(Mar. 15, 2016) What does "asylum" mean in the context of mental illness treatment?
In popular usage, "asylum" has long been linked to state psychiatric hospitals, once known as "insane asylums." What asylum should mean, two authors maintain in a recent publication, is "sanctuary" - a place that provides "protection, safety, security and social support."
In "Rediscovering the concept of asylum for persons with serious mental illness," H. Richard Lamb, MD,* and Linda E. Weinberger, PhD, call for a recognition that many individuals with severe mental illness still need the functions state hospitals once performed in order to live optimally.
The Functions of Asylum
They identify five such functions:
- Lowering stress
- Providing protection and social support
- Matching demands for performance to capabilities
- Providing adequate treatment services
- Supplying structure
"Asylum can be provided in the home by the patient's family or in a community facility, such as a board-and-care home," the authors write in the Journal of the American Academy of Psychiatry and the Law. "In many cases, the structure of a psychiatric hospital is needed."
"Serious problems will most likely arise whenever a community lacks adequate equivalents for the full range of functions traditionally served by state mental hospitals. This includes the provision of asylum to those patients who need it. Indeed, it is apparent that many of the problems plaguing deinstitutionalization today derive, first, from our failure to recognize that some psychiatric patients with serious mental illness still have a need for asylum and, second, from our failure to offer that asylum even when we recognize the necessity."
Practical Realities
The authors describe four situations in which the concept of asylum has practical impacts:
- Rehabilitation. Effective rehabilitation can reduce the need for asylum but, for individuals in need of shelter or structure, "the elements of asylum often need to be supplied concurrently if rehabilitation programs are to achieve maximum results."
- Expectations. There is "a narrow line" between two dangers in treatment - too much and too little stimulation - and it needs to be walked with a recognition that "fruitless efforts to push people to adjust to a lifestyle beyond their capabilities" causes the patients anguish and runs the risk of contributing to their relapse.
- Institutionalism. This syndrome of withdrawal, disinterest and excessive reliance on other institutions was once thought to be entirely the result of living in institutions providing asylum. Increasingly, institutionalism is viewed at least in part as a reflection of the schizophrenic disease process. "A place of asylum should include treatment interventions that increase the individual's ability to tolerate stress. Testing these interventions in a safe and supportive environment can assist in assuring successful transition to less structured settings in the community."
- Incarceration. Mentally ill offenders have additional needs for the functions of asylum when they are released from jails and prisons. Offenders without access to such functions are at higher risk for reoffending and relapse.
"Treating persons with serious mental illness requires more than just making the correct diagnosis, prescribing the right medications and providing the appropriate psychotherapeutic approach," Lamb and Weinberger conclude. "There should be an in-depth understanding of patients' needs for structure and their ability to cope with stress, as well as an assurance that they are in suitable living situations. Above all, the importance of asylum and sanctuary cannot be underestimated."
* H. Richard Lamb is a member of the Treatment Advocacy Center Board of Directors
Doris A. Fuller
Chief of Research and Public Affairs
References
Lamb, H. Richard, Weinberger, Linda E. (1 March 2016). (1 March 2016). Rediscovering the concept of asylum for persons with serious mental illness. Journal of the American Academy of Psychiatry and the Law.
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