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[[Image:Francisco Goya - Casa de locos.jpg|thumb|''[[Il manicomio|Casa de locos]]'', [[Francisco Goya]], [[1815]].]]
Un '''ospedale psichiatrico''', in passato conosciuto come '''manicomio''', è un [[ospedale]] specializzato nella cura dei [[disturbi mentali]].
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I riformatori, come la statunitense [[Dorothea Dix]], iniziarono a sostenere un atteggiamento più umano e progressivo verso i malati di mente. Alcuni venivano motivati da un dovere cristiano nei confronti di cittadini malati. Negli Stati Uniti, ad esempio, numerosi stati stabilirono che le strutture per la cura della salute mentale fossero pagate con i soldi dei contribuenti (e spesso con i contributi dei parenti dei pazienti ricoverati). Questi istituti centralizzati erano spesso legati a vari enti governativi, anche se la qualità dei trattamenti e del servizio variava notevolmente da struttura a struttura. Essi erano in genere geograficamente isolati, situati lontano dalle aree urbane perché il costo per l'acquisizione degli ampi spazi necessari era molto minore e perché c'era meno opposizione politica alla costruzione di un manicomio molto al di fuori dei centri abitati. Molti ospedali statali negli Stati Uniti furono costruiti tra il 1850 e il 1860 con il [[piano Kirkbride]] (sviluppato dallo psichiatra [[Thomas Story Kirkbride]]), che prevedeva la costruzione di strutture con uno stile architettonico particolare che avrebbe dovuto infondere effetti curativi.<ref>{{Cita libro|cognome=Yanni|nome=Carla|titolo=The Architecture of Madness: Insane Asylums in the United States|editore=Minnesota University Press|città=Minneapolis|anno=2007|url=http://books.google.com/books?id=fJOC_rSW1kgC&lpg=PP1&pg=PP1#v=onepage&q=&f=false |isbn=978-0-8166-4939-6}}</ref> In molti stati americani furono realizzate così grandi architetture che spesso assomigliavano ai grandi palazzi europei, anche se i finanziamenti per il programma erano in realtà piuttosto limitati. Molti pazienti contestarono il trasferimento spesso forzato dagli ospedali privati alle strutture statali. Alcuni pazienti del Retreat Brattleboro cercarono di nascondersi quando giunsero i funzionari statali arrivati in loco per trasferirli al nuovo Waterbury State Hospital. Questo calo del numero dei pazienti portò al crollo di molti istituti privati.
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==20th century==
===Radical politics===
In February 1919, the first [[Soviet (council)|soviet]] in the [[British Isles]] was established at [[Monaghan Lunatic Asylum]], in [[Monaghan]], [[Ireland]]. This led to the claim by [[Joseph Devlin]] in the [[House of Commons of the United Kingdom|House of Commons]] that "that the only successfully conducted institutions in Ireland are the lunatic asylums"<ref>[http://hansard.millbanksystems.com/commons/1919/feb/20/monaghan-lunatic-asylum Hansard], 20 February 1919, accessed 18 July 2010</ref>
 
===Terapie fisiche===
Una serie di terapie fisiche radicali furono sviluppate nell'Europa centrale e continentale durante gli '10, '20 e soprattutto durante gli anni '30. Tra questi, ricordiamo l' innovativa terapia della malaria per la [[paralisi generale del malato psichico]] (o [[neurosifilide]]) sviluppata dallo psichiatra austriaco [[Julius Wagner-Jauregg]] che la usò per la prima volta nel 1917 e grazie alla quale vinse il [(Premio Nobel)] nel 1927.<ref>{{Cita pubblicazione | doi = 10.1177/0957154X0001104403 | autore = Brown Edward M | anno = 2000 | titolo = Why Wagner-Jauregg won the Nobel Prize for discovering malaria therapy for General Paresis of the Insane | url = | rivista = History of Psychiatry | volume = 11 | numero = 44| pagine = 371–382 }}</ref>
 
