It is commonly believed that in order to improve the situation of mental healthcare, that we need more psychiatric institutions. It is also true that the number of psychiatrists in India at the moment is too less to provide high quality healthcare to each individual. The two notions sound similar but aren’t exactly the same. In fact, the WHO says that we don’t need more psychiatric institutes. I have talked about this before in the article about Pyramid of Mental healthcare.
Why is it that psychiatric institutes are now being discouraged?
Psychiatric Institutions were Prisons
Psychiatric institutes like asylums were the main method of treatment of psychiatric patients in the 19th and 20th century. These institutes were believed to have a remedial environment which was necessary for treating mental illnesses. It was only around the 1950s that people actually started looking into what happens in a psychiatric institute.
Academicians started noticing how the routine of a person in an asylum was very similar to that of an incarcerated prisoner. They were often isolated, had to stick to strict routines and had to face alienation from their social roles.
Inside an asylum, a father of 2 and a faithful husband wasn’t treated as a human. He was rather seen as an illness. This alienation of people and categorizing into the same category ultimately harmed them. Even the workers in these asylums weren’t trained or sensitized enough to treat the patients with empathy. They were often reported to be cruel and abusive to the patients.
Moreover, the isolation of these mentally ill people from the society didn’t help anyone either. Cutting people off from society to make them more integrated in the society seems like a moronic idea now.
De-Institutionalization divides Opinions
It is still a raging debate in the psychiatry world. Whether we should move away from institutions or make more of them polarizes opinions. The WHO claims that if we move towards community care, we can increase the availability of mental healthcare and remove the stigma around mental illnesses as well. Some psychiatrists on the other hand claim that limiting the number of psychiatric institutes would reduce the quality of healthcare and make it more difficult to have a deeper look into the various intricacies of mental illnesses.
Personally, I believe that moving towards a community based healthcare system would be better for collectivistic cultures. It is important to stress that this doesn’t have to be the core of mental healthcare but can be the facilitator that psychiatric professionals need. We do need more psychiatrists but they need to be made available in already established general hospitals.
The more we isolate psychiatric care, the more it will scare people. We don’t need to make mental healthcare look scary. We need to make it accessible.
Chow and Priebe BMC Psychiatry 2013, 13:169 http://www.biomedcentral.com/1471-244X/13/169