History of hospitalization
The journey of hospitalization for mental health patients has been a complex one, reflecting the changing attitude of society, and the evolution of medical knowledge and patient care. From unethical and cruel practices to today’s inclusive, community-based therapy, psychiatric treatment has come a long way.
Isolation: A medieval solution
Up until the 1800s, mental health was not considered a legitimate domain of health. People with mental illness were marginalized and relegated to institutions that focused on keeping them out of society. Many of these patients were removed from their homes and subjected to strange and inhuman practices in these facilities.
Additionally, they were “treated” using methods which included ice water baths, physical restraint using straitjackets and solitary confinement. The hygiene and sanitation conditions in these institutions were questionable and overcrowding was the norm. There was no concept of treatment and all patients were treated the same irrespective of the kind of mental health issues they suffered from.
Cycles of Reform
The Cycle of Reform is the evolution of mental healthcare in the United States, in four periods:
- The Moral Treatment Era
- The Mental Hygiene Movement
- Community Mental Health Movement and Deinstitutionalization
- Community Support Era
Moral treatment era
The Age of Reason paved the way for moral treatment, which saw the need for a more compassionate approach towards patients.
Asylums were transformed into idyllic settings with occupational treatment, recreational activities, and nurturing providers. The idea was to provide a safe space for patients to rest and recuperate.
The hope of moral treatment was to have small therapeutic hospitals. However, with a limited understanding of psychiatric illness and growing patient populations, they eventually resorted to containment.
The Mental Hygiene Era
The early 1900’s saw some revival of moral treatment in the form of the mental hygiene movement, which endorsed that mental illness was treatable. They saw the benefit of early identification and treatment as a strategy to reduce the severity and reoccurrence of mental health issues.
The movement resulted in the construction of psychiatric hospitals across the United States, but their reach left out two categories of patients – the chronically ill and the marginalized.
Despite the promise of forging new scientific advancements with social reform, the hospitals were unable to address chronic mental illness or change the general atmosphere of mental healthcare.
This, once again, led to state mental hospitals becoming custodial care facilities for the poor and chronically ill.
Community mental health movement and deinstitutionalization
After World War 2, great efforts were made to reshape the mental health systems.
One landmark milestone was the synthesis of chlorpromazine, the first antipsychotic drug in the 1950s. This pioneered the treatment of mental illnesses and helped phase out earlier practices of restraint and containment.
The goal of the community mental health movement was to treat patients within the community itself, rather than institutionalizing them. However, this approach overlooked the shortcomings of community-based care in the case of severe mental illness. This left many patients homeless or living in squalid conditions.
The consumer-survivor-ex-patient movement
The 60s and 70s saw the rise of a movement by ex-patients that originally aimed at identifying the abuse patients were subjected to in psychiatric hospital settings. It eventually led to a model of empowerment that emphasized the importance of patients’ involvement in choosing their own course of treatment. This was the foundation of a patient-centric approach to treatment that continues till date.
The Community Support Era
The Community Support Reform (CSP) emerged in the 80s. It advocated for a system of social and community support aimed at improving the quality of life of those with chronic mental illness. The support included psychosocial rehabilitation, supportive living, employment support, case management, and medical and mental healthcare.
The inclusion of the patient in defining the system provides for active interaction between patients in different stages of recovery. The validation and empathy gained from sharing experiences worked as agencies of hope to all those in the process of recovery.
Hospitalization today
The focus on patient-centric care continues in the current system of hospitalization offering psychiatric rehabilitation, integrated care, and assisted living, if necessary.
Psychiatric rehabilitation focuses on helping the patient reach an optimal level of functioning to achieve their life goals. In addition, they also help them develop social and vocational skills required to integrate with mainstream society. Once the treatment is over, they return to their home and resume their role in society.
For those who don’t have a place to go, assisted living offers a variety of home-like living arrangements and provides a supportive environment integrated with mental health services. Patients can avail services such as housekeeping, accounting, nutrition and medication so that they can focus their energies on their work and other activities. This empowers them to live lives of dignity and fulfillment.
The success of hospitalization as a legitimate medical intervention cannot be measured by the number of beds occupied in facilities. It lies in a patient being able to access the right kind of treatment when they need it, for as long as they need it, and of their own accord.
References
Admin-Risepoint. (2025, January 24). A History of Mental Illness Treatment: Obsolete Practices. CSP Global. https://online.csp.edu/resources/article/history-of-mental-illness-treatment/
White Swan Foundation, & White Swan Foundation. (2015, June 30). What is psychiatric rehabilitation? White Swan Foundation. https://www.whiteswanfoundation.org/mental-health-matters/understanding-mental-health/what-is-psychiatric-rehabilitation
History of psychiatric hospitals. (n.d.). https://www.nursing.upenn.edu/nhhc/nurses-institutions-caring/history-of-psychiatric-hospitals/
George, P., Jones, N., Goldman, H., & Rosenblatt, A. (2023b). Cycles of reform in the history of psychosis treatment in the United States. SSM – Mental Health, 3, 100205. https://doi.org/10.1016/j.ssmmh.2023.100205
Lamb, H. R., & Bachrach, L. L. (2001). Some perspectives on deinstitutionalization. Psychiatric Services, 52(8), 1039–1045. https://doi.org/10.1176/appi.ps.52.8.1039
