Psychiatric hospital

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Danvers State Hospital, Danvers, Massachusetts, Kirkbride Complex, c. 1893 Danvers State Hospital, Danvers, Massachusetts, Kirkbride Complex, circa 1893.jpg
Danvers State Hospital, Danvers, Massachusetts, Kirkbride Complex, c. 1893
Niuvanniemi Hospital in Niuva, Finland Niuvanniemen sairaala.jpg
Niuvanniemi Hospital in Niuva, Finland
McLean Hospital's administration building in Belmont, Massachusetts; the hospital treated several notable New England residents, including Massachusetts governor Nathaniel P. Banks, musician James Taylor, and poet Anne Sexton Administration Building, McLean Hospital, Belmont MA.jpg
McLean Hospital's administration building in Belmont, Massachusetts; the hospital treated several notable New England residents, including Massachusetts governor Nathaniel P. Banks, musician James Taylor, and poet Anne Sexton

Psychiatric hospitals, also known as mental health hospitals, or behavioral health hospitals are hospitals or wards specializing in the treatment of severe mental disorders, including schizophrenia, bipolar disorder, eating disorders, dissociative identity disorder, major depressive disorder, and others.

Contents

Psychiatric hospitals vary widely in their size and grading. Some psychiatric hospitals may specialize only in short-term or outpatient therapy for low-risk patients. Others specialize in the temporary or permanent confinement of patients who need routine assistance, treatment, or a specialized and controlled environment due to a patient's psychiatric disorder. Patients often choose voluntary commitment, but those who psychiatrists believe pose significant danger to themselves or others may be subject to involuntary commitment and involuntary treatment. [1] [2] Psychiatric hospitals are sometimes referred to as psychiatric wards/units, psych, wards, or units when they are located in a hospital.

Modern psychiatric hospitals evolved from and eventually replaced the older lunatic asylum. 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, most modern psychiatric hospitals emphasize treatment, usually including a combination of psychiatric medications and psychotherapy, that assist patients in functioning in the outside world. Many countries have prohibited the use of physical restraints on patients, which includes tying psychiatric patients to their beds for days or even months at a time, [5] [6] though this practice still is periodically employed in India, Japan, and other countries. [7]

History

York Retreat, built in the late 18th century by William Tuke, a pioneer in moral treatment of the mentally ill RetreatOriginalBuildingssm.jpg
York Retreat, built in the late 18th century by William Tuke, a pioneer in moral treatment of the mentally ill

Modern psychiatric hospitals evolved from, and eventually replaced, the older lunatic asylum. Their development also entails the rise of organized institutional psychiatry. Hospitals known as bimaristans were built in the Middle East in the early ninth century; the first was built in Baghdad under the leadership of Harun al-Rashid. While not devoted solely to patients with psychiatric disorders, early psychiatric hospitals often contained wards for patients exhibiting mania or other psychological distress. [8]

Because of cultural taboos against refusing to care for one's family members, mentally ill patients would be surrendered to a bimaristan only if the patient demonstrated violence, incurable chronic illness, or some other extremely debilitating ailment. [9] Psychological wards were typically enclosed by iron bars owing to the aggression of some of the patients. [10]

In Western Europe, the first idea and set up for a proper mental hospital entered through Spain. A member of the Mercedarian Order named Juan Gilaberto Jofré traveled frequently to Islamic countries and observed several institutions that confined the insane. He proposed the founding of an institution exclusive for "sick people who had to be treated by doctors", something very modern for the time. The foundation was carried out in 1409 thanks to several wealthy men from Valencia who contributed funds for its completion. It was considered the first institution in the world at that time specialized in the treatment of mental illnesses.

Later on, physicians, including Philippe Pinel at Bicêtre Hospital in France and William Tuke at York Retreat in England, began to advocate for the viewing of mental illness as a disorder that required compassionate treatment that would aid in the rehabilitation of the victim. In the Western world, the arrival of institutionalisation as a solution to the problem of madness was very much an advent of the nineteenth century. The first public mental asylums were established in Britain; the passing of the County Asylums Act 1808 empowered magistrates to build rate-supported asylums in every county to house the many 'pauper lunatics'. Nine counties first applied, the first public asylum opening in 1812 in Nottinghamshire. In 1828, the newly appointed Commissioners in Lunacy were empowered to license and supervise private asylums. The Lunacy Act 1845 made the construction of asylums in every county compulsory with regular inspections on behalf of the Home Secretary, and required asylums to have written regulations and a resident physician. [11]