This treatment heralded the beginning of a radical and experimental era in psychiatric medicine that increasingly broke with an asylum based culture of therapeutic nihilism in the treatment of chronic [[psychiatric disorders]],<ref>Ugo Cerletti, for instance, described psychiatry during the interwar period as a "funereal science". Quoted in Shorter, Edward (1997). ''A History of Psychiatry: From the Era of the Asylum to the Age of Prozac''. Wiley: p. 218</ref> most particularly [[dementia praecox]] (increasingly known as [[schizophrenia]] from the 1910s, although the two terms were used more or less interchangeably until at least the end of the 1930s), which were typically regarded as [[hereditary]] degenerative disorders and therefore unamenable to any therapeutic intervention.<ref>{{Cita pubblicazione | autore = Hoenig J | anno = 1995 | titolo = Schizophrenia. In Berrios, German and Porter, Roy (Eds.), ''A History of Clinical Psychiatry''. Athlone: p. 337; Meduna, L.J. (1985). Autobiography of L.J. Meduna | url = | rivista = Convulsive Therapy | volume = 1 | numero = 1| page = 53 }}</ref> Malarial therapy was followed in 1920 by [[barbiturate]] induced [[deep sleep therapy]] to treat [[dementia praecox]], which was popularized by the Swiss psychiatrist [[Jakob Klaesi]]. In 1933 the Viennese based psychiatrist [[Manfred Sakel]] introduced [[insulin shock therapy]] and in August 1934 [[Ladislas J. Meduna]], a Hungarian neuropathologist and psychiatrist working in [[Budapest]], introduced [[cardiazol]] shock therapy ([[cardiazol]] is the tradename of the chemical compound [[pentylenetetrazol]], known by the tradename [[metrazol]] in the [[United States]]), which was the first convulsive or seizure therapy for a [[psychiatric disorder]]. Again, both of these therapies were initially targeted at curing [[dementia praecox]]. [[Cardiazol]] shock therapy, founded on the theoretical notion that there existed a biological antagonism between [[schizophrenia]] and [[epilepsy]] and that therefore inducing epiletiform fits in schizophrenic patients might effect a cure, was superseded by [[electroconvulsive therapy]] (ECT), invented by the Italian neurologist [[Ugo Cerletti]] in 1938.<ref>Shorter, Edward (1997). ''A History of Psychiatry''. Wiley: pp. 190-225.</ref> In 1935 the Portuguese neurologist [[Egas Moniz]] devised the leucotomy, a surgical procedure targeting the brain's frontal lobes. This was shortly thereafter adapted by [[Walter Freeman (neurologist)|Walter Freeman]] and James W. Watts in what is known as Freeman-Watts procedure or the standard prefrontal [[lobotomy]]. From 1946, Freeman developed the transorbital lobotomy, using a device akin to an ice-pick. This was an "office" procedure which did not have to be performed in a surgical theatre and took as little as fifteen minutes to complete. Freeman is credited with the popularisation of the technique in the United States. In 1949, 5074 lobotomies were carried out in the United States and by 1951 18,608 people had undergone the controversial procedure in that country.<ref>Shorter, Edward (1997).''A History of Psychiatry: From the Era of the Asylum to the Age of Prozac''. Wiley: pp. 226-229.</ref>
 
In modern times, insulin shock therapy and lobotomies are viewed as being almost as barbaric as the Bedlam "treatments", although the insulin shock therapy was still seen as the only option which produced any noticeable effect on patients. ECT is still used in the West, but it is seen as a last resort for treatment of mood disorders, and is administered much more safely than in the past.<ref>{{Cita libro|autore=Yanni, Carla. |titolo=The Architecture of Madness: Insane Asylums in the United States (Architecture, Landscape and Amer Culture) |editore=[[University of Minnesota Press]] |data=2007-04-12 |id=ISBN 978-0-8166-4940-2 |edizione=1 |pagine=53–62 |url=http://books.google.com/books?id=fJOC_rSW1kgC&lpg=PP1&pg=PP1#v=onepage&q=&f=false}}</ref> Elsewhere, particularly in [[India]], use of ECT is reportedly increasing, as a cost-effective alternative to drug treatment. The effect of a shock on an overly excitable patient often allowed these patients to be discharged to their homes, which was seen by administrators (and often guardians) as a preferable solution to institutionalization. Lobotomies were performed in the hundreds from the 1930s to the 1950s, and were ultimately replaced with modern psychotropic drugs.
 
