Psychiatric hospital

Once called a lunatic asylum, a psychiatric hospital, also known as a mental hospital, is an inpatient treatment center for patients with serious mental disorders such as schizophrenia, bipolar disorder, and severe depression. A move toward deinstitutionalization in the 1950s and 1960s along with the passage of the Community Mental Health Centers Act of 1963 caused most state psychiatric hospitals in the United States to close. As of 2019, there were only 620 private psychiatric hospitals in the country, a number not sufficient enough to provide care for those who need it. Furthermore, since these facilities are private, the cost is out of reach for many people with mental illnesses.

History

The history of the psychiatric hospital dates back to the early eighteenth century, when individuals with mental illnesses began to receive care in separate wards in private hospitals and almshouses, which were houses for the poor that were built by charitable organizations. Prior to the establishment of these wards, patients with severe mental illnesses were cared for at home by their families. However, some patients with serious mental illnesses were prone to violence and a danger to their caregivers.

Moral Treatment

In the nineteenth century, those with psychiatric disorders began to be institutionalized in asylums where they received “moral treatment,” which centered on the idea that the mentally ill might eventually be cured if they were treated with kindness and learned to think rationally using a part of their brain not affected by the psychiatric disorder. These asylums were constructed in peaceful country settings to encourage relaxation and recreation. The Friends Asylum, established by the Quaker community in Philadelphia in 1814, was the first asylum to implement moral treatment. Unlike later asylums, however, the Friends Asylum was run by a lay staff and not medical professionals. Soon other similar institutions run by physicians were established, such as the Bloomingdale Insane Asylum in New York City in 1816 and the Institute of the Pennsylvania Hospital in Philadelphia in 1841. The latter incorporated the philosophies of Thomas Kirkbride, who was the medical superintendent there. Kirkbride developed a prototype for public insane asylums based on moral treatment. His plan called for no more than 250 patients per facility, which would have areas where patients had access to sunshine and fresh air. Facilities following Kirkbride’s plan were often large, elaborate Victorian-era buildings with extensive grounds.

State Facilities

Psychiatric facilities following the Kirkbride prototype were significantly better than those of the past but were only available to patients who could afford them; the cost to stay in these facilities was too high for poor individuals with mental illnesses.

Dorothea Dix, a New England school teacher who became an advocate for the mentally ill, witnessed the terrible conditions under which the mentally ill from poor families were forced to live in. Dix lobbied for forty years for the US government to provide psychiatric facilities for the poor, and by the 1870s, the US government funded the construction of thirty-two state psychiatric hospitals.

Harsh Criticism

At the time, professionals considered institutionalization the best way to treat and care for patients with mental illnesses. Additionally, institutionalization relieved families of the burden of having to care for individuals with serious psychiatric disorders. However, state psychiatric hospitals came under fire in the 1850s after widespread reports that they were underfunded, understaffed, and overcrowded. States were not prepared to fund the large number of patients needing admission to these facilities.

Mental hospitals were accused of keeping patients in unhealthy and dangerous conditions and violating their human rights. Contributing to the overcrowding was the admission of many elderly patients into state psychiatric hospitals. Local governments redefined dementia as a mental illness to avoid having to pay for the care of the elderly in almshouses or public hospitals. This practice continued even though elderly patients with dementia did not respond well to institutionalization.

The superintendents of psychiatric hospitals responded by opening training schools for nurses within their facilities in the 1860s and 1870s, a practice that had yielded positive results in Europe. Unlike those in traditional hospitals, training schools in asylums admitted men, which substantially increased the number of trained caregivers. While helpful, these efforts were not enough to alter the negative perception of psychiatric hospitals.

By the 1900s, most psychiatrists contended that institutionalization should be used only as a last resort. Furthermore, state funding was inadequate to properly maintain the enormous structures erected under Kirkbride’s plan, which led to the closure of some state psychiatric hospitals. By the twentieth century, the remaining state psychiatric hospitals were extremely overcrowded. For example, Weston State Hospital (formerly Trans-Alleghany Lunatic Asylum) in West Virginia housed more than 2,600 patients at its peak in the 1950s even though it was designed to house only 250.