At the beginning of the 19th century there were a few thousand people housed in a variety of disparate institutions throughout England, but by 1900 that figure had grown to about 100,000. This growth coincided with the growth of alienism, later known as psychiatry, as a medical specialism. [12] The treatment of inmates in early lunatic asylums was sometimes very brutal and focused on containment and restraint. [3] [4]

In the late 19th and early 20th centuries, psychiatric institutions ceased using terms such as "madness", "lunacy" or "insanity", which assumed a unitary psychosis, and began instead splitting into numerous mental diseases, including catatonia, melancholia, and dementia praecox, which is now known as schizophrenia. [13]

In 1961, sociologist Erving Goffman described a theory [14] [15] of the "total institution" and the process by which it takes efforts to maintain predictable and regular behavior on the part of both "guard" and "captor", suggesting that many of the features of such institutions serve the ritual function of ensuring that both classes of people know their function and social role, in other words of "institutionalizing" them. Asylums as a key text in the development of deinstitutionalization. [16]

With successive waves of reform and the introduction of effective evidence-based treatments, modern psychiatric hospitals provide a primary emphasis on treatment; and further, they 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. [17] These treatments can be involuntary. Involuntary treatments are among the many psychiatric practices which are questioned by the mental patient liberation movement.[ citation needed ]

Types

Republican Vilnius Psychiatric Hospital in Naujoji Vilnia, one of the largest health facilities in Lithuania, built in 1902 Vilnius Psychiatric Hospital 1.jpg
Republican Vilnius Psychiatric Hospital in Naujoji Vilnia, one of the largest health facilities in Lithuania, built in 1902
The Art Nouveau-styled Roykka Hospital, formerly known as Nummela Sanatorium, in Roykka, Finland Roykan sairaala.jpg
The Art Nouveau-styled Röykkä Hospital, formerly known as Nummela Sanatorium, in Röykkä, Finland

There are several different types of modern psychiatric hospitals, but all of them house people with mental illnesses of varying severity. In the United Kingdom, both crisis admissions and medium-term care are usually provided on acute admissions wards. Juvenile or youth wards in psychiatric hospitals or psychiatric wards are set aside for children or youth with mental illness. Long-term care facilities have the goal of treatment and rehabilitation within a short time-frame (two or three years). Another institution for the mentally ill is a community-based halfway house.

Crisis stabilization

Crisis Stabilization Units (CSU) are small facilities with minimal beds used for people in crisis whose needs cannot be met safely in residential service settings.

Open units

Open psychiatric units are not as secure as crisis stabilization units. They are not used for acutely suicidal people; instead, 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 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, depression or other mental illnesses.

Long-term care facilities

Narrenturm in Vienna, built in 1784, is named for a German language phrase, meaning "fools' tower"; the hospital was among the earliest buildings designed specifically for the mentally ill. Narrenturm Vienna June 2006 575.jpg
Narrenturm in Vienna, built in 1784, is named for a German language phrase, meaning "fools' tower"; the hospital was among the earliest buildings designed specifically for the mentally ill.

In the United Kingdom, long-term care facilities are now being replaced with smaller secure units, some within hospitals. Modern buildings, modern security, and being locally situated to help with reintegration into society once medication has stabilized the condition [18] [19] are often features of such units. Examples of this include the Three Bridges Unit at St Bernard's Hospital in West London and the John Munroe Hospital in Staffordshire. These units have the goal of treatment and rehabilitation to allow for transition back into society within a short time-frame, usually lasting two or three years. Not all patients' treatment meets this criterion, however, leading larger hospitals to retain this role.

These hospitals provide stabilization and rehabilitation for those who are actively experiencing uncontrolled symptoms of mental disorders such as depression, bipolar disorders, eating 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 [20] for an extended period of time for patients with mental illnesses, and they 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. One notable historical example was the use of punitive psychiatry in the Soviet Union [21] and China. [22] Like the former Soviet Union and China, Belarus also has used punitive psychiatry toward political opponents and critics of current government in modern times. [23] [24]

Secure units

In the United Kingdom, criminal courts or the Home Secretary can, under various sections of the Mental Health Act, order the detention of offenders in a psychiatric hospital, but the term "criminally insane" is no longer legally or medically recognized. Secure psychiatric units exist in all regions of the UK for this purpose; in addition, there are a few specialist hospitals which offer treatment with high levels of security. These facilities are divided into three main categories: High, Medium and Low Secure. Although the phrase "Maximum Secure" is often used in the media, there is no such classification. "Local Secure" is a common misnomer for Low Secure units, as patients are often detained there by local criminal courts for psychiatric assessment before sentencing.

