Volume 10 Issue 7 July, 2019
In my 15 years in Psychiatry, I have trained in the United Kingdom and in Singapore, before returning to practice in my native city in India. I have been fortunate to witness Psychiatry in varied socio cultural contexts. Working in the last remnants of the mental asylum system made me reflect on deinstitutionalization.
The history of institutional psychiatric care is a fascinating one, and the shift to more community-based care in recent decades comes with challenges and rewards. Our culture has a more family-based role in the care of people with severe and enduring mental illnesses. Though this may provide loving and reliable care, it also brings a burden of care giver stress and exploitation of vulnerable patients. Conversely, the United Kingdom has a socialistic health care system, the National Health Service. This is more geared to a cultural system where the individual is supported by government-provided health and social services, with minimal expectations of support from family. This was previously provided by mental asylums such as the infamous Bedlam Hospital; since the 1980s, a gradual shift to community-based resettlement, mental health care and social support has occurred. I was fortunate to work for some years in a Rehabilitation service which covered both long-term institutionalized patients as well as others being rehabilitated to live and work independently in the community. I was fascinated by the hospital-an imposing Victorian building which had been built with 20 wards that had previously accommodated up to 1200 patients! However, in the previous decades, so many people had been moved to community placements and out reach care that the numbers had dwindled to around 300, with many wards shutdown. The psychiatric nurses-especially the ones who had worked there for decades-would relate tales of paranormal experiences on nights shifts; anyone who has spent time in these asylums will feel that different atmosphere. I also enjoyed talking to the long-term patients, most of whom were elderly and had spent over 40 years living in the hospital!
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