Deinstitutionalization

By the mid-1950s, a trend toward deinstitutionalization and outpatient treatment began, in part because of the availability of antipsychotic drugs to treat serious mental illnesses such as schizophrenia and bipolar disorder. It was also believed that community-based mental health treatments were better for patients than being in an asylum. Psychiatrists thought patients would have a better quality of life if they were living at home and treated in their communities.

The Community Mental Health Centers Act of 1963 was ultimately responsible for the closure of many of the remaining state psychiatric hospitals. The act imposed strict requirements for admission to a state psychiatric hospital. Only individuals who were an imminent danger to themselves and others could be institutionalized.

While the trend toward deinstitutionalization continues into the twentieth-first century, it is not without its share of criticisms. Studies have shown that individuals with mental illnesses living in private homes do not receive proper medical care and often suffer from poor health and loneliness. When families cannot care for the mentally ill, they are moved to nursing homes, which are usually not equipped to handle psychiatric disorders.

In the twenty-first century, only a few state psychiatric hospitals remain open. Patients with mental illnesses more often receive short-term care and are then discharged, sometimes to homelessness.

Overview

As of 2019, the United States faced a severe shortage of inpatient care facilities for the mentally ill. While some patients responded well to deinstitutionalization and community-based programs, others with serious and chronic psychiatric disorders needed long-term inpatient care. However, getting such care was difficult if not impossible. Before being released, many patients in state psychiatric institutions were given new medications and placed in community-care programs but wound up homeless. Others ended up in jail or prison, which the psychiatric community dubs “the nation’s largest health care facilities.”

According to the American Hospital Association (AHA), as of 2019, there were 620 non-federal psychiatric hospitals in the United States. This amounts to about 14 beds per 100,000 people. And those who manage to find a bed may not be able to pay for it. Most of these private psychiatric hospitals do not accept insurance and may charge more than $30,000 a month. Many low-income patients rely on Medicaid for mental health care, but a legal provision prohibits the federal government from paying for long-term institutional care.

Because of this, those experiencing a severe mental health crisis must go to an emergency room, where the staff is not trained to treat them. Sometimes patients with mental illnesses are “boarded” in emergency rooms or jails until a bed is available in a psychiatric hospital. During this time, they may spend weeks strapped down and in isolation.

Modern options other than long-term care in a psychiatric hospital include day treatment centers where patients may receive medication management and therapy and attend classes on managing their mental illness. Short-term mental health inpatient units are available in some hospitals. These wards typically handle emergencies such as an attempted suicide.

Bibliography

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D’Antonio, Patricia. “History of Psychiatric Hospitals.” Penn Nursing, University of Pennsylvania School of Nursing, www.nursing.upenn.edu/nhhc/nurses-institutions-caring/history-of-psychiatric-hospitals/.Accessed 4 June 2019.

“Mental Institutions.” Brought to Life Science Museum, broughttolife.sciencemuseum.org.uk/broughttolife/themes/menalhealthandillness/mentalinstitutions. Accessed 4 June 2019.

Pan, Deanna. “TIMELINE: Deinstitutionalization And Its Consequences.” Mother Jones, 29 Apr. 2013, www.pbs.org/wgbh/pages/frontline/shows/asylums/special/excerpt.html.Accessed 4 June 2019.

Raphelson, Samantha. “How The Loss Of US Psychiatric Hospitals Led To A Mental Health Crisis.” National Public Radio, 30 Nov. 2017, www.npr.org/2017/11/30/567477160/how-the-loss-of-u-s-psychiatric-hospitals-led-to-a-mental-health-crisis. Accessed 4 June 2019.

Ruffalo, Mark L. “The American Mental Asylum: A Remnant of History.” Psychology Today, 13 July 2018, www.psychologytoday.com/us/blog/freud-fluoxetine/201807/the-american-mental-asylum-remnant-history. Accessed 4 June 2019.

Torrey, E. Fuller. “Deinstitutionalization: A Psychiatric ‘Titanic’.” Frontline, www.pbs.org/wgbh/pages/frontline/shows/asylums/special/excerpt.html. Accessed 4 June 2019.