Run by the National Health Service, these facilities which provide psychiatric assessments can also provide treatment and accommodation in a safe hospital environment which prevents absconding. Thus there is far less risk of patients harming themselves or others. In Dublin, the Central Mental Hospital performs a similar function. [25] [26]

Community hospital utilization

Community hospitals across the United States regularly discharge mental health patients, who are then typically referred to out-patient treatment and therapy. A study of community hospital discharge data from 2003 to 2011, however, found that mental health hospitalizations had increased for both children and adults. Compared to other hospital utilization, mental health discharges for children were the lowest while the most rapidly increasing hospitalizations were for adults under 64. [27] Some units have been opened to provide therapeutically enhanced Treatment, a subcategory to the three main hospital unit types.[ citation needed ]

In the UK, high secure hospitals exist, including Ashworth Hospital in Merseyside, [28] Broadmoor Hospital in Crowthorne, Rampton Secure Hospital in Retford, and the State Hospital in Carstairs, Scotland. [29] In Northern Ireland, the Isle of Man, and the Channel Islands, medium and low secure units exist but high secure units on the UK mainland are used for patients who qualify for the treatment under the Out of Area (Off-Island Placements) Referrals provision of the Mental Health Act 1983. Among the three unit types, medium secure facilities are the most prevalent in the UK. As of 2009, there were 27 women-only units in England. [30] Irish units include those at prisons in Portlaise, Castelrea, and Cork.

Criticism

Traverse City State Hospital in Traverse City, Michigan, U.S., in operation from 1881 to 1989 NorthernMichiganAsylumCTraverseCityMI.JPG
Traverse City State Hospital in Traverse City, Michigan, U.S., in operation from 1881 to 1989

Psychiatrist Thomas Szasz in Hungary has argued that psychiatric hospitals are like prisons unlike other kinds of hospitals, and that psychiatrists who coerce people (into treatment or involuntary commitment) function as judges and jailers, not physicians. [31] 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 bourgeois 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). [32] [33]

Erving Goffman coined the term "total institution" for mental hospitals and similar places which took over and confined a person's whole life. [34] : 150  [35] : 9  Goffman placed psychiatric hospitals in the same category as concentration camps, prisons, military organizations, orphanages, and monasteries. [36] In his book Asylums Goffman describes how the institutionalisation process socialises people into the role of a good patient, someone "dull, harmless and inconspicuous"; in turn, it reinforces notions of chronicity in severe mental illness. [37] The Rosenhan experiment of 1973 demonstrated the difficulty of distinguishing sane patients from insane patients.

Franco Basaglia, a leading psychiatrist who inspired and planned the psychiatric reform in Italy, also defined the 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. Patients, doctors and nurses are all subjected (at different levels) to the same process of institutionalism. [38] 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 the patients, whom it was ostensibly there to serve. [39]

The anti-psychiatry movement coming to the fore in the 1960s has opposed many of the practices, conditions, or existence of mental hospitals; due to the extreme conditions in them. The psychiatric consumer/survivor movement has often objected to or campaigned against conditions in mental hospitals or their use, voluntarily or involuntarily. The mental patient liberation movement emphatically opposes involuntary treatment but it generally does not object to any psychiatric treatments that are consensual, provided that both parties can withdraw consent at any time.[ citation needed ]

Undercover journalism

Alongside the 1973 academic investigation by Rosenhan and other similar experiments, several journalists have been willingly admitted to hospitals in order to conduct undercover journalism. These include:

See also

Related Research Articles

Involuntary commitment, civil commitment, or involuntary hospitalization/hospitalisation is a legal process through which an individual who is deemed by a qualified agent to have symptoms of severe mental disorder is detained in a psychiatric hospital (inpatient) where they can be treated involuntarily. This treatment may involve the administration of psychoactive drugs, including involuntary administration. In many jurisdictions, people diagnosed with mental health disorders can also be forced to undergo treatment while in the community; this is sometimes referred to as outpatient commitment and shares legal processes with commitment.

Anti-psychiatry, sometimes spelled antipsychiatry without the hyphen, is a movement based on the view that psychiatric treatment is often more damaging than helpful to patients, highlighting controversies about psychiatry. Objections include the reliability of psychiatric diagnosis, the questionable effectiveness and harm associated with psychiatric medications, the failure of psychiatry to demonstrate any disease treatment mechanism for psychiatric medication effects, and legal concerns about equal human rights and civil freedom being nullified by the presence of diagnosis. Historical critiques of psychiatry came to light after focus on the extreme harms associated with electroconvulsive therapy or insulin shock therapy. The term "anti-psychiatry" is in dispute and often used to dismiss all critics of psychiatry, many of whom agree that a specialized role of helper for people in emotional distress may at times be appropriate, and allow for individual choice around treatment decisions.

