Psychiatric hospital
Overview
 
Psychiatric hospitals, also known as mental hospitals, are hospital
Hospital
A hospital is a health care institution providing patient treatment by specialized staff and equipment. Hospitals often, but not always, provide for inpatient care or longer-term patient stays....

s 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.
Encyclopedia
Psychiatric hospitals, also known as mental hospitals, are hospital
Hospital
A hospital is a health care institution providing patient treatment by specialized staff and equipment. Hospitals often, but not always, provide for inpatient care or longer-term patient stays....

s 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
Voluntary commitment
Voluntary commitment is the act or practice of a person being admitted to a psychiatric hospital, or other mental health facility, voluntarily, and without the process of involuntary commitment...

, but involuntary commitment
Involuntary commitment
Involuntary commitment or civil commitment is a legal process through which an individual with symptoms of severe mental illness is court-ordered into treatment in a hospital or in the community ....

 is practiced when an individual may pose a significant danger to themselves or others.

History

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
Psychiatry
Psychiatry is the medical specialty devoted to the study and treatment of mental disorders. These mental disorders include various affective, behavioural, cognitive and perceptual abnormalities...

. 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
Psychiatry
Psychiatry is the medical specialty devoted to the study and treatment of mental disorders. These mental disorders include various affective, behavioural, cognitive and perceptual abnormalities...

, later known as psychiatry, as a medical specialism is not coincidental.

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 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
Psychotherapy
Psychotherapy is a general term referring to any form of therapeutic interaction or treatment contracted between a trained professional and a client or patient; family, couple or group...

. These treatments can be involuntary and are questioned by the Anti-Psychiatric movement
Anti-psychiatry
Anti-psychiatry is a configuration of groups and theoretical constructs that emerged in the 1960s, and questioned the fundamental assumptions and practices of psychiatry, such as its claim that it achieves universal, scientific objectivity. Its igniting influences were Michel Foucault, R.D. Laing,...

. Most psychiatric hospitals now restrict internet access and any device that can take photos.

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

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 are often features of such units. An example of this is the Three Bridges Unit, in the grounds of Hanwell Asylum
Hanwell Asylum
The County Asylum at Hanwell, also known as Hanwell Insane Asylum, and Hanwell Pauper and Lunatic Asylum, was built for the pauper insane and is now the West London Mental Health Trust ...

 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
Halfway house
The purpose of a halfway house, also called a recovery house or sober house, is generally to allow people to begin the process of reintegration with society, while still providing monitoring and support; this is generally believed to reduce the risk of recidivism or relapse when compared to a...

. 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 psychiatrist
Psychiatrist
A psychiatrist is a physician who specializes in the diagnosis and treatment of mental disorders. All psychiatrists are trained in diagnostic evaluation and in psychotherapy...

s, 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 and China
China
Chinese civilization may refer to:* China for more general discussion of the country.* Chinese culture* Greater China, the transnational community of ethnic Chinese.* History of China* Sinosphere, the area historically affected by Chinese culture...

.

Secure Units

In the UK, criminal courts or the Home Secretary
Home Secretary
The Secretary of State for the Home Department, commonly known as the Home Secretary, is the minister in charge of the Home Office of the United Kingdom, and one of the country's four Great Offices of State...

 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
National Health Service
The National Health Service is the shared name of three of the four publicly funded healthcare systems in the United Kingdom. They provide a comprehensive range of health services, the vast majority of which are free at the point of use to residents of the United Kingdom...

, 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
Ashworth Hospital
Ashworth Hospital is a high security psychiatric hospital at Maghull in the Metropolitan Borough of Sefton in Merseyside, England.Ashworth is one of only three high-security specialist psychiatric hospitals in England and Wales, along with Rampton and Broadmoor, that exist to work with people who...

 in Merseyside
Merseyside
Merseyside is a metropolitan county in North West England, with a population of 1,365,900. It encompasses the metropolitan area centred on both banks of the lower reaches of the Mersey Estuary, and comprises five metropolitan boroughs: Knowsley, St Helens, Sefton, Wirral, and the city of Liverpool...

