A group of bioethicists at the University of Pennsylvania are recommending reestablishment of mental asylums in a new paper titled “Improving Long-term Psychiatric Care, Bring Back the Asylum.”
Lead author Dominic Sisti says the use of the word “asylum” in the paper — featured in the Journal of the American Medical Association — 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,” Sisti says.
The Philadelphia Inquirer reports:
In the essay, the Penn team said the number of patients in the country’s state psychiatric facilities fell from 560,000 in 1955 to 45,000 as a result of the deinstitutionalization movement. The United States 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.
Pennsylvania has about 1,390 patients in its state psychiatric hospitals, with room for 1,450. The highest number on record was 35,000 inpatients in 1966. The New Jersey Department of Human Services did not respond to a request for information.
The bioethicists, who do not shrink from multi-syllable words, argue that what really happened was not deinstitutionalization but transinstitutionalization. That means that at least some residents of mental hospitals did not thrive in their communities, as hoped, but shifted to inappropriate institutions, most notably prisons.
“Prisons have become our largest mental health facility,” Sisti said.
An estimated 10 million U.S. residents have serious mental illnesses, according to the article. And many of them – especially those with severe schizophrenia and bipolar disorder – cycle among the street, hospitals, and jails.
While it is clear that the country did not create enough community services, the ethicists argue that some seriously mentally ill people need inpatient care because they “cannot live alone, cannot care for themselves, or are a danger to themselves and others.”
The deinstitutionalization movement began in earnest in the 1960s due to several factors — horrific conditions in some (mental) hospitals (remember One Flew Over the Cuckoo’s Nest?), development of better psychiatric drugs, and laws/court decisions which greatly limited involuntary institutionalization.
Contributing in the legal realm were the Supreme Court case O’Connor v. Donaldson (pushed by the ACLU) and California’s Lanterman-Petris-Short Act, which served as a national model.
Critics say deinstitutionalization has contributed to homelessness and, as noted in the article, incarceration of the mentally ill.
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