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54-654: The Cassel Hospital is a psychiatric facility in a Grade II listed building at 1 Ham Common , Richmond , Ham in the London Borough of Richmond upon Thames . It is run by the West London NHS Trust . The hospital was founded and endowed by Ernest Cassel in England in 1919. It was initially for the treatment of " shell shock " victims. Originally at Swaylands in Penshurst , Kent, it moved to Stoke-on-Trent during

108-568: A controlled environment due to their psychiatric condition. Patients may choose voluntary commitment , but those deemed to pose a significant danger to themselves or others may be subject to involuntary commitment and treatment . In general hospitals, psychiatric wards or units serve a similar purpose. Modern psychiatric hospitals have evolved from the older concept of lunatic asylums , shifting focus from mere containment and restraint to evidence-based treatments that aim to help patients function in society. With successive waves of reform, and

162-530: A non-stimulant. Common stimulants: Professionals, such as David Rosenhan , Peter Breggin , Paula Caplan , Thomas Szasz and Stuart A. Kirk sustain that psychiatry engages "in the systematic medicalization of normality". More recently these concerns have come from insiders who have worked for and promoted the APA (e.g., Robert Spitzer , Allen Frances ). Scholars such as Cooper , Foucalt , Goffman , Deleuze and Szasz believe that pharmacological "treatment"

216-404: A noticeable effect as the regulation of receptors in the brain adapts. There are multiple classes of antidepressants which have different mechanisms of action. Another type of antidepressant is a monoamine oxidase inhibitor (MAOI), which is thought to block the action of monoamine oxidase , an enzyme that breaks down serotonin and norepinephrine . MAOIs are not used as first-line treatment due to

270-506: A number of institutions specializing only in the treatment of juveniles, particularly when dealing with drug abuse, self-harm, eating disorders, anxiety, depression or other mental illnesses. In the United Kingdom, long-term care facilities are now being replaced with smaller secure units, some within hospitals. Modern buildings, modern security, and being locally situated to help with reintegration into society once medication has stabilized

324-445: A resident physician . At the beginning of the 19th century there were a few thousand people housed in a variety of disparate institutions throughout England, but by 1900 that figure had grown to about 100,000. This growth coincided with the growth of alienism , later known as psychiatry, as a medical specialism. The treatment of inmates in early lunatic asylums was sometimes very brutal and focused on containment and restraint. In

378-514: A time, though this practice still is periodically employed in the United States , India , Japan , and other countries. Modern psychiatric hospitals evolved from, and eventually replaced, the older lunatic asylum. Their development also entails the rise of organized institutional psychiatry . Hospitals known as bimaristans were built in the Middle East in the early ninth century; the first

432-521: A whole new way of working that reduced dependence upon services and fostered patients' working collaboratively. Nurses were supported and taught to understand their reparative need, to challenge their sense of omnipotence and to rely on the patient group as the most useful resource. In 1948 Eileen Skellern came for her training and joined the staff in 1949. The hospital formally established a research department in 1995 and has collaborative relationships with University College London , Imperial College and

486-436: A wide range of substances with various types of psychoactive properties. The professional and commercial fields of pharmacology and psychopharmacology do not typically focus on psychedelic or recreational drugs , and so the majority of studies are conducted on psychiatric medication. While studies are conducted on all psychoactive drugs by both fields, psychopharmacology focuses on psychoactive and chemical interactions within

540-742: Is argued that this presents a risk of adverse effects, especially brain damage , in real-life mixed medication psychiatry that are not visible in the clinical trials of one medicine at a time (similar to mixed drug abuse causing significantly more damage than the additive effects of brain damages caused by using only one illegal drug). Outside clinical trials, there is evidence for an increase in mortality when psychiatric patients are transferred to polypharmacy with an increased number of medications being mixed. There are five main groups of psychiatric medications. Antidepressants are drugs used to treat clinical depression , and they are also often used for anxiety and other disorders. Most antidepressants will hinder

594-602: Is far less risk of patients harming themselves or others. In Dublin , the Central Mental Hospital performs a similar function. Community hospitals across the United States regularly discharge mental health patients, who are then typically referred to out-patient treatment and therapy. A study of community hospital discharge data from 2003 to 2011, however, found that mental health hospitalizations had increased for both children and adults. Compared to other hospital utilization, mental health discharges for children were

