Psychiatric hospital

This article is about today's psychiatric hospitals. For historical lunatic asylums, seeLunatic asylum.

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Danvers State Hospital, Danvers, Massachusetts, Kirkbride Complex,c. 1893

Niuvanniemi HospitalinNiuva,Finland

McLean Hospital's administration building inBelmont, Massachusetts;the hospital treated several notableNew Englandresidents, includingMassachusetts governorNathaniel P. Banks,musicianJames Taylor,and poetAnne Sexton

Psychiatric hospitals,also known asmental health hospitals,orbehavioral health hospitalsarehospitalsor wards specializing in the treatment of severemental disorders,includingschizophrenia,bipolar disorder,eating disorders,major depressive disorder,and others.

Psychiatric hospitals vary widely in their size and grading. Some psychiatric hospitals may specialize only in short-term or outpatient therapy for low-riskpatients.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 choosevoluntary commitment,but those whopsychiatristsbelieve pose significant danger to themselves or others may be subject toinvoluntary commitmentandinvoluntary treatment.Psychiatric hospitals are sometimes referred to aspsychiatric wards/units,psych,wards,orunitswhen they are located in a hospital.

Modern psychiatric hospitals evolved from and eventually replaced the olderlunatic asylum.The treatment of inmates in early lunatic asylums was sometimes brutal and focused on containment and restraint.

With successive waves of reform, and the introduction of effectiveevidence-basedtreatments, most modern psychiatric hospitals emphasize treatment, usually including a combination ofpsychiatric medicationsandpsychotherapy,that assist patients in functioning in the outside world. Many countries have prohibited the use ofphysical restraintson patients, which includes tying psychiatric patients to their beds for days or even months at a time,though this practice still is periodically employed inIndia,Japan,and other countries.

History

Main article:Lunatic asylum

York Retreat,built in the late 18th century byWilliam 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 institutionalpsychiatry. Hospitals known asbimaristanswere built in theMiddle Eastin the early ninth century; the first was built inBaghdadunder the leadership ofHarun 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.

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

InWestern Europe,the first idea and set up for a proper mental hospital entered throughSpain.A member of theMercedarian OrdernamedJuan Gilaberto Jofrétraveled 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 fromValenciawho 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, includingPhilippe PinelatBicêtre Hospitalin France andWilliam TukeatYork Retreatin 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 ofinstitutionalisationas 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 theCounty Asylums Act 1808empowered magistrates to build rate-supported asylums in everycountyto house the many 'pauper lunatics'. Nine counties first applied, the first public asylum opening in 1812 inNottinghamshire.In 1828, the newly appointedCommissioners in Lunacywere empowered to license and supervise private asylums. TheLunacy Act 1845made the construction of asylums in every county compulsory with regular inspections on behalf of theHome Secretary,and required asylums to have written regulations and a residentphysician.

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 ofalienism,later known as psychiatry, as a medical specialism.The treatment of inmates in early lunatic asylums was sometimes very brutal and focused on containment and restraint.

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 asschizophrenia.

In 1961, sociologistErving Goffmandescribed a theoryof 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 andsocial role,in other words of "institutionalizing"them. Asylums as a key text in the development ofdeinstitutionalization.

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 ofpsychiatric drugsandpsychotherapy.These treatments can be involuntary. Involuntary treatments are among the many psychiatric practices which are questioned by themental patient liberation movement.

Types

Republican Vilnius Psychiatric Hospital in Naujoji Vilnia, one of the largest health facilities inLithuania,built in 1902

TheArt Nouveau-styled Röykkä Hospital, formerly known asNummela Sanatorium,inRöykkä,Finland

There are several different types of modern psychiatric hospitals, but all of them house people with mental illnesses of varying severity. In theUnited 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-basedhalfway 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

NarrenturminVienna,built in 1784, is named for aGerman languagephrase, 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 conditionare often features of such units. Examples of this include the Three Bridges Unit atSt Bernard's HospitalinWest Londonand the John Munroe Hospital inStaffordshire.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-basedhalfway house.These facilities provide assisted livingfor 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 manypsychiatrists,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 ofpunitive psychiatry in the Soviet UnionandChina. Like the former Soviet Union and China,Belarusalso has used punitive psychiatry toward political opponents and critics of current government in modern times.

Secure units

In the United Kingdom, criminal courts or theHome Secretarycan, 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 theNational 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. InDublin,theCentral Mental Hospitalperforms a similar function.

Community hospital utilization

Community hospitals across theUnited Statesregularly 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.Some units have been opened to provide therapeutically enhanced Treatment, a subcategory to the three main hospital unit types.

In the UK, high secure hospitals exist, includingAshworth HospitalinMerseyside,Broadmoor HospitalinCrowthorne,Rampton Secure HospitalinRetford,and theState HospitalinCarstairs,Scotland.InNorthern Ireland,theIsle of Man,and theChannel 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 theMental 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.Irish units include those at prisons in Portlaise, Castelrea, and Cork.

Criticism

Traverse City State HospitalinTraverse City, Michigan,U.S., in operation from 1881 to 1989

PsychiatristThomas SzaszinHungaryhas 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.HistorianMichel Foucaultis widely known for his comprehensive critique of the use and abuse of the mental hospital system inMadness and Civilization.He argued that Tuke and Pinel's asylum was a symbolic recreation of the condition of a child under abourgeoisfamily. It was a microcosm symbolizing the massive structures ofbourgeois societyand its values: relations of Family–Children (paternal authority), Fault–Punishment (immediate justice), Madness–Disorder (social and moral order).

Erving Goffmancoined the term "total institution"for mental hospitals and similar places which took over and confined a person's whole life.Goffman placed psychiatric hospitals in the same category asconcentration camps,prisons,military organizations,orphanages,and monasteries.In his bookAsylumsGoffman 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.TheRosenhan experimentof 1973 demonstrated the difficulty of distinguishing sane patients from insane patients.

Franco Basaglia,a leading psychiatrist who inspired and planned thepsychiatric 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.American psychiatristLoren Moshernoticed 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, thedegradation ceremony,authoritarianism, and the primacy of institutional needs over the patients, whom it was ostensibly there to serve.

Theanti-psychiatrymovement 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. Thepsychiatric consumer/survivor movementhas 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.

Undercover journalism

Alongside the 1973 academic investigation byRosenhanand othersimilar experiments,several journalists have been willingly admitted to hospitals in order to conductundercover journalism.These include:

• Julius Chambers,who visitedBloomingdale Insane Asylumin 1872, leading to the 1876 bookA Mad World and Its People.
• Nellie Bly,who admitted herself to a mental institution in 1887, leading to the workTen Days in a Mad-House.
• Frank Smith in 1935 admitted himself into aKankakeehospital, leading to the articles "Seven days in the Madhouse" in theChicago Daily Times.
• Michael Mok, who investigated similarly in New York 1961, winning theLasker prize.
• Frank Sutherland, who received coaching from a psychiatrist in order to accurately feign symptoms, and spent 31 days in late 1973 to early 1974, leading to a series of articles in theNashville Tennessean.
• Betty Wells, who investigated in 1974, with the articles titled "A Trip into Darkness" for theWichita Eagle.

See also

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

External links

• Camarillo State Mental Hospital History
• Historical Asylums website
• Asylum Projects– Asylum wiki database
• National Resource Center on Psychiatric Advance Directives
• Kirkbride BuildingsHistory and photographs of early psychiatric hospitals
• TheTimeChamber Asylum ListComprehensive List of Victorian Insane Asylums in the UK
• Bipolar Disorder at WebMD
• Psychiatric hospitals rankings