=== Eugenics movement ===
==== Compulsory sterilization of the "feeble-minded" ====
{{Main|compulsory sterilization|Buck v. Bell}}
{{Expand section|date=January 2010}}
The [[eugenics]] movement of the early 20th century led to a number of countries enacting laws for the compulsory sterilization of the "feeble minded", which resulted in the forced sterilization of numerous psychiatric inmates.{{Citation needed|date=January 2010}} As late as the 1950s, laws in [[Japan]] allowed the forcible sterilization of patients with psychiatric illnesses.{{Citation needed|date=January 2010}}
 
==== Germany and occupied Europe: Nazi euthanasia program ====
{{Main|Action T4}}
{{Expand section|date=November 2009}}
Under [[Nazi Germany]], the [[Aktion T4]] [[euthanasia]] program resulted in the killings of thousands of the mentally ill housed in state institutions. In 1939, the Nazis secretly began to exterminate the mentally ill in a euthanasia campaign. Around 6,000 disabled babies, children and teenagers were murdered by starvation or lethal injection.<ref name="Genocide">{{Cita pubblicazione |autore=Torrey E.F., Yolken R.H. |titolo=Psychiatric Genocide: Nazi Attempts to Eradicate Schizophrenia |rivista=[[Schizophrenia Bulletin]] |volume= 36|numero= 1|pagine=1–7 |anno=2009 |mese=September 16 |id=PMID 19759092|pmc= 2800142|doi=10.1093/schbul/sbp097 |url=http://www.schizophreniaforum.org/images/livedisc/PsychiatricGenocide.pdf}}</ref>
 
===Drugs===
 
The twentieth century saw the development of the first effective [[psychiatric drug]]s.
 
The first [[neuroleptics|antipsychotic drug]], [[chlorpromazine]] (known under the trade name [[Largactil]] in Europe and [[Thorazine]] in the United States), was first synthesised in France in 1950. [[Pierre Deniker]], a psychiatrist of the Saint-Anne Psychiatric Centre in Paris, is credited with first recognising the specificity of action of the drug in psychosis in 1952. Deniker travelled with a colleague to the United States and Canada promoting the drug at medical conferences in 1954. The first publication regarding its use in North America was made in the same year by the Canadian psychiatrist [[Heinz Lehmann]], who was based in Montreal. Also in 1954 another antipsychotic, [[reserpine]], was first used by an American psychiatrist based in New York, Nathan S. Kline. At a Paris based colloquium on [[neuroleptics]] (antipsychotics) in 1955 a series of psychiatric studies were presented by, among others, [[Hans Hoff]] (Vienna), Aksel{{Who|date=January 2010}} (Istanbul), Felix Labarth (Basle), [[Linford Rees]] (London), Sarro{{Who|date=January 2010}} (Barcelona), [[Manfred Bleuler]] (Zurich), [[William Mayer-Gross]] (Birmingham), Winford{{Who|date=January 2010}} (Washington) and Denber{{Who|date=January 2010}} (New York) attesting to the effective and concordant action of the new drugs in the treatment of psychosis.{{Citation needed|date=January 2010}}
 