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648-404: Is not well understood. Common non-antipsychotic mood stabilizers include: A stimulant is a drug that stimulates the central nervous system, increasing arousal, attention and endurance. Stimulants are used in psychiatry to treat attention deficit-hyperactivity disorder . Because the medications can be addictive, patients with a history of drug abuse are typically monitored closely or treated with

702-439: Is only a placebo effect, and that administration of drugs is just a religion in disguise and ritualistic chemistry. Other scholars have argued against psychiatric medication in that significant aspects of mental illness are related to the psyche or environmental factors, but medication works exclusively on a pharmacological basis. Antipsychotics have been associated with decreases in brain volume over time, which may indicate

756-552: Is widely known for his comprehensive critique of the use and abuse of the mental hospital system in Madness and Civilization . He argued that Tuke and Pinel's asylum was a symbolic recreation of the condition of a child under a bourgeois family. It was a microcosm symbolizing the massive structures of bourgeois society and its values: relations of Family–Children (paternal authority), Fault–Punishment (immediate justice), Madness–Disorder (social and moral order). Erving Goffman coined

810-645: The Home Secretary can, under various sections of the Mental Health Act, order the detention of offenders in a psychiatric hospital, but the term "criminally insane" is no longer legally or medically recognized. Secure psychiatric units exist in all regions of the UK for this purpose; in addition, there are a few specialist hospitals which offer treatment with high levels of security. These facilities are divided into three main categories: High, Medium and Low Secure. Although

864-1086: The Isle of Man , and the Channel Islands , medium and low secure units exist but high secure units on the UK mainland are used for patients who qualify for the treatment under the Out of Area (Off-Island Placements) Referrals provision of the Mental Health Act 1983 . Among the three unit types, medium secure facilities are the most prevalent in the UK. As of 2009, there were 27 women-only units in England. Irish units include those at prisons in Portlaise, Castelrea, and Cork. Psychiatrist Thomas Szasz in Hungary has argued that psychiatric hospitals are like prisons unlike other kinds of hospitals, and that psychiatrists who coerce people (into treatment or involuntary commitment) function as judges and jailers, not physicians. Historian Michel Foucault

918-600: The Second World War . In 1948 it relocated to its present site at No. 1 Ham Common , Ham . The present hospital was originally a late 18th-century house known as Morgan House after its owner, philanthropist and writer, John Minter Morgan . Morgan died in 1854 and is buried in nearby St Andrew's Church, Ham . In 1863 it became home to the newly married Duc de Chartres . In 1879 it became West Heath Girls' School . The school moved to its present site in Sevenoaks , Kent in

972-514: The mental patient liberation movement . There are several different types of modern psychiatric hospitals, but all of them house people with mental illnesses of varying severity. In the United Kingdom , both crisis admissions and medium-term care are usually provided on acute admissions wards. Juvenile or youth wards in psychiatric hospitals or psychiatric wards are set aside for children or youth with mental illness. Long-term care facilities have

1026-475: The 10 most prescribed psychiatric drugs by number of prescriptions were alprazolam , sertraline , citalopram , fluoxetine , lorazepam , trazodone , escitalopram , duloxetine , bupropion XL , and venlafaxine XR . Psychiatric medications are prescription medications , requiring a prescription from a physician , such as a psychiatrist , or a psychiatric nurse practitioner , PMHNP, before they can be obtained. Some U.S. states and territories , following

1080-633: The 1930s, and the building became the Lawrence Hall Hotel until its purchase by the Cassel Foundation in 1947. The building was Grade II listed in 1950. In 2023, the West London NHS Trust indicated that it planned to vacate the site and allow its redevelopment at a future date. The hospital developed approaches informed by psychoanalytic thinking alongside medicinal interventions, techniques of group and individual psychotherapy . It

1134-437: The 1950s onward, benzodiazepines were originally thought to be non-addictive at therapeutic doses, but are now known to cause withdrawal symptoms similar to barbiturates and alcohol . Benzodiazepines are generally recommended for short-term use. Z-drugs are a group of drugs with effects generally similar to benzodiazepines, which are used in the treatment of insomnia. Common benzodiazepines and z-drugs include: In 1949,

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1188-631: The 1973 academic investigation by Rosenhan and other similar experiments , several journalists have been willingly admitted to hospitals in order to conduct undercover journalism . These include: Psychiatric medication A psychiatric or psychotropic medication is a psychoactive drug taken to exert an effect on the chemical makeup of the brain and nervous system. Thus, these medications are used to treat mental illnesses . These medications are typically made of synthetic chemical compounds and are usually prescribed in psychiatric settings, potentially involuntarily during commitment . Since

