By Morgan C. Shields and Ana Zeghibe
Morgan Shields is a PhD student at the Heller School for Social Policy and Management at Brandeis University. This past summer, while working at the Harvard T.H. Chan School of Public Health, Morgan mentored Ana Zeghibe, a high school student visiting from London, St. Paul’s Girls School. Together, they analyzed mainstream news accounts of harm towards patients of inpatient psychiatric care in both the United States and the United Kingdom.
While policymakers and reformers are concerned with access to and parity of mental healthcare, we desperately need more attention towards the monitoring and safety of such care, especially regarding inpatient care. Despite numerous cases of harm to consumers at psychiatric facilities, policymakers and advocates want to bring back long-term asylums as a remedy to the failing mental healthcare system.
Deinstitutionalization: Shared history and consequences
In the early 20th century, psychiatric consumers in both the U.S. and U.K. were often warehoused in long-term psychiatric hospitals. These hospitals became infamous for gross neglect and abuse. In the U.S. during the 1960s -70s, a convergence of disability activism, awareness, expanded government health insurance, and a desire for cheaper alternatives resulted in many psychiatric hospitals shutting down. The U.K. followed suit shortly thereafter with their “Care in the Community” scheme.
While U.S. and U.K. deinstitutionalization was a milestone towards increased human rights for an especially disenfranchised group, there have been some negative consequences due in part to lack of adequate community-based care, including an increase in homelessness and incarceration of persons with psychiatric diagnoses. In addition, some express concerns regarding violence, despite this fear being unfounded.
Nevertheless, homelessness, imprisonment, and fear of violence have catalyzed a push to bring back long-term asylums. Such arguments for regressing back to institutionalization are misguided and ignore the horrors of the past. Moreover, they do not recognize present day harms occurring within inpatient contexts and do not adequately focus on the impact that strengthened community supports could have.
News reports are our best source of data on harms to consumers as there exists no other data monitoring system (the closest measurement system we have focuses only on crude process domains of quality). Despite their different structures of healthcare financing, the U.S. and U.K. report similar harms towards consumers at psychiatric facilities, such as death, abuse, and neglect.
For example, in the U.S. Universal Health Services has been found culpable for fraud, understaffing and lack of staff credentials, and death of consumers due to gross negligence, medication toxicity, and suicide. At Tomah Veterans Affairs Medical Center, consumers were given large amounts of pain medication, resulting in death. This institution retaliated against whistleblowing staff by firing them, resulting in a clinical psychologist committing suicide. At the Center for Adolescent Treatment Services, youth were restrained physically and chemically for being annoying to staff, were sexually assaulted by staff, and were overmedicated.
In the U.K., The Priory Hospital Ticehurst House has had several stories reporting on the death of youth, neglect, and suicide. At the Linden Centre, a consumer died and staff falsified records by creating a care plan after the consumer’s death and post-dating it. At Berrywood Hospital, a consumer died due to an undiagnosed broken back. Staff ignored the consumer’s complaints, not taking her seriously.
Even in countries with radically different approaches to financing their healthcare systems, we see similar media accounts of harm specifically when it comes to inpatient psychiatric care. Suicide, sexual assault (especially for youth), negligence, and falsifying records were salient in the media accounts for both U.S. and U.K. At the systemic level, bed and staffing shortages were common and shared factors as well.
It is not clear why the U.S. and U.K. have such similar harms, but it might be due to a U.S.-U.K. shared conceptualization of psychological suffering, lack of consumer agency and power, professional stigma, and reliance on the medical model to treatment. Indeed, in places where mental differences are thought of differently relative to the medical model, such as in some developing countries, we do not see these harms or even much of an existence of inpatient psychiatry in general.
In interpreting our media analysis, it is important to note that news stories tend to focus on only the most extreme of cases. Further, the reporting of harms and their causes are influenced by mainstream rhetoric. Stories on emotional trauma and re-traumatization were absent, as well as consumer perspectives. While our brief summary of harms is not intended to be exhaustive, it points to a serious problem. We need a comprehensive surveillance system that could capture information on physical and non-physical harms within inpatient psychiatric facilities. Only then would we be able to understand the extent and nature of the issues at hand, at least at the institutional level.
Counterproductively, experiencing inpatient psychiatric care could be hurtful and even cost one’s life. There were human rights violations prior to deinstitutionalization and there are still similar harms. Knowing this, expanding inpatient care could be unethical. While people point to homelessness and incarceration as reason to bring back asylums, this might just be an easy and inhumane attempt to hide a problem that requires deep analysis of our culture, value of people, and true commitment to inclusion.