Psychiatric hospital: Difference between revisions
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{{About|modern psychiatric hospitals|historical lunatic asylums|history of psychiatric institutions}} |
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[[File:NorthernMichiganAsylumCTraverseCityMI.JPG|thumb|right|220px|[[Traverse City State Hospital]], [[Traverse City, Michigan]]]] |
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'''Psychiatric hospitals''', also known as '''mental hospitals''', are [[hospital]]s specializing in the treatment of serious [[mental disorder]]s. Psychiatric hospitals vary widely in their size and grading. Some hospitals may specialize only in short-term or outpatient therapy for low-risk [[patient]]s. Others may specialize in the temporary or permanent care of residents who, as a result of a psychological disorder, require routine assistance, treatment, or a specialized and controlled environment. Patients are often admitted on a [[voluntary commitment|voluntary basis]], but people who psychiatrists believe may pose a significant danger to themselves or others, may be subject to [[involuntary commitment]].<ref>{{cite news |url=http://www.nytimes.com/1995/06/01/us/white-house-intruder-put-in-mental-ward.html |newspaper=New York Times |title=White House Intruder Put in Mental Ward |date=June 1, 1995 }}</ref> |
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==History== |
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[[File:AustinStateHospitalEntrance.JPG|thumb|[[Austin State Hospital]] - [[Austin, Texas]]]] |
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{{Main|History of psychiatric institutions}} |
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Modern psychiatric hospitals evolved from, and eventually replaced the older [[lunatic asylum]]s. 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 [[psychiatry|alienism]], later known as psychiatry, as a medical specialism is not coincidental.<ref>Porter, Roy (2006). ''Madmen: A Social History of Madhouses, Mad-Doctors & Lunatics''. Tempus: p. 14.</ref> In the late 19th and early 20th centuries, terms such as "madness," "lunacy" or "insanity" -- all of which assumed a unitary psychosis -- were split into numerous "mental diseases," of which dementia praecox and schizophrenia were the most common in psychiatric institutions.<ref>{{cite web|last=Yuhas|first=Daisy|title=Throughout History, Defining Schizophrenia Has Remained a challenge|url=http://www.scientificamerican.com/article.cfm?id=throughout-history-defining-schizophrenia-has-remained-challenge|publisher=Scientific American Mind (March 2013)|accessdate=2 March 2013}}</ref> |
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The treatment of inmates in early lunatic asylums was sometimes brutal and focused on containment and restraint.<ref>[http://www.mnddc.org/parallels2/prologue/6a-bedlam/6a-bedlam.html Life Magazine]</ref><ref>[http://www.mnddc.org/parallels2/prologue/6a-bedlam/bedlam-life1946.pdf Life Magazine]</ref> 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 drug]]s and [[psychotherapy]].<ref>[http://www.surgeongeneral.gov/library/mentalhealth/chapter2/sec7.html Surgeongeneral.gov]</ref> These treatments can be involuntary. Involuntary treatments are among the many psychiatric practices which are questioned by the [[Anti-Psychiatry|Anti-Psychiatric movement]]. Involuntary treatment is emphatically opposed by the mental patient liberation movement, but this movement does not have any issue with any psychiatric treatment that is consensual, provided that both parties are free to withdraw consent at any time. |
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Most psychiatric hospitals now restrict internet access and any device that can take photos.<ref>[http://www.cqc.org.uk/_db/_documents/CQC_Monitoring_the_use_of_the_Mental_Health_Act_in_200910_Main_report_Tagged.pdf Cqc.org.uk]</ref> |
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==Types== |
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There are a number of different types of modern psychiatric hospitals, but all of them house people with mental illnesses of widely variable severity. |
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===Open units=== |
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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. |
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===Medium-term=== |
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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. |
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===Juvenile wards=== |
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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, depression or other mental illness. |
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===Long-term care facilities=== |
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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<ref>[http://www.medscape.com/viewarticle/481700_3 Medscape.com]</ref><ref>[http://www.hospital.com/psychiatry.html Hospital.com]</ref> 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. |
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These hospitals provide stabilization and rehabilitation for those who are having difficulties such as depression, eating disorders, mental disorders, and so on. |
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===Halfway houses=== |
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One type of institution for the mentally ill is a community-based [[halfway house]]. These facilities provide assisted living<ref>{{cite journal |last=Vaslamatzis |first=G. |last2=Katsouyanni |first2=K. |last3=Markidis |first3=M. |title=The efficacy of a psychiatric halfway house: a study of hospital recidivism and global outcome measure |journal=European Psychiatry |volume=12 |issue=2 |year=1997 |pages=94–97 |doi=10.1016/S0924-9338(97)89647-2 }}</ref> 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 [[psychiatrist]]s, although some localities lack sufficient funding. |