1242-536: The Australian John Cade discovered that lithium salts could control mania , reducing the frequency and severity of manic episodes. This introduced the now popular drug lithium carbonate to the mainstream public, as well as being the first mood stabilizer to be approved by the U.S. Food & Drug Administration . Besides lithium, several anticonvulsants and atypical antipsychotics have mood stabilizing activity. The mechanism of action of mood stabilizers

1296-674: The Centre for the Economics of Mental Health at the Institute of Psychiatry , London. It is now a psychotherapeutic community which provides day, residential, and outreach services for young people and adults with severe and enduring personality disorders . Psychiatric hospital Psychiatric hospitals vary considerably in size and classification. Some specialize in short-term or outpatient therapy for low-risk patients , while others provide long-term care for individuals requiring routine assistance or

1350-499: The aggression of some of the patients. In Western Europe , the first idea and set up for a proper mental hospital entered through Spain . A member of the Mercedarian Order named Juan Gilaberto Jofré traveled frequently to Islamic countries and observed several institutions that confined the insane. He proposed the founding of an institution exclusive for "sick people who had to be treated by doctors", something very modern for

1404-866: The brain. Physicians who research psychiatric medications are psychopharmacologists , specialists in the field of psychopharmacology. Psychiatric disorders, including depression, psychosis, and bipolar disorder, are common and gaining more acceptance in the United States. The most commonly used classes of medications for these disorders are antidepressants, antipsychotics, and lithium. Unfortunately, these medications are associated with significant neurotoxicities. Psychiatric medications carry risk for neurotoxic adverse effects . The occurrence of neurotoxic effects can potentially reduce drug compliance . Some adverse effects can be treated symptomatically by using adjunct medications such as anticholinergics (antimuscarinics). Some rebound or withdrawal adverse effects, such as

1458-447: The breakdown of serotonin , norepinephrine , and/or dopamine . A commonly used class of antidepressants are called selective serotonin reuptake inhibitors (SSRIs), which act on serotonin transporters in the brain to increase levels of serotonin in the synaptic cleft . Another is the serotonin-norepinephrine reuptake inhibitors (SNRIs), which increase both serotonin and norepinephrine. Antidepressants will often take 3–5 weeks to have

1512-929: The condition are often features of such units. Examples of this include the Three Bridges Unit at St Bernard's Hospital in West London and the John Munroe Hospital in Staffordshire . These units have the goal of treatment and rehabilitation to allow for transition back into society within a short time-frame, usually lasting two or three years. Not all patients' treatment meets this criterion, however, leading larger hospitals to retain this role. These hospitals provide stabilization and rehabilitation for those who are actively experiencing uncontrolled symptoms of mental disorders such as depression, bipolar disorders, eating disorders, and so on. One type of institution for

1566-505: The creation of the prescriptive authority for psychologists movement , have granted prescriptive privileges to clinical psychologists who have undergone additional specialised education and training in medical psychology . In addition to the familiar dosage in pill form, psychiatric medications are evolving into more novel methods of drug delivery. New technologies include transdermal , transmucosal , inhalation , suppository or depot injection supplements. Psychopharmacology studies

1620-473: The difficulty of distinguishing sane patients from insane patients. Franco Basaglia , a leading psychiatrist who inspired and planned the psychiatric reform in Italy , also defined the mental hospital as an oppressive, locked, and total institution in which prison-like, punitive rules are applied, in order to gradually eliminate its own contents. Patients, doctors and nurses are all subjected (at different levels) to

1674-399: The focus in these units is to make life as normal as possible for patients while continuing treatment to the point where they can be discharged. However, patients are usually still not allowed to hold their own medications in their rooms because of the risk of an impulsive overdose. While some open units are physically unlocked, other open units still use locked entrances and exits, depending on

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1728-545: The fore in the 1960s has opposed many of the practices, conditions, or existence of mental hospitals; due to the extreme conditions in them. The psychiatric consumer/survivor movement has often objected to or campaigned against conditions in mental hospitals or their use, voluntarily or involuntarily. The mental patient liberation movement emphatically opposes involuntary treatment but it generally does not object to any psychiatric treatments that are consensual, provided that both parties can withdraw consent at any time. Alongside

