For many, the phrase “psychiatric asylum” conjures up haunting and disturbing images: lobotomy procedures, drugged and restrained patients, the creepy facility in the movie “Shutter Island,” the cruel Nurse Ratched from “One Flew Over the Cuckoo’s Nest.” But that image may be outdated.
In a provocative new paper published in the Journal of the American Medical Association, bioethicists at the University of Pennsylvania outline the crisis of mental-health care in the United States, and propose a solution: Rehabilitate the ill-reputed institution of the psychiatric asylum.
“It’s really not as radical as it sounds,” said Dominic A. Sisti, assistant professor of medical ethics, health policy, and psychiatry. Psychiatrists have been making arguments for expanding long-term inpatient care for some time, he says. In their call to “bring back the asylum,” Sisti and his colleagues speak of the original, 19th-century meaning of the term asylum: a place that is a safe sanctuary, that provides long-term care for the mentally ill. “It is time to build them—again,” they write.
Although psychiatric hospitals still exist, the dearth of long-term care options for the mentally ill in the U.S. is acute, the researchers say. State-run psychiatric facilities house 45,000 patients, less than a tenth of the number of patients they did in 1955. With the doubling of the U.S. population, the researchers write, this is a 95 percent decline.