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===Political imprisonment=== |
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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]]<ref name="Matvejević">{{cite book|last=Matvejević|first=Predrag|title=Between exile and asylum: an eastern epistolary|year=2004|publisher=Central European University Press|isbn=963-9241-85-7|pages=32|url=http://books.google.ru/books?id=qRrv8MqXMxYC&printsec=frontcover#PPA32,M1}}</ref> and [[China]].<ref name="LaFraniere">{{cite news|last1=LaFraniere|first1=Sharon|last2=Levin|first2=Dan|title=Assertive Chinese Held in Mental Wards|url=http://www.nytimes.com/2010/11/12/world/asia/12psych.html?_r=1&pagewanted=print|accessdate=22 March 2012|newspaper=[[The New York Times]]|date=11 November 2010}}</ref> |
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===Secure units=== |
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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. |
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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. |
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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. |
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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]];<ref>[http://www.merseycare.nhs.uk/services/clinical/high_secure/High_Secure_Services_Contact_Us.asp Official site], Accessed 2010-06-02</ref> [[Broadmoor Hospital]] in [[Crowthorne]], Berkshire and [[Rampton Secure Hospital]] in [[Retford]], [[Nottinghamshire]] and in Scotland is [[State Hospital Carstairs|The State Hospital]], Carstairs.<ref>[http://www.tsh.scot.nhs.uk/ Official site], Accessed 2010-06-02</ref> 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]]. |
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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.<ref>Georgie Parry‐Crooke (June 2009) [http://www.ohrn.nhs.uk/resource/policy/WMSSEvaluationFinalReport.pdf My life: in safe hands?]. Accessed 2010-06-02</ref> Irish units include those at prisons in Portlaise, Castelrea and Cork. |
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==Criticism== |
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American psychiatrist [[Thomas Szasz]] insisted that psychiatric hospitals are like prisons, not hospitals, and that psychiatrists who subject others to coercion function as judges and jailers not physicians.<ref name=Szasz>{{cite journal|last=Szasz|first=Thomas|authorlink=Thomas Szasz|title=The myth of mental illness: 50 years later|journal=[[The Psychiatrist]]|year=2011|volume=35|pages=179–182|doi=10.1192/pb.bp.110.031310|url=http://www.psychiatry.freeuk.com/Szasz50.pdf|accessdate=27 April 2012}}</ref> |
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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|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).<ref name="DeleuzePinelTuke">Deleuze and Guattari (1972) ''[[Anti-Oedipus]]'' p. 102</ref><ref name="FoucaultPinelTuke">[[Michel Foucault]] [1961] ''[[The History of Madness]]'', '''Routledge 2006, pp.490-1, 507-8, 510-1</ref> |
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[[Erving Goffman]] coined the term "[[Total Institution]]" for mental hospitals and similar places which took over and confined a person's whole life.<ref name="Davidson">{{cite book |last1=Davidson |first1=Larry |last2=Rakfeldt |first2=Jaak |last3=Strauss |first3=John (editors) |title=The Roots of the Recovery Movement in Psychiatry: Lessons Learned |url=http://books.google.ru/books?id=tp4L_1zw9ngC&printsec=frontcover#PPA150,M1 |location= |publisher=John Wiley and Sons |year=2010 |pages=150''' |isbn=88-464-5358-1}}</ref>{{rp|150}}<ref name="Wallace">{{cite book |last=Wallace |first=Samuel |title=Total Institutions |url=http://books.google.ru/books?id=F7uN3eHD1xQC&printsec=frontcover#PPA9,M1 |location= |publisher=Transaction Publishers |year=1971 |pages=9 |isbn=88-464-5358-1}}</ref>{{rp|9}} Goffman placed psychiatric hospitals in the same category as concentration camps, prisons, military organizations, orphanages, and monasteries.<ref name="Weinstein">{{cite journal |author=Weinstein R. |title=Goffman's Asylums and the Social Situation of Mental Patients |journal=Orthomolecular psychiatry |volume=11 |issue=N 4 |pages=267–274 |year=1982 |month= |pmid= |doi= |url=http://www.orthomolecular.org/library/jom/1982/pdf/1982-v11n04-p267.pdf}}</ref> In his book ''[[Asylums (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.<ref name="Lester">{{cite journal |author=Lester H., Gask L. |title=Delivering medical care for patients with serious mental illness or promoting a collaborative model of recovery? |journal=British Journal of Psychiatry |volume=188 |issue= 5|pages=401–402 |year=2006 |month=May |pmid=16648523 |doi=10.1192/bjp.bp.105.015933 |url=http://bjp.rcpsych.org/cgi/content/full/188/5/401}}</ref> |
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[[Franco Basaglia]], a leading Italian psychiatrist who inspired and was the architect of 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, and patients, doctors and nurses are all subjected (at different levels) to the same process of institutionalism.<ref name="Tansella">{{cite journal |author=Tansella M. |title=Community psychiatry without mental hospitals--the Italian experience: a review |journal=[[Journal of the Royal Society of Medicine]] |volume=79 |issue=11 |pages=664–669 |year=1986 |month=November |pmid=3795212 |pmc=1290535 |doi= }}</ref> |
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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.<ref name="Mosher">{{cite journal |author=Mosher L.R. |title=Soteria and other alternatives to acute psychiatric hospitalization: a personal and professional review |journal=[[Journal of Nervous and Mental Disease]] |volume=187 |issue=3 |pages=142–149 |year=1999 |month=March |pmid=10086470 |doi=10.1097/00005053-199903000-00003 |url=http://www.cmha.ca/data/1/rec_docs/1166_alternatives%20to%20acute%20psychiatric%20hospitalization.pdf}}</ref> |