1782-667: The goal of treatment and rehabilitation within a short time-frame (two or three years). Another institution for the mentally ill is a community-based halfway house . In the United States, there are high acuity and low acuity crisis facilities (or Crisis Stabilization Units). High acuity crisis stabilization units serve individuals who are actively suicidal, violent, or intoxicated. Low acuity crisis facilities include peer respites, social detoxes, and other programs to serve individuals who are not actively suicidal/violent. Open psychiatric units are not as secure as crisis stabilization units. They are not used for acutely suicidal people; instead,

1836-413: The introduction of effective evidence-based treatments, most modern psychiatric hospitals emphasize treatment, usually including a combination of psychiatric medications and psychotherapy , that assist patients in functioning in the outside world. Many countries have prohibited the use of physical restraints on patients, which includes tying psychiatric patients to their beds for days or even months at

1890-429: The introduction of effective evidence-based treatments, modern psychiatric hospitals provide a primary emphasis on treatment; and further, they attempt—where possible—to help patients control their own lives in the outside world with the use of a combination of psychiatric drugs and psychotherapy . These treatments can be involuntary. Involuntary treatments are among the many psychiatric practices which are questioned by

1944-410: The late 19th and early 20th centuries, psychiatric institutions ceased using terms such as "madness", "lunacy" or "insanity", which assumed a unitary psychosis, and began instead splitting into numerous mental diseases, including catatonia, melancholia, and dementia praecox, which is now known as schizophrenia . In 1961, sociologist Erving Goffman described a theory of the " total institution " and

1998-722: The lowest while the most rapidly increasing hospitalizations were for adults under 64. Some units have been opened to provide therapeutically enhanced Treatment, a subcategory to the three main hospital unit types. In the UK, high secure hospitals exist, including Ashworth Hospital in Merseyside , Broadmoor Hospital in Crowthorne , Rampton Secure Hospital in Retford , and the State Hospital in Carstairs , Scotland . In Northern Ireland ,

2052-531: The many 'pauper lunatics'. Nine counties first applied, the first public asylum opening in 1812 in Nottinghamshire . In 1828, the newly appointed Commissioners in Lunacy were empowered to license and supervise private asylums. The Lunacy Act 1845 made the construction of asylums in every county compulsory with regular inspections on behalf of the Home Secretary , and required asylums to have written regulations and

2106-471: The mental institution may be used for the incarceration of political prisoners as a form of punishment. One notable historical example was the use of punitive psychiatry in the Soviet Union and China . Like the former Soviet Union and China, Belarus also has used punitive psychiatry toward political opponents and critics of current government in modern times. In the United Kingdom, criminal courts or

2160-415: The mentally ill is a community-based halfway house . These facilities provide assisted living for an extended period of time for patients with mental illnesses, and they often aid in the transition to self-sufficiency. These institutions are considered to be one of the most important parts of a mental health system by many psychiatrists , although some localities lack sufficient funding. In some countries,

2214-429: The mid-20th century, such medications have been leading treatments for a broad range of mental disorders and have decreased the need for long-term hospitalization, thereby lowering the cost of mental health care. The recidivism or rehospitalization of the mentally ill is at a high rate in many countries, and the reasons for the relapses are under research. Several significant psychiatric drugs were developed in

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2268-542: The mid-20th century. In 1948, lithium was first used as a psychiatric medicine. One of the most important discoveries was chlorpromazine , an antipsychotic that was first given to a patient in 1952. In the same decade, Julius Axelrod carried out research into the interaction of neurotransmitters, which provided a foundation for the development of further drugs. The popularity of these drugs have increased significantly since then, with millions prescribed annually. The introduction of these drugs brought profound changes to

2322-528: The phrase "Maximum Secure" is often used in the media, there is no such classification. "Local Secure" is a common misnomer for Low Secure units, as patients are often detained there by local criminal courts for psychiatric assessment before sentencing. Run by the National Health Service , these facilities which provide psychiatric assessments can also provide treatment and accommodation in a safe hospital environment which prevents absconding. Thus there

2376-547: The possibility of a sudden or severe emergence or re-emergence of psychosis in antipsychotic withdrawal, may appear when the drugs are discontinued, or discontinued too rapidly. While clinical trials of psychiatric medications, like other medications, typically test medicines separately, there is a practice in psychiatry (more so than in somatic medicine) to use polypharmacy in combinations of medicines that have never been tested together in clinical trials (though all medicines involved have passed clinical trials separately). It