; Broadmoor Hospital
Broadmoor Hospital
Broadmoor Hospital is a high-security psychiatric hospital at Crowthorne in the Borough of Bracknell Forest in Berkshire, England. It is the best known of the three high-security psychiatric hospitals in England, the other two being Ashworth and Rampton...

 in Crowthorne
Crowthorne
Crowthorne is also a suburb of Johannesburg, South AfricaCrowthorne is a village and civil parish in the Bracknell Forest district of south-eastern Berkshire. It has a population of 6,711...

, Berkshire and Rampton Secure Hospital
Rampton Secure Hospital
Rampton Secure Hospital is a high security psychiatric hospital near the village of Woodbeck between Retford and Rampton in the Bassetlaw District of Nottinghamshire, England...

 in Retford
Retford
Retford is a market town in Nottinghamshire in the East Midlands of England, located 31 miles from the city of Nottingham, and 23 miles west of Lincoln, in the district of Bassetlaw. The town is situated in a valley with the River Idle and the Chesterfield Canal running through the centre of the...

, Nottinghamshire
Nottinghamshire
Nottinghamshire is a county in the East Midlands of England, bordering South Yorkshire to the north-west, Lincolnshire to the east, Leicestershire to the south, and Derbyshire to the west...

 and in Scotland is The State Hospital, Carstairs. 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
Mental Health Act 1983
The Mental Health Act 1983 is an Act of the Parliament of the United Kingdom which applies to people in England and Wales. It covers the reception, care and treatment of mentally disordered persons, the management of their property and other related matters...

.

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. Irish units include those at prisons in Portlaise, Castelrea and Cork.

Anti-psychiatry objections

Some critics, notably psychiatrist
Psychiatrist
A psychiatrist is a physician who specializes in the diagnosis and treatment of mental disorders. All psychiatrists are trained in diagnostic evaluation and in psychotherapy...

 Dr. Thomas Szasz
Thomas Szasz
Thomas Stephen Szasz is a psychiatrist and academic. Since 1990 he has been Professor Emeritus of Psychiatry at the State University of New York Health Science Center in Syracuse, New York. He is a well-known social critic of the moral and scientific foundations of psychiatry, and of the social...

, have objected to calling mental hospitals "hospitals" (see anti-psychiatry
Anti-psychiatry
Anti-psychiatry is a configuration of groups and theoretical constructs that emerged in the 1960s, and questioned the fundamental assumptions and practices of psychiatry, such as its claim that it achieves universal, scientific objectivity. Its igniting influences were Michel Foucault, R.D. Laing,...

).

The French historian Michel Foucault
Michel Foucault
Michel Foucault , born Paul-Michel Foucault , was a French philosopher, social theorist and historian of ideas...

 is widely known for his comprehensive critique of the use and abuse of the mental hospital system in Madness and Civilization
Madness and Civilization
Madness and Civilization: A History of Insanity in the Age of Reason by Michel Foucault, is the English edition of Histoire de la folie à l'âge classique, a 1964 abridged edition of the 1961 Folie et déraison: Histoire de la folie à l'âge classique. An English translation of the complete 1961...

. He argued that Tuke and Pinel's asylum was a symbolic recreation of the condition of a child under a bourgeoisie
Bourgeoisie
In sociology and political science, bourgeoisie describes a range of groups across history. In the Western world, between the late 18th century and the present day, the bourgeoisie is a social class "characterized by their ownership of capital and their related culture." A member of the...

 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
Erving Goffman
Erving Goffman was a Canadian-born sociologist and writer.The 73rd president of American Sociological Association, Goffman's greatest contribution to social theory is his study of symbolic interaction in the form of dramaturgical perspective that began with his 1959 book The Presentation of Self...

 coined the term "Total Institution
Total institution
A total institution is place of work and residence where a great number of similarly situated people, cut off from the wider community for a considerable time, together lead an enclosed, formally administered round of life...

" for mental hospitals and similar places which took over and confined a person's whole life. Goffman placed psychiatric hospitals in the same category as concentration camps, prisons, military organizations, orphanages, and monasteries. 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.

