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A psychiatric hospital, also known as a mental health hospital, a behavioral health hospital, or an asylum is a specialized medical facility that focuses on the treatment of severe Mental disorder. These institutions cater to patients with conditions such as schizophrenia, bipolar disorder, major depressive disorder, and Eating disorder, among others.
In general hospitals, psychiatric wards or units serve a similar purpose. Modern psychiatric hospitals have evolved from the older concept of lunatic asylum, shifting focus from mere containment and restraint to evidence-based treatments that aim to help patients function in society.
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With successive waves of reform, and the introduction of effective evidence-based treatments, most modern psychiatric hospitals emphasize treatment, usually including a combination of psychiatric medications and psychotherapy, that assist patients in functioning in the outside world. Many countries have prohibited the use of physical restraints on patients, which includes tying psychiatric patients to their beds for days or even months at a time,長谷川利夫. (2016). 精神科医療における隔離・ 身体拘束実態調査 ～その急増の背景要因を探り縮減への道筋を考える～. 病院・地域精神医学, 59(1), 18–21. though this practice still is periodically employed in the United States, India, Japan, and other countries.
Because of cultural taboos against refusing to care for one's family members, mentally ill patients would be surrendered to a bimaristan only if the patient demonstrated violence, incurable chronic illness, or some other extremely debilitating ailment.Youssef, H. A., Youssef, F. A., & Dening, T. R. (1996). Evidence for the existence of schizophrenia in medieval Islamic society. History of Psychiatry, 7(25), 055–62. Psychological wards were typically enclosed by iron bars owing to the aggression of some of the patients.
In Western Europe, the first idea and set up for a proper mental hospital entered through Spain. A member of the Mercedarian Order named Juan Gilaberto Jofré traveled 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 from Valencia who 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, including Philippe Pinel at Bicêtre Hospital in France and William Tuke at York Retreat in 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 of institutionalisation as 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 the County Asylums Act 1808 empowered magistrates to build rate-supported asylums in every county to house the many 'pauper lunatics'. Nine counties first applied, the first public asylum opening in 1812 in Nottinghamshire. In 1828, the newly appointed Commissioners in Lunacy were empowered to license and supervise private asylums. The Lunacy Act 1845 made the construction of asylums in every county compulsory with regular inspections on behalf of the Home Secretary, and required asylums to have written regulations and a resident physician.Unsworth, Clive."Law and Lunacy in Psychiatry's 'Golden Age'", Oxford Journal of Legal Studies. Vol. 13, No. 4. (Winter, 1993), pp. 482.
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 of psychiatry, later known as psychiatry, as a medical specialism.Porter, Roy (2006). Madmen: A Social History of Madhouses, Mad-Doctors & Lunatics. Tempus: p. 14. 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 as schizophrenia.
In 1961, sociologist Erving Goffman described a theory
of 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 and social role, in other words of "institutionalizing" them. Asylums as a key text in the development of deinstitutionalization.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 of and psychotherapy. These treatments can be involuntary. Involuntary treatments are among the many psychiatric practices which are questioned by the Anti-Psychiatry.
In America history in the 1980s after the "12,225,000 Acre Bill" it was emphasized that care would be given in asylums instead of housing the individuals in jails, poorhouses, or having them live on the streets. Due to the decrease over the years of psychiatric hospitals available depending on the state the availability of space and beds for new patients has drastically decreased.
As of 2020, the statistics of mental illness among inmates in jails and juvenile wards range from 15% to 20%. Because of this, many juvenile wards and prisons have opened an inpatient mental health unit within their facility.
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.
In the United States long-term care facilities are used for individuals with severe and continuous mental health struggles. These hospitals provide a different form of care compared to other psychiatric hospitals; this type is designed to provide comprehensive care over an extended period of time, higher level of support and care, as well as heavy monitoring of patients. Within these facilities the care can be better adapted to best fit each individual patient, this allows for a more patient centered focus on the form of care they are receiving.
Run by the National 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. In Dublin, the Central Mental Hospital performs a similar function.
In the UK, high security hospitals exist, including Ashworth Hospital in Merseyside, Official site, Accessed 2 June 2010 Broadmoor Hospital in Crowthorne, Rampton Secure Hospital in Retford, and the State Hospital in Carstairs, Scotland. Official site, Accessed 2 June 2010 In Northern Ireland, the Isle of Man, and the Channel 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 the Mental 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.Georgie Parry‐Crooke (June 2009) My life: in safe hands?. Accessed 2 June 2010 Irish units include those at prisons in Portlaise, Castelrea, and Cork.
Erving Goffman coined 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 as concentration camps, , military organizations, , and monasteries. In his 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. The Rosenhan experiment of 1973 demonstrated the difficulty of distinguishing sane patients from insane patients.Franco Basaglia, a leading psychiatrist who inspired and planned 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. Patients, doctors and nurses are all subjected (at different levels) to the same process of institutionalism. 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 Cashiering, authoritarianism, and the primacy of institutional needs over the patients, whom it was ostensibly there to serve.
The anti-psychiatry movement 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. The 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 it generally does not object to any psychiatric treatments that are consensual, provided that both parties can withdraw consent at any time.
While there is a lot of criticism to the set up and the form of care psychiatric hospitals provide, there is the more prominent issue of stigmatization from other individuals and the communities surrounding these hospitals. There has been an increase in the stigmatization towards individuals who receive professional mental health care in psychiatric hospitals. Stigmatization has a major impact on not only the patients in these hospitals but also the clients of so-called alternative settings. Having this stigma can cause future patients and individuals who need this care to be more hesitant to get the care due to the fear of future judgement and being a victim of this stigmatization.
Some other criticism that can occur is by peers. This can have a direct impact on the patients. This alone can cause them not to feel as they can share or seek help from a professional mental health provider.
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