The old psychiatric hospitals had a horrific reputation. Abuse, misdiagnosis and bad treatment was fairly common. Nonetheless, I believe that they have a place in modern psychiatric treatment.
The move toward deinstitutionalisation came in the 1980s. The new model emphasises community care, and inpatient admits only for stabilising acute cases. And it’s not working. Acute inpatient units are holding people for months, even years. There are very few inpatient beds available for acute patients. And the current acute wards are not designed for long-term residents.
The blunt truth is that some people cannot be treated in an outpatient setting. They’re a risk to themselves or their community, or they need more intensive treatment than can be provided in outpatient care.
Some people need long-term hospitalisation to become well enough to live in the community. They need time to find the right combination of medications and skills in order to be able to function in a community setting. Consigning them to acute wards that are ill-equipped for long-term care is not good for them, and not good for the wards.
The stability of well-designed long-term residential care would be better for people who need such care. Seeing acute cases come and go while long-termers are stuck can be very demoralising. Being in a community of long-term residents would be easier than being in an acute ward.
Long-term facilities would also be able to have life-skills programmes that acute wards cannot. The aim of long-term care should not be to keep patients permanently, but to give them the tools needed to survive in the outside world. Life skills and education could be offered to help people do better in the community.
Learning therapeutic techniques to help in living a more normal life would be part of the treatment plan, and a sheltered environment to practise these skills before needing to use them on the outside would be useful.
The spectre of the old lunatic asylums looms over any proposal for long-term residential care. But I believe that while we need to learn from the past horrors that occurred, we also shake off the stigma and seriously consider the needs of the people being failed by the community care model.