Historically, mental disorders have had three major explanations, namely, the supernatural, biological and psychological models. For much of recorded history, deviant behavior has been considered supernatural and a reflection of the battle between good and evil. When confronted with unexplainable, irrational behavior and by suffering and upheaval, people have perceived evil. In fact, in the Persian Empire from 550 to 330 B.C., all physical and mental disorders were considered the work of the devil. Physical causes of mental disorders have been sought in history. Hippocrates was important in this tradition as he identified syphilis as a disease and was, therefore, an early proponent of the idea that psychological disorders are biologically caused. This was a precursor to modern psycho-social treatment approaches to the causation of psychopathology, with the focus on psychological, social and cultural factors. Well known philosophers like Plato, Aristotle, etc., wrote about the importance of fantasies, dreams, and thus anticipated, to some extent, the fields of psychoanalytic thought and cognitive science that were later developed. They were also some of the first to advocate for humane and responsible care for individuals with psychological disturbances.

<span class="mw-page-title-main">Rosenhan experiment</span> Experiment to determine the validity of psychiatric diagnosis

The Rosenhan experiment or Thud experiment was an experiment conducted to determine the validity of psychiatric diagnosis. Participants submitted themselves for evaluation at various psychiatric institutions and feigned hallucinations in order to be accepted, but acted normally from then onward. Each was diagnosed with psychiatric disorders and were given antipsychotic medication. The study was conducted by psychologist David Rosenhan, a Stanford University professor, and published by the journal Science in 1973 under the title "On Being Sane in Insane Places".

<span class="mw-page-title-main">Mental Health Act 1983</span> Law in England and Wales

The Mental Health Act 1983 is an Act of the Parliament of the United Kingdom. It covers the reception, care and treatment of mentally disordered people, the management of their property and other related matters, forming part of the mental health law for the people in England and Wales. In particular, it provides the legislation by which people diagnosed with a mental disorder can be detained in a hospital or police custody and have their disorder assessed or treated against their wishes, informally known as "sectioning". Its use is reviewed and regulated by the Care Quality Commission. The Act was significantly amended by the Mental Health Act 2007. A white paper proposing changes to the act was published in 2021 following an independent review of the act by Simon Wessely.

<span class="mw-page-title-main">Fulbourn Hospital</span> Hospital in Cambridge

Fulbourn Hospital is a mental health facility located between the Cambridgeshire village of Fulbourn and the Cambridge city boundary at Cherry Hinton, about 5 miles (8 km) south-east of the city centre. It is managed by the Cambridgeshire and Peterborough NHS Foundation Trust. The Ida Darwin Hospital site is situated behind Fulbourn Hospital. It is run and managed by the same trust, with both hospitals sharing the same facilities and staff pool.

<span class="mw-page-title-main">Deinstitutionalisation</span> Replacement of psychiatric hospitals

Deinstitutionalisation is the process of replacing long-stay psychiatric hospitals with less isolated community mental health services for those diagnosed with a mental disorder or developmental disability. In the late 20th century, it led to the closure of many psychiatric hospitals, as patients were increasingly cared for at home, in halfway houses and clinics, in regular hospitals, or not at all.

Psychiatry is the medical specialty devoted to the diagnosis, prevention, and treatment of deleterious mental conditions. These include various matters related to mood, behaviour, cognition, and perceptions.

<span class="mw-page-title-main">Kew Asylum</span> Former hospital in Victoria, Australia

Kew Lunatic Asylum is a decommissioned psychiatric hospital located between Princess Street and Yarra Boulevard in Kew, a suburb of Melbourne, Australia. Operational from 1871 to 1988, Kew was one of the largest asylums ever built in Australia. Later known as Willsmere, the complex of buildings were constructed between 1864 and 1872 to the design of architects G.W. Vivian and Frederick Kawerau of the Victorian Public Works Office to house the growing number of "lunatics", "inebriates", and "idiots" in the Colony of Victoria.

<span class="mw-page-title-main">Sunbury Asylum</span> Hospital in Victoria, Australia

Sunbury Lunatic Asylum was a 19th-century mental health facility known as a lunatic asylum, located in Sunbury, Victoria, Australia, first opened in October 1879.