2430-443: The process by which it takes efforts to maintain predictable and regular behavior on the part of both "guard" and "captor", suggesting that many of the features of such institutions serve the ritual function of ensuring that both classes of people know their function and social role , in other words of " institutionalizing " them. Asylums as a key text in the development of deinstitutionalization . With successive waves of reform and

2484-1059: The risk of hypertensive crisis related to the consumption of foods containing the amino acid tyramine . Common antidepressants: Antipsychotics are drugs used to treat various symptoms of psychosis, such as those caused by psychotic disorders or schizophrenia . Atypical antipsychotics are also used as mood stabilizers in the treatment of bipolar disorder , and they can augment the action of antidepressants in major depressive disorder . Antipsychotics are sometimes referred to as neuroleptic drugs and some antipsychotics are branded "major tranquilizers". There are two categories of antipsychotics: typical antipsychotics and atypical antipsychotics . Most antipsychotics are available only by prescription. Common antipsychotics: Benzodiazepines are effective as hypnotics, anxiolytics, anticonvulsants, myorelaxants and amnesics. Having less proclivity for overdose and toxicity, they have widely supplanted barbiturates , although barbiturates (such as pentobarbital ) are still used for euthanasia . Developed in

2538-456: The same process of institutionalism. American psychiatrist Loren Mosher noticed that the psychiatric institution itself gave him master classes in the art of the "total institution": labeling, unnecessary dependency, the induction and perpetuation of powerlessness, the degradation ceremony , authoritarianism, and the primacy of institutional needs over the patients, whom it was ostensibly there to serve. The anti-psychiatry movement coming to

2592-570: The term " total institution " for mental hospitals and similar places which took over and confined a person's whole life. Goffman placed psychiatric hospitals in the same category as concentration camps , prisons , military organizations, orphanages , and monasteries. In his book Asylums Goffman describes how the institutionalisation process socialises people into the role of a good patient, someone "dull, harmless and inconspicuous"; in turn, it reinforces notions of chronicity in severe mental illness. The Rosenhan experiment of 1973 demonstrated

2646-455: The time. The foundation was carried out in 1409 thanks to several wealthy men from Valencia who contributed funds for its completion. It was considered the first institution in the world at that time specialized in the treatment of mental illnesses. Later on, physicians, including Philippe Pinel at Bicêtre Hospital in France and William Tuke at York Retreat in England, began to advocate for

2700-430: The treatment of mental illness. It meant that more patients could be treated without the need for confinement in a psychiatric hospital . It was one of the key reasons why many countries moved towards deinstitutionalization , closing many of these hospitals so that patients could be treated at home, in general hospitals and smaller facilities. Use of physical restraints such as straitjackets also declined. As of 2013,

2754-482: The type of patients admitted. Another type of psychiatric hospital is medium term, which provides care lasting several weeks. Most drugs used for psychiatric purposes take several weeks to take effect, and the main purpose of these hospitals is to monitor the patient for the first few weeks of therapy to ensure the treatment is effective. Juvenile wards are sections of psychiatric hospitals or psychiatric wards set aside for children with mental illness. However, there are

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2808-631: The viewing of mental illness as a disorder that required compassionate treatment that would aid in the rehabilitation of the victim. In the Western world, the arrival of institutionalisation as a solution to the problem of madness was very much an advent of the nineteenth century. The first public mental asylums were established in Britain; the passing of the County Asylums Act 1808 empowered magistrates to build rate-supported asylums in every county to house

2862-617: Was built in Baghdad under the leadership of Harun al-Rashid . While not devoted solely to patients with psychiatric disorders, early psychiatric hospitals often contained wards for patients exhibiting mania or other psychological distress. Because of cultural taboos against refusing to care for one's family members, mentally ill patients would be surrendered to a bimaristan only if the patient demonstrated violence, incurable chronic illness, or some other extremely debilitating ailment. Psychological wards were typically enclosed by iron bars owing to

2916-418: Was here that Tom Main , along with Doreen Wedell (the hospital's Matron from 1946 to 1963), pioneered the concept of a therapeutic community in the late 1940s. Together they pioneered and developed the concept of psychosocial nursing. By promoting and being proud of the role of the nurse – rather than try to imitate therapists; working alongside the patient in everyday activities, Weddell & Main developed

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