010-06-02
14. ^ Georgie Parry‐Crooke (June 2009) My life: in safe hands?. Accessed 2010-06-02
15. ^ Deleuze and Guattari (1972) Anti-Oedipus p. 102
16. ^ Michel Foucault [1961] The History of Madness, Routledge 2006, pp.490-1, 507-8, 510-1
17. ^ Davidson, Larry; Rakfeldt, Jaak; Strauss, John (editors) (2010). The Roots of the Recovery Movement in Psychiatry: Lessons Learned. John Wiley and Sons. pp. 150. ISBN 8846453581. http://books.google.ru/books?id=tp4L_1zw9ngC&printsec=frontcover#PPA150,M1. 
18. ^ Wallace, Samuel (1971). Total Institutions. Transaction Publishers. pp. 9. ISBN 8846453581. http://books.google.ru/books?id=F7uN3eHD1xQC&printsec=frontcover#PPA9,M1. 
19. ^ Weinstein R. (1982). "Goffman's Asylums and the Social Situation of Mental Patients". Orthomolecular psychiatry 11 (N 4): 267–274. http://www.orthomolecular.org/library/jom/1982/pdf/1982-v11n04-p267.pdf. 
20. ^ Lester H., Gask L. (May 2006). "Delivering medical care for patients with serious mental illness or promoting a collaborative model of recovery?". British Journal of Psychiatry 188 (5): 401–402. doi:10.1192/bjp.bp.105.015933. PMID 16648523. http://bjp.rcpsych.org/cgi/content/full/188/5/401. 
21. ^ Tansella M. (November 1986). "Community psychiatry without mental hospitals--the Italian experience: a review". Journal of the Royal Society of Medicine 79 (11): 664–669. PMC 1290535. PMID 3795212. http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=1290535. 
22. ^ Mosher L.R. (March 1999). "Soteria and other alternatives to acute psychiatric hospitalization: a personal and professional review". Journal of Nervous and Mental Disease 187 (3): 142–149. doi:10.1097/00005053-199903000-00003. PMID 10086470. http://www.cmha.ca/data/1/rec_docs/1166_alternatives%20to%20acute%20psychiatric%20hospitalization.pdf. 

External links

• Camarillo State Mental Hospital History
• Historical Asylums website
• Asylum Projects - Asylum wiki database
• "AlterNet: Movie Mix: Must-See Indy Film Exposes Cruel Teen Correction Programs". http://www.alternet.org/movies/56241/. Retrieved 2007-07-08. 
• National Resource Center on Psychiatric Advance Directives
• Kirkbride Buildings History and photographs of early psychiatric hospitals
• TheTimeChamber Asylum List Comprehensive List of Victorian Insane Asylums in the UK