This is a timeline of the modern development of psychiatry. Related information can be found in the Timeline of psychology and Timeline of psychotherapy articles.

<span class="mw-page-title-main">Lunatic asylum</span> Place for housing the insane, an aspect of history

The lunatic asylum, insane asylum or mental asylum was an early precursor of the modern psychiatric hospital.

<span class="mw-page-title-main">St. Brendan's Hospital, Dublin</span> Hospital in North Dublin, Ireland

St. Brendan's Hospital was a psychiatric facility located in the north Dublin suburb of Grangegorman. It formed part of the mental health services of Dublin North East with its catchment area being North West Dublin. It is now the site of a modern mental health facility known as the "Phoenix Care Centre". Since the official opening of the Richmond Lunatic Asylum in 1815 the Grangegorman site has continuously provided institutional facilities for the reception of the mentally ill until the present day. As such the Phoenix Care Centre represents the continuation of the oldest public psychiatric facility in Ireland.

The following outline is provided as an overview of and topical guide to the psychiatric survivors movement:

The following outline is provided as an overview of and topical guide to psychiatry:

Glenside Hospital, as it was known from 1967, previously the Public Colonial Lunatic Asylum of South Australia, Parkside Lunatic Asylum and Parkside Mental Hospital, was a complex of buildings used as a psychiatric hospital in Glenside, South Australia.

Transinstitutionalisation is the phenomenon where inmates released from one therapeutic community move into other institutions, either as planned move or as an unforeseen consequence. For instance, when the residential mental hospitals in the United States were closed as the result of a political policy change, the prison population increased by an equivalent number.

Mental healthcare generally refers to services ranging from assessment, diagnosis, treatment, to counseling, dedicated to maintaining and restoring mental well being of people. In Nigeria, there is significant disparity between the demand and supply of mental health services. Though there are policies aimed at addressing mental health issues in Nigeria, in-depth information on mental health service in Nigeria is non-existent. This makes it difficult to identify areas of needs, coordinate activities of advocacy groups, and make an informed decision about policy direction. In effect, there is continued neglect of mental health issues. About 25-30 percent of Nigerians suffer from mental illness and less than 10 percent of this population have access to professional assistance. The World Health Organization estimates that only about three percent of the government's budget on health goes to mental health.

<span class="mw-page-title-main">Mental health in India</span> Overview of mental health care system in India

Mental healthcare in India is a right secured to every person in the country by law. Indian mental health legislation, as per a 2017 study, meets 68% (119/175) of the World Health Organization (WHO) standards laid down in the WHO Checklist of Mental Health Legislation. However, human resources and expertise in the field of mental health in India is significantly low when compared to the population of the country. The allocation of the national healthcare budget to mental health is also low, standing at 0.16%. India's mental health policy was released in 2014.

References

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  40. ↑ ""Seven Days in the Madhouse!" - Frank Smith - Chicago Daily Times · Undercover Reporting". undercover.hosting.nyu.edu. Retrieved 18 July 2022.
  41. ↑ "Blog4 — 7 days of Frank Smith doing undercover reporting at a mental hospital by Baidi Wang". C409 - News Media Ethics. 4 April 2018. Retrieved 18 July 2022.
  42. ↑ Hofschneider, Mark. "Historical Archive: Awards No Longer Given by the Foundation". Lasker Foundation. Retrieved 18 July 2022.
  43. ↑ ""I Was a Mental Patient" - Michael Mok - New York World-Telegram & Sun · Undercover Reporting". undercover.hosting.nyu.edu. Retrieved 18 July 2022.
  44. ↑ Kroeger, Brooke; Hamill, Pete (2012). "HARD TIME". Undercover Reporting. Northwestern University Press. p. 193. ISBN   978-0-8101-2619-0. JSTOR   j.ctt22727sf.15.
  45. ↑ "Central State Psychiatric Hospital Exposé - Frank Sutherland - Nashville Tennessean · Undercover Reporting". undercover.hosting.nyu.edu. Retrieved 18 July 2022.
  46. ↑ Kroeger, Brooke; Hamill, Pete (2012). "HARD TIME". Undercover Reporting. Northwestern University Press. p. 196. ISBN   978-0-8101-2619-0. JSTOR   j.ctt22727sf.15.
  47. ↑ ""Trip Into Darkness" - Betty Wells - Wichita Eagle and Wichita Beacon · Undercover Reporting". undercover.hosting.nyu.edu. Retrieved 18 July 2022.
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