A case for aboloishing Phyc Wards
Psych wards must be abolished.
Here are some more humane Alternatives:
By Elijah Brahmi
Psych wards need to be abolished, and the few promising replacements around the world today do not get the funding they deserve. It may seem like a radical view for some, but for the survivors of psychiatric incarceration and abuse, forced institutionalization is akin to torture and oftentimes can devolve into just that. Many who do not know someone who's mentally ill and don't live with severe mental illness themselves often perpetuate the misconception that psych wards may be unpleasant but we need them, and their treatment for the "most far gone in society" and are necessary for society to function, to keep the thin line between order and chaos.
Truth be told, psych wards are not treatment. As someone who's been to several over the years, in the teen and adult ward in many different states, I have a unique perspective on a comprehensive view of what psych wards are really like. Not horror movies, but oftentimes they can feel that way since the system is designed with very few changes made since the days of asylums. Truth is, psych wards are simply prisons for the crime of being mentally ill, which isn't a crime yet it's criminalized on many levels in practice. Oftentimes people in psych wards aren't even severely mentally ill. They are just homeless, pretending to be crazy to get a warm bed. They are actual criminals and sex offenders who lied to get sent to a ward instead of prison, despite actually being dangerous. And oftentimes people in psych wards are just women or queer people with abusive family who tried to put them away by lying they were crazy and violent, because queerness and being a woman oftentimes trying to speak out against sexual assault is pathologized. Truth is, there are a lot of issues with psych wards that in my opinion make it a net negative in society and need to be abolished and replaced with a new widespread more humane model of care. Problem is, no one quite puts forth the solutions to these problems because it's inconvenient, and when someone is crazy or a criminal most would just be happy to put them away and not think about it nor the abuses that almost always take place inside.
Even if there is no abuse done by the staff or other patients, psych wards are designed like prisons in a way that's inherently abusive, dehumanizing, and makes treatment impossible and recidivism common. They are not treatment because simply they don't treat you. They treat your diagnosis and usually not well. Some of the many reasons psych wards are not treatment and truly abusive: They often lie to you to get you admitted against your will, saying you can leave at any time, when in reality they're allowed to lie to you to get you admitted, then you can't leave for usually a month minimum. They often put people of far too wide a variety of needs in the same ward, often just a small hallway. There's women on the same ward as violent sex offenders on court orders. They take away all your property and often lose it when it's time to give it back to you, including your phone, all your clothes. You need to wear scrubs the whole time you're there. You can't have most personal property because they view almost everything—even stress toys, sketchbooks, pens, phones, hoodies, etc.—as a risk to be used for suicide. You often have to downplay your true struggles, symptoms and needs, to pretend not to be crazy to convince the doctors you're ready to leave as soon as possible because the barren, empty and highly controlled environment deprived of stimulation