The new antipsychotics had an immense impact on the lives of psychiatrists and patients. For instance, [[Henry Ey]], a French psychiatrist at Bonneval, related that between 1921 and 1937 only 6 per cent of patients suffering from schizophrenia and chronic delirium were discharged from his institution. The comparable figure for the period from 1955 to 1967, after the introduction of chlorpromazine, was 67 per cent. Between 1955 and 1968 the residential psychiatric population in the United States dropped by 30 per cent.<ref>Thuillier, Jean (1999). ''Ten Years that Changed the Face of Mental Illness''. Trans. Gordon Hickish. Martin Dunitz: pp. 110,114, 121-123, 130. ISBN 1-85317-886-1</ref> Newly developed [[antidepressants]] were used to treat cases of [[clinical depression|depression]], and the introduction of [[muscle relaxants]] allowed [[Electroconvulsive therapy|ECT]] to be used in a modified form for the treatment of severe depression and a few other disorders. {{Citation needed|date=November 2009}}
 
The discovery of the [[mood stabilizing]] effect of [[lithium carbonate]] by [[John Cade]] in 1948 would eventually revolutionize the treatment of [[bipolar disorder]], although its use was banned in the United States until the 1970s.{{Citation needed|date=November 2009}}
 
The use of [[psychosurgery]] was narrowed to a very small number of people for specific indications.{{Which?|date=January 2010}}{{Citation needed|date=November 2009}} New treatments led to reductions in the number of patients in mental hospitals.{{Citation needed|date=November 2009}}
 
=== Country-specific/regional events ===
==== United States: Reform in the 1940s ====
From 1942 to 1947, [[conscientious objectors]] in the US assigned to psychiatric hospitals under [[Civilian Public Service]] exposed abuses throughout the psychiatric care system and were instrumental in reforms of the 1940s and 1950s. The CPS reformers were especially active at the [[Philadelphia State Hospital]] where four [[Society of Friends|Quakers]] initiated ''The Attendant'' magazine as a way to communicate ideas and promote reform. This periodical later became ''The Psychiatric Aide'', a professional journal for mental health workers. On May 6, 1946, ''[[Life Magazine|Life]]'' magazine printed an exposé of the psychiatric system by [[Albert Q. Maisel]] based on the reports of COs.<ref>{{Cita libro|url=http://books.google.com/books?id=BlUEAAAAMBAJ&pg=PA102|titolo=Bedlam 1946|autore=Albert Q. Maisel|editore=LIFE magazine|pagine=102|data=1946-May-6}}</ref> Another effort of CPS, namely the ''Mental Hygiene Project'', became the [[National Mental Health Foundation]]. Initially skeptical about the value of Civilian Public Service, [[Eleanor Roosevelt]], impressed by the changes introduced by COs in the mental health system, became a sponsor of ''the National Mental Health Foundation'' and actively inspired other prominent citizens including [[Owen J. Roberts]], [[Pearl Buck]] and [[Harry Emerson Fosdick]] to join her in advancing the organization's objectives of reform and humane treatment of patients.{{Citation needed|date=November 2009}}
 
==== Psychiatric internment as a political device ====
{{See also|Political abuse of psychiatry|Political abuse of psychiatry in the Soviet Union}}
 
