Psychiatric Assylums Flashcards
What does “achieving asylum” require?
1) offering sanctuary (protection, safety, security, and social support for individuals with SMI experiencing considerable stress)
2) providing adequate treatment services for SMI and comorbid disorders (such as substance abuse) including medication and therapy
3) structure (ie, adequate housing, appropriate security and low staff-to patient ratio, limits on inappropriate/violent behaviour)
4) treatment interventions that increase the individual’s ability to tolerate stress
5) flexibility regarding duration of stay (some patients might need more time, others less)
How did deinstitutionalisation impact individuals with SMI (where are they now)?
- 350,000 persons with SMI are in US jails and prisons
- 250,000 persons with SMI are homeless in the US
Why are prisons not considered asylums?
- They provide structure but not the other amenities of asylums such as relief from stress and therapy
- The staff are not always trained to recognize SMI
- Double stigma from being in prison and having SMI
What is “adaptation by decompression”?
When individuals with SMI find refuge at home or in facilities away from life’s pressures where there is support, structure, and some treatment (medication)
What is the relationship between asylum and rehabilitation?
- rehabilitation goes a step beyond asylum and may reduce the need for it
- vocational and social rehab programs can enhance quality of life for individuals with SMIs
- support and protective elements of asylums should be built into rehab programs
- rehab programs may increase vocational ability, autonomy and social functioning
What are the components of accepting the limitations of many persons with SMI?
1) normalization of the patient’s environment as much as possible
2) realizing that this ideal won’t be achieved for every patient, but that doesn’t make them failures
3) there are benefits to assisting a person to live their most functional lives, however that compares to the general population, to prevent re-emergence of psychopathology from too much stimulation or too little
What is insitutionalism?
A syndrome characterized by lack of initiative, apathy, withdrawal, submissiveness to authority, excessive dependence on the institution, and feelings of worthlessness and dehumanization
- originally attributed to living in and adapting to an institution
- however, now known that it is probably (at least partially) attributable to the schizophrenic process and dependence on environment with minimal social stimulation/activity
What are the problems associated with decarceration of mentally ill prisoners due to overcrowding of prisons and unsustainable costs?
- appropriate community residential and treatment programs may not be keeping pace with the need
- many individuals incarcerated for years are not able to navigate community living without monitoring and support
- risk for reoffending and decompensation increase without support
What are Hughes objections to the idea of asylums?
1) asylums are often not very nice places (dehumanizing and abusive)
2) asylums were total institutions that encouraged stigma
3) people who shouldn’t have been there ended up incarcerated there
4) they promote prejudice and paternalism (infantilizing attitudes)
5) if they could be run humanely, they would have been already (we’ve had approximately a century to get it right)
What is “intelligent kindness”?
A binding, creative and problem-solving force that inspires and focuses the imagination and goodwill, directing attention and efforts toward building relationships with patients, recognizing their needs, and treating them well.