Franco Basaglia
Franco Basaglia
Franco Basaglia was an Italian psychiatrist and neurologist, professor who proposed the dismantling of psychiatric hospitals, pioneer of the modern concept of mental health, Italian psychiatry reformer, charismatic leader in Italian psychiatry, figurehead and founder of Democratic...

, 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.

American psychiatrist Loren Mosher
Loren Mosher
Loren Richard Mosher was an American psychiatrist, clinical professor of psychiatry, expert on schizophrenia and the chief of the Center for Studies of Schizophrenia in the National Institute of Mental Health...

 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.

The anti-psychiatry
Anti-psychiatry
Anti-psychiatry is a configuration of groups and theoretical constructs that emerged in the 1960s, and questioned the fundamental assumptions and practices of psychiatry, such as its claim that it achieves universal, scientific objectivity. Its igniting influences were Michel Foucault, R.D. Laing,...

 movement coming to the fore in the 1960s oppose many of the practices, conditions, or existence of mental hospitals. The psychiatric consumer/survivor movement
Psychiatric survivors movement
The psychiatric survivors movement is a diverse association of individuals who are either currently clients of mental health services , or who consider themselves survivors of interventions by psychiatry, or who identify themselves as ex-patients of mental health services...

 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

  • Deinstitutionalisation
    Deinstitutionalisation
    Deinstitutionalization or deinstitutionalization is the process of replacing long-stay psychiatric hospitals with less isolated community mental health service for those diagnosed with a mental disorder or developmental disability. Deinstitutionalization can have multiple definitions; the first...

  • History of mental illness
    History of mental illness
    -Prehistoric times:There is limited evidence by which to judge the existence or nature of mental disorder prior to written records. Evolutionary psychology suggests that some of the underlying genetic dispositions, psychological mechanisms and social demands were present, although some disorders...

  • History of psychiatric institutions
    History of psychiatric institutions
    The story of the rise of the lunatic asylum and its gradual transformation into, and eventual replacement by, the modern psychiatric hospital, is also the story of the rise of organized, institutional psychiatry...

  • Institutional syndrome
  • Kirkbride Plan
    Kirkbride Plan
    The Kirkbride Plan refers to a system of mental asylum design advocated by Philadelphia psychiatrist Thomas Story Kirkbride in the mid-19th century.-History:The establishment of state mental hospitals in the U.S...

  • Mental health law
    Mental health law
    Mental health law is the area of the law that applies to persons with a diagnosis or possible diagnosis of mental illness, and to those involved in managing or treating such people.-Mental health law in general:...

  • MindFreedom International
    MindFreedom International
    MindFreedom International is an international coalition of over one hundred grassroots groups and thousands of individual members from fourteen nations. It was founded in 1990 to advocate against forced medication, medical restraints, and involuntary electroconvulsive therapy. Its stated mission is...

  • New Freedom Commission on Mental Health
    New Freedom Commission on Mental Health
    The controversial New Freedom Commission on Mental Health was established by U.S. President George W. Bush in April 2002 to conduct a comprehensive study of the U.S. mental health service delivery system and make recommendations based on its findings...

  • Psychiatric survivors movement
    Psychiatric survivors movement
    The psychiatric survivors movement is a diverse association of individuals who are either currently clients of mental health services , or who consider themselves survivors of interventions by psychiatry, or who identify themselves as ex-patients of mental health services...

  • Punitive psychiatry in the Soviet Union
  • Salutogenesis
    Salutogenesis
    Salutogenesis is a term coined by Aaron Antonovsky, a professor of medical sociology. The term describes an approach focusing on factors that support human health and well-being, rather than on factors that cause disease...

    , a best-practice methodology for the design of psychiatric facilities.
  • Treatment Advocacy Center
    Treatment Advocacy Center
    The Treatment Advocacy Center is national U.S. nonprofit organization dedicated to eliminating legal and other barriers to the timely and effective treatment of severe mental illness...

    , 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

The source of this article is wikipedia, the free encyclopedia.  The text of this article is licensed under the GFDL.
 
x
OK