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

Psychiatric hospitals, also known as mental hospitals, are hospitals for treatment of serious mental illness.

Psychiatric hospitals are different in their goals and methods. Some hospitals only accept patients for short visits or outpatient therapy. Others work to help the mentally ill through temporary or permanent care of residents. These patients suffer as a result of a mental illness, need routine help, treatment or a controlled place. Patients are often admitted on a by their choice, but involuntary commitment happens when an person may pose a danger to themselves or others.

History

See the 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 at the answer of institutionalisation as the correct 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 should coincide with the growth of alienism, later known as psychiatry, as a medical specialism is not coincidental.

The treatment of inmates in lunatic asylums was often brutal, focused on containment and restraint. 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 aid of a combination of psychiatric drugs and psychotherapy.

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

See the 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. Laws in many jurisdictions providing for long term involuntary commitment require a commitment order issued by a judge within a short time (after 72 hours, the evaluation period ) of the patient's entry to the unit, if the patient does not or is unable to consent themselves.

Open units

Open units are psychiatric units that are less secure than 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 a 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 mutilation, or eating disorders.

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 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.

Halfway houses

One type of institution for the mentally ill is a community-based halfway house. These facilities provide assisted living 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 (see Psikhushka).

In some nations, such as North Korea, the former Soviet Union, East Germany, and Romania during Communist rule, mental hospitals were, and in some cases still are, used as sites for the stifling of political dissent.

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 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).

Erving Goffman coined the term 'Total Institution' for places which took over and confined a person's whole life. The anti-psychiatry movement coming to the fore in the 1960s oppose many of the practices, conditions, or existence of mental hospitals. The 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 less legal rights, or on the converse grounds that insanity is not a coherent concept and so should not be a basis for different treatment.

In popular culture

• One Flew Over the Cuckoo's Nest
• A Beautiful Mind
• the fictional Arkham Asylum
• Changeling
• The Dream Team (film) (1989)
• The Snake Pit (1948)
• Girl, Interrupted (film) (1999)
• Session 9 (film) (2001)
• It's Kind of a Funny Story (2010)

See also

• History of psychiatric institutions
• History of mental illness
• Deinstitutionalisation
• Institutionalization (psychology)
• Kirkbride Plan
• Mental health law
• MindFreedom International
• New Freedom Commission on Mental Health
• Punitive psychiatry in the Soviet Union
• Psychiatric survivors movement
• 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.

External links

• BBC.co.uk - 'Mental hospital wards "dire"', BBC (July 7, 2000)
• Historical Asylums website
• Asylum Projects - Asylum wiki database
• Example of Patient Rights policy in U.S.
• "AlterNet: Movie Mix: Must-See Indy Film Exposes Cruel Teen Correction Programs". Retrieved 2007-07-08.
• National Resource Center on Psychiatric Advance Directives
• Kirkbride Buildings History and photographs of early psychiatric hospitals