Psychiatrists around the world have been involved in the suppression of individual rights by states wherein the definitions of mental disease had been expanded to include political disobedience.<ref name=Semple>{{Cita libro|cognome=Semple|nome=David|last2=Smyth|first2=Roger|last3=Burns|first3=Jonathan|titolo=Oxford handbook of psychiatry|anno=2005|editore=Oxford University Press|città=Oxford|id=ISBN 0-19-852783-7|pagine=6|url=http://books.google.com/books?id=1MeRuoTs0loC&pg=PA6}}</ref>{{rp|6}} Nowadays, in many countries, political prisoners are sometimes confined to mental institutions and abused therein.<ref name="Noll">{{Cita libro|cognome=Noll|nome=Richard|titolo=The encyclopedia of schizophrenia and other psychotic disorders|anno=2007|editore=Infobase Publishing|id=ISBN 0-8160-6405-9|pagine=3|url=http://books.google.ru/books?id=jzoJxps189IC&pg=PA3}}</ref>{{rp|3}} Psychiatry possesses a built-in capacity for abuse which is greater than in other areas of medicine.<ref name="Medicine betrayed">{{Cita libro|titolo=Medicine betrayed: the participation of doctors in human rights abuses|anno=1992|editore=Zed Books|id=ISBN 1-85649-104-8|pagine=65|url=http://books.google.com/books?id=bMTu_oIfVsIC&pg=PA65}}</ref>{{rp|65}} The diagnosis of mental disease can serve as proxy for the designation of social dissidents, allowing the state to hold persons against their will and to insist upon therapies that work in favour of ideological conformity and in the broader interests of society.<ref name="Medicine betrayed"/>{{rp|65}} In a monolithic state, psychiatry can be used to bypass standard legal procedures for establishing guilt or innocence and allow political incarceration without the ordinary odium attaching to such political trials.<ref name="Medicine betrayed"/>{{rp|65}} In [[Nazi Germany]] in the 1940s, the 'duty to care' was violated on an enormous scale: A reported 300,000 individuals were sterilized and 100,000 killed in Germany alone, as were many thousands further afield, mainly in [[eastern Europe]].<ref name="Birley">{{cite doi|10.1111/j.0902-4441.2000.007s020[dash]3.x}}</ref> From the 1960s up to 1986, [[political abuse of psychiatry]] was reported to be systematic in the [[Soviet Union]], and to surface on occasion in other Eastern European countries such as [[Communist Romania|Romania]], [[People's Republic of Hungary|Hungary]], [[Czechoslovak Socialist Republic|Czechoslovakia]], and [[Socialist Federal Republic of Yugoslavia|Yugoslavia]].<ref name="Medicine betrayed"/>{{rp|66}} A "mental health genocide" reminiscent of the Nazi aberrations has been located in the history of [[Sudafrica]]n oppression during the [[apartheid]] era.<ref name="Press conference">{{Cita web|titolo=Press conference exposes mental health genocide during apartheid, 14 June 1997|url=http://www.info.gov.za/speeches/1997/06160x76497.htm|editore=South African Government Information|accesso=2012-January-16}}</ref> A continued misappropriation of the discipline was subsequently attributed to the [[People's Republic of China]].<ref name="van Voren 2010">{{Cita pubblicazione|cognome=van Voren|nome=Robert|titolo=Political Abuse of Psychiatry—An Historical Overview|rivista=[[Schizophrenia Bulletin]]|anno=2010|mese=January|volume=36|numero=1|pagine=33–35|id=PMID 19892821|pmc=2800147|doi=10.1093/schbul/sbp119}}</ref>
 
=== Deinstitutionalization ===
{{Main|Deinstitutionalization}}
By the beginning of the 20th century, ever-increasing admissions had resulted in serious overcrowding. Funding was often cut, especially during periods of economic decline, and during wartime in particular many patients starved to death. Asylums became notorious for poor living conditions, lack of hygiene, overcrowding, and ill-treatment and [[abuse of patients]].<ref name=Fakhourya07>{{Cita pubblicazione |autore=Fakhourya W, Priebea S |titolo=Deinstitutionalization and reinstitutionalization: major changes in the provision of mental healthcare |rivista=Psychiatry |volume=6 |issue8= |pagine=313–316 |mese=August |anno=2007 |doi=10.1016/j.mppsy.2007.05.008 |url=http://linkinghub.elsevier.com/retrieve/pii/S1476179307001085 |numero=8}}</ref>
 
The first community-based alternatives were suggested and tentatively implemented in the 1920s and 1930s, although asylum numbers continued to increase up to the 1950s. The movement for deinstitutionalization came to the fore in various countries in the 1950s and 1960s.
 
The prevailing public arguments, time of onset, and pace of reforms varied by country.<ref name=Fakhourya07/> [[Class action lawsuit]]s in the United States, and the scrutiny of institutions through [[disability activism]] and [[antipsychiatry]], helped expose the poor conditions and treatment. Sociologists and others argued that such institutions maintained or created dependency, passivity, exclusion and disability, causing people to be [[institutional syndrome|institutionalized]].
 
There was an argument that community services would be cheaper. It was suggested that new psychiatric medications made it more feasible to release people into the community.<ref>{{Cita pubblicazione |autore=Rochefort DA |titolo=Origins of the "Third psychiatric revolution": the Community Mental Health Centers Act of 1963 |rivista=J Health Polit Policy Law |volume=9 |numero=1 |pagine=1–30 |data=Spring 1984 |id=PMID 6736594 |url=http://jhppl.dukejournals.org/cgi/pmidlookup?view=long&pmid=6736594 |doi=10.1215/03616878-9-1-1}}</ref>
 
There were differing views on deinstitutionalization, however, in groups such as mental health professionals, public officials, families, advocacy groups, public citizens, and unions.<ref>{{Cita pubblicazione |autore=Scherl DJ, Macht LB |titolo=Deinstitutionalization in the absence of consensus |rivista=Hosp Community Psychiatry |volume=30 |numero=9 |pagine=599–604 |anno=1979 |mese=September |id=PMID 223959 |url=http://ps.psychiatryonline.org/cgi/pmidlookup?view=long&pmid=223959}}</ref>
 
==21st century==
===Asia===
In Japan, the number of hospital beds has risen steadily over the last few decades.<ref name=Fakhourya07/>
 
In [[Hong Kong]], a number of residential care services such as half-way houses, long-stay care homes, and supported hostels are provided for the discharged patients. In addition, a number of community support services such as Community Rehabilitation Day Services, Community Mental Health Link, Community Mental Health Care, etc. have been launched to facilitate the re-integration of patients into the community.
 
===New Zealand===
[[New Zealand]] established a [[Truth and reconciliation commission|reconciliation]] initiative in 2005 in the context of ongoing [[damages|compensation]] payouts to ex-patients of state-run mental institutions in the 1970s to 1990s. The forum heard of poor reasons for admissions; unsanitary and overcrowded conditions; lack of communication to patients and family members; physical violence and sexual misconduct and abuse; inadequate complaints mechanisms; pressures and difficulties for staff, within an [[authoritarian]] [[psychiatric]] hierarchy based on containment; fear and humiliation in the misuse of [[seclusion]]; over-use and abuse of [[Electroconvulsive therapy|ECT]], [[psychiatric medication]] and other treatments/punishments, including [[group therapy]], with continued [[adverse effects]]; lack of support on discharge; interrupted lives and lost potential; and continued stigma, prejudice and emotional distress and trauma.
 
There were some references to instances of helpful aspects or kindnesses despite the system. Participants were offered counseling to help them deal with their experiences, and advice on their rights, including access to records and legal redress.<ref>Dept of Internal Affairs, New Zealand Government. [http://www.confidentialforum.govt.nz/ Te Aiotanga: Report of the Confidential Forum for Former In-Patients of Psychiatric Hospitals] June 2007</ref>
 
===Africa===
* [[Uganda]] has one psychiatric hospital.<ref name=Fakhourya07/>
* [[Sudafrica]] has several psychiatric hospitals. These hospitals are spread throughout the country. Some of the most well-known institutions are: Weskoppies Psychiatric Hospital [[Weskoppies Psychiatric Hospital]], colloquially known as Groendakkies ("Little Green Roofs") and Denmar Psychiatric Hospital [[Denmar Psychiatric Hospital]] in Pretoria, TARA[http://www.medpages.co.za/sf/index.php?page=organisation&orgcode=241845] in Johannesburg, and Valkenberg [[Valkenberg Hospita]] in Cape Town.
 
===Europe===
Countries where deinstitutionalization has happened may be experiencing a process of "re-institutionalization" or relocation to different institutions, as evidenced by increases in the number of [[supported housing]] facilities, [[forensic psychiatry|forensic psychiatric]] beds and rising numbers in the prison population.<ref>{{Cita pubblicazione |autore=Priebe S |titolo=Reinstitutionalisation in mental health care: comparison of data on service provision from six European countries |rivista=BMJ |volume=330 |numero=7483 |pagine=123–6 |anno=2005 |mese=January |id=PMID 15567803 |pmc=544427 |doi=10.1136/bmj.38296.611215.AE |url=http://bmj.com/cgi/pmidlookup?view=long&pmid=15567803 |author-separator=, |author2=Badesconyi A |author3=Fioritti A |display-authors=3 |last4=Hansson |first4=L |last5=Kilian |first5=R |last6=Torres-Gonzales |first6=F |last7=Turner |first7=T |last8=Wiersma |first8=D}}</ref>
 
Some developing European countries still rely on asylums.
 
===United States===
The United States has experienced two waves of [[deinstitutionalization]]. Wave one began in the 1950s and targeted people with mental illness.<ref name="Stroman">Stroman, Duane. 2003. “The Disability Rights Movement: From Deinstitutionalization to Self-determination.'' University Press of America.</ref> The second wave began roughly fifteen years after and focused on individuals who had been diagnosed with a [[developmental disability]] (e.g. mentally impaired).<ref name="Stroman"/> Although these waves began over fifty years ago, deinstitutionalization continues today; however, these waves are growing smaller as fewer people are sent to institutions.
 
A process of indirect [[cost-shifting]] may have led to a form of "re-institutionalization" through the increased use of jail detention for those with mental disorders deemed unmanageable and noncompliant.<ref>{{Cita pubblicazione |autore=Domino ME, Norton EC, Morrissey JP, Thakur N |titolo=Cost shifting to jails after a change to managed mental health care |rivista=Health Serv Res |volume=39 |numero=5 |pagine=1379–401 |anno=2004 |mese=October |id=PMID 15333114 |pmc=1361075 |doi=10.1111/j.1475-6773.2004.00295.x }}</ref> In Summer 2009, author and columnist [[Heather Mac Donald]] stated in ''[[City Journal (New York)|City Journal]]'', "[[jails]] have become society's primary mental institutions, though few have the funding or expertise to carry out that role properly... at [[Rikers]], 28 percent of the inmates require mental health services, a number that rises each year."<ref>{{Cita news|titolo=The Jail Inferno|nome=Heather|cognome=Mac Donald|url=http://www.city-journal.org/2009/19_3_jails.html|editore=''[[City Journal (New York)|City Journal]]''|accesso=2009-July-27|linkautore=Heather Mac Donald}}</ref>
 
===South America===
In several [[South American]] countries, the total number of beds in asylum-type institutions has decreased, replaced by psychiatric inpatient units in general hospitals and other local settings.<ref name=Fakhourya07/>
 
==Types==
There are a number of different types of modern psychiatric hospitals, but all of them house people with mental illnesses of widely variable severity.
 
===Crisis stabilization===
{{Main|Emergency psychiatry}}
The crisis stabilization unit is in effect an [[emergency room]] for psychiatry, frequently dealing with suicidal, violent, or otherwise critical individuals.
 
===Open units===
Open units are psychiatric units that are not as secure as crisis stabilization units. They are not used for acutely suicidal persons; 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 the type of patients admitted.
 
===Medium-term===
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===
Juvenile wards are sections of psychiatric hospitals or psychiatric wards set aside for children and/or adolescents with mental illness. However, there are 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 illness.
 
===Long-term care facilities===
In the UK long-term care facilities are now being replaced with smaller secure units (some within the hospitals listed above). Modern buildings, modern security and being locally sited to help with reintegration into society once medication has stabilized the condition<ref>[http://www.medscape.com/viewarticle/481700_3 Medscape.com]</ref><ref>[http://www.hospital.com/psychiatry.html Hospital.com]</ref> are often features of such units. An example of this is the Three Bridges Unit, in the grounds of [[Hanwell Asylum]] in West London and the John Munroe Hospital in Staffordshire. However these modern units have the goal of treatment and rehabilitation back into society within a short time-frame (two or three years) and not all [[forensic]] [[patients]]' treatment can meet this criterion, so the large hospitals mentioned above often retain this role.
These hospitals provide stabilization and rehabilitation for those who are having difficulties such as depression, eating disorders, mental disorders, and so on.
 
===Halfway houses===
One type of institution for the mentally ill is a community-based [[halfway house]]. These facilities provide assisted living<ref>{{Cita pubblicazione |cognome=Vaslamatzis |nome=G. |last2=Katsouyanni |first2=K. |last3=Markidis |first3=M. |titolo=The efficacy of a psychiatric halfway house: a study of hospital recidivism and global outcome measure |rivista=European Psychiatry |volume=12 |numero=2 |anno=1997 |pagine=94–97 |doi=10.1016/S0924-9338(97)89647-2 }}</ref> for patients with mental illnesses for an extended period of time, and 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 [[psychiatrist]]s, although some localities lack sufficient funding.
 
===Political imprisonment===
In some countries the mental institution may be used for the incarceration of political prisoners, as a form of punishment. A notable historical example was the use of [[punitive psychiatry in the Soviet Union]]<ref name="Matvejević">{{Cita libro|cognome=Matvejević|nome=Predrag|titolo=Between exile and asylum: an eastern epistolary|anno=2004|editore=Central European University Press|id=ISBN 963-9241-85-7|pagine=32|url=http://books.google.ru/books?id=qRrv8MqXMxYC&printsec=frontcover#PPA32,M1}}</ref> and [[China]].<ref name="LaFraniere">{{Cita news|cognome=LaFraniere|nome=Sharon|last2=Levin|first2=Dan|titolo=Assertive Chinese Held in Mental Wards|url=http://www.nytimes.com/2010/11/12/world/asia/12psych.html?_r=1&pagewanted=print|accesso=2012-March-22|newspaper=[[The New York Times]]|data=2010-November-11}}</ref>.
 
===Secure units===
In the [[UK]], criminal courts or the [[Home Secretary]] can refer people to what are known as ''psychiatric secure units'', even though for many decades now, the term "criminally insane" is no longer legally or medically recognized. They are hospitals mostly run by the [[National Health Service]], which undertake psychiatric assessments and can also provide treatment and accommodation in a safe, hospital environment where its patients can be prevented from harming themselves or others. They also run under clearly defined [[Home Office]] rules.
These secure hospital facilities are divided into three main categories and are referred to as High, Medium and Low Secure. Although it is a phrase often used by newspapers, there is no such classification as "Maximum Secure". Low Secure units are often referred to as "Local Secure" as patients are referred there frequently by local criminal courts for psychiatric assessment before sentencing.
 
Some units have been opened in recent years with the specific purpose of providing ''Therapeutically Enhanced Treatment'' and so form a subcategory to the three main ones.
 
The general public are familiar with the names of the High Secure Hospitals due to the frequency that they are mentioned in the news reports about the people who are sent there. Those in England include, [[Ashworth Hospital]] in [[Merseyside]];<ref>[http://www.merseycare.nhs.uk/services/clinical/high_secure/High_Secure_Services_Contact_Us.asp Official site], Accessed 2010-06-02</ref> [[Broadmoor Hospital]] in [[Crowthorne]], Berkshire and [[Rampton Secure Hospital]] in [[Retford]], [[Nottinghamshire]] and in Scotland is [[State Hospital Carstairs|The State Hospital]], Carstairs.<ref>[http://www.tsh.scot.nhs.uk/ Official site], Accessed 2010-06-02</ref> Northern Ireland and the Isle of Man have their own Medium and Low Secure units but use the mainland faculties for High Secure, which smaller Channel Islands also transfer their patients to as ''Out of Area Referrals'' under the [[Mental Health Act 1983]].
 
Of the Medium Secure units, there are many more of these in number scattered throughout the UK. As of 2009 there were 27 women only units in England alone.<ref>Georgie Parry‐Crooke (June 2009) [http://www.ohrn.nhs.uk/resource/policy/WMSSEvaluationFinalReport.pdf My life: in safe hands?]. Accessed 2010-06-02</ref> Irish units include those at prisons in Portlaise, Castelrea and Cork.
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==Note==
Estratto da "https://it.wikipedia.org/wiki/Ospedale_psichiatrico"