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The [[anti-psychiatry]] movement coming to the fore in the 1960s has opposed many of the practices, conditions, or existence of mental hospitals. The [[Psychiatric survivors movement|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 generally does not have any issue with any psychiatric treatments that are consensual, provided that both parties are free to withdraw consent at any time. |
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===Not really voluntary=== |
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{{globalize/USA|section|date=December 2012}} |
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Some patients in psychiatric hospitals may remain confined until their psychiatrists consider them to no longer be dangerous, sometimes for the remainder of their lives. Some of the patients, while they are technically considered to be voluntary patients, have volunteered to be hospitalized in lieu of being subjected to penal actions by judicial systems. If they were to leave the hospital, they would be subject to imprisonment in penal institution. In some cases, the conditions inside psychiatric hospitals are actually more unpleasant - more punishing - than the penal institutions they replace. Long term involuntary commitment requires legal proceedings, but individuals may be held for shorter periods of time, for observation, upon the opinion of two doctors, usually one of which is a psychiatrist. Hospitals must annually advise all committed patients of their right to a hearing on whether they can be released. Additionally, a court-appointed psychiatrist must examine each patient annually. A full hearing is required at least every two years. Patients may also apply for release at any time and receive a full hearing on the application. <ref>{{cite news|url=http://www.cga.ct.gov/2002/rpt/2002-R-0848.htm | newspaper=OLR Research Report | title=Involuntary Commitment Law| date=Oct 2, 2002}} </ref> However, since patients may be isolated from the outside world, getting assistance in preparing for hearings may be difficult. The ability to contact a family member or lawyer, afforded to persons who are under arrest, may not be readily available to psychiatric patients. However patients may be afforded occasional opportunities to leave the institution temporarily, often accompanied by a visitor, and may be able to use this as an opportunity to leave permanently. |
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==See also== |
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{{Portal|Health and fitness}} |
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* [[Deinstitutionalisation]] |
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* [[History of mental illness]] |
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* [[History of psychiatric institutions]] |
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* [[Institutional syndrome]] |
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* [[Kirkbride Plan]] |
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* [[Mental health law]] |
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* [[MindFreedom International]] |
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* [[New Freedom Commission on Mental Health]] |
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* [[Psychiatric survivors movement]] |
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* [[Punitive psychiatry in the Soviet Union]] |
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* [[Salutogenesis]], a best-practice methodology for the design of psychiatric facilities. |
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* [[Treatment Advocacy Center]], involuntary treatment proponent group |
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''To see lists of individual establishments: view the categorical index for Psychiatric hospitals; which appears at the very bottom of this article.'' |
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{{-}} |
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==References== |
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{{Reflist|30em}} |
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==External links== |
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{{Commons category|Psychiatric institutions}} |
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* [http://resist.ca/~kirstena/pagecamarillo.html Camarillo State Mental Hospital History] |
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* [http://www.rootsweb.com/~asylums/ Historical Asylums website] |
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* [http://www.asylumprojects.org/ Asylum Projects] - Asylum wiki database |
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* {{Cite web |url=http://www.alternet.org/movies/56241/ |title=AlterNet: Movie Mix: Must-See Indy Film Exposes Cruel Teen Correction Programs |accessdate=2007-07-08 |format= |work=}} |
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* [http://www.nrc-pad.org National Resource Center on Psychiatric Advance Directives] |
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* [http://www.kirkbridebuildings.com/ Kirkbride Buildings] History and photographs of early psychiatric hospitals |
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*[http://www.thetimechamber.co.uk/sites/Hospital/History/List/theasylumlist.php TheTimeChamber Asylum List] Comprehensive List of Victorian Insane Asylums in the UK |
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{{Psychiatry}} |
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{{DEFAULTSORT:Psychiatric Hospital}} |
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[[Category:Psychiatric hospitals| ]] |
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[[Category:Hospital departments]] |
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[[Category:Total institutions]] |
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[[Category:Psychiatric institutions]] |
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Revision as of 16:36, 5 March 2013
Schizophrenia.