Should We Bring Back Mental Asylums?

newer meby Marvin Ross

Dr Dawson provided an excellent history of how much we have regressed in our treatment of those with mental illness in his five part series. Despite better (but not perfect) medications, and greater knowledge of the brain, we have, as he said, “For a significant number of mentally ill people (and their families) we have, over the past 30 years, reversed the reforms provoked by Dorothea Dix in 1843.”

Certainly, the statistics for Canada, the US and the UK, bear this out. The Canadian Journal of Psychiatry pointed out that there was a rapid closure of beds in the 1970s and 1980s but that was offset by an increase in days of care in the psychiatric units of general hospitals. They called this transinstitutionalization. But, by the 1990s the overall days of inpatient care began to decrease. Between 1985 to 1999 there was a decline of 41.6% in average days of care per 1000 pop in psychiatric hospitals and a decline of 33.7% in psych units in general hospitals. Days in hospital declined but there were more frequent stays for patients – the revolving door.

In a document by the Public Health Agency of Canada called the Human Face of Mental Illness, it was stated that “This discontinuity and inadequacy of care after hospitalization is common among seniors who have lived with schizophrenia for most of their lives. After being transferred from psychiatric institutions they may find themselves in long- term care facilities that generally have limited availability of mental health professionals.”

Meanwhile, there was a near-doubling in the total proportion of prison inmates in Canada with mental illnesses between 1997 and 2009. Prisoners often end up in segregation units and without adequate treatment because the prisons don’t have the staff or resources to properly care for them.

In the US according to the Treatment Advocacy Center, in 1955 there were 340 public psychiatric beds available per 100,000 U.S. citizens. By 2005, the number plummeted to a staggering 17 beds per 100,000 persons. And we know that the largest psychiatric facilities in the US are the jails in New York City, Chicago and LA.

The Guardian newspaper in the UK recently reported that more than 2,100 mental health beds have closed since April 2011, amounting to a 12% decline in the total number available. It also found that seven people had killed themselves since 2012 after being told there were no hospital beds for them.

On one occasion last year, there were no beds available for adults in England.

In 2011, Dr Peter Tyrer, a professor of community psychiatry at the Centre for Mental Health at Imperial College, London, wrote in the British Medical Journal that “I am now rueing the success of the community psychiatric movement in the UK, where the inane chant of “community good, hospital bad” has taken over every part of national policy. At some point in the steady reduction of psychiatric beds, from a maximum of 155 000 in 1954 to 27 000 in 2008 the downward slope has to level off or rise.”

Meanwhile, earlier this year, three medical ethicists at the University of Pennsylvania, Dominic Sisti, Andrea Segal and Ezekiel Emanuel, argued for a return of the mental asylum in the Journal of the American Medical Association. They said that their use of the word asylum wasn’t meant to be “intentionally provocative.”

“We’re hoping to reappropriate the term to get back to its original meaning, which is a place of safety, sanctuary, and healing, or at least dignified healing for people who are very sick.”

The United States, they said, now has 14 public psychiatric beds per 100,000 people, the same as in 1850. On average, Sisti said, countries in the European Union have 50 beds per 100,000.

On a personal level, author Katherine Flannery Dering whose book Shot in the Head discusses how she and her 8 siblings cared for a brother with schizophrenia, described the impact of what she called The Great Emptying on one of the talks that she gave. As she says, the number of people needing hospitals did not shrink as much as hospitals did.

Asylums (or psychiatric hospitals) do not have to be evil places where patients are abused or ignored. There is no reason they cannot be caring compassionate places that give patients the necessary time to heal or to protect them from the outside world if that is what they need.


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5 thoughts on “Should We Bring Back Mental Asylums?

  1. Another excellent discourse on the true landscape of ‘modern’ mental health services. I worked for a charitable organisation in Oxford England which was providing ‘asylum’ in a social care setting. Having come from a forty year NHS focussed career I was pleasantly suprised to see what can be provided. Unfortunately the fly in the ointment was, as you mention in this piece the limited availability of mental health professionals. Not only limited availability but they had little to offer and could rarely facvilitate access to in-patient beds in a timely fashion or allow people to have an effective lengthy of stay when hospitalised. The secret is to have an asylum of a cost effective size which is contained and not dispersed. The organisation also has a range of other more dispersed facilities and access to floating support once people have left the intensive services. See http://www.sitra.org/documents/do-we-really-make-a-difference-john-mcfadyen/ also http://response.org.uk/

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  2. Marvin, thanks again for giving readers the advantage of your well researched blogs, By synthesizing many facts in a single column, you provide an easily digestible way of sorting out the progression of mistakes we have made that allowed society to abandon humane care and treatment for society’s seriously mentally ill citizens.

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  3. Another possibility is to have small operations like our proposed Home on the Hill Supportive Housing initiative in Richmond Hill, where supportive housing is provided and families are welcome to participate in support services. The asylum often treated families as intruders in the past and this may have been one reason why abuses happened. Partnership with local politicians and community organizations would also be a healthy alternative to remaining solely within the current mental health system, where it has been documented that discrimination towards clients and families happen. Such an undertaking would make use of what the community has to offer and, in my opinion, raise the bar regarding how people with mental illness are viewed by society.

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  4. Though I recognize that many who would have in earlier times been kept too long in hospital, it has become clear to me that some will always need asylum for the long term with skilled professionals tending them 24/7.Beds for shorter periods will also be required for people who slip out of remission through no fault of their own. It is the nature of the very severe forms of mental illness. Anyone visiting a hospital can see that it is a brain thing. The growth area is forensic psychiatry. Why ? It is direct result of proper hospital safety nets that would admit people in a timely fashion to minimize collateral damage. I would agree with John Mcfadyen that the dearth of trained professionals makes matters a whole lot worth. A lot more on that subject later. I have met many ideal professionals, but given what they are expected to do it is no wonder the number decreases.

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  5. I think we need to address the sad state of our current facilities first. I was hospitalized against my will last January and sent to St. Joe’s psych after taking too many pills during a psychotic episode. During my stay I was not given clothing for the first 24 hours (not even underwear), the bathrooms were so foul and filthy they were almost unusable, I found dirty underwear in my bed and socks in my nightstand. I didn’t receive ANY of my medications while I was there, the only thing they wanted to give me was clonazepam – one of the drugs I had just overdosed on. I was left hallucinating and wandering around the hallways when I arrived, refused a wheel chair and suffered a serious hip and wrist injury after falling down. And when I passed my experience on to my GP he wasn’t surprised in the slightest. Everything I told him he had heard before from other patients.

    I would like to see the response from the general public if cancer or diabetes patients were treated this way. Shame on the entire system, and everyone in it who isn’t fighting tooth and nail to improve things. In the meantime, I would rather die than spend another day in that horror show.

    And then there’s the fact that there are no resources between GPs and hospitalization. I waited a year after my hospitalization to finally receive a follow up appointment to the mood clinic. A YEAR. In a city the size of Hamilton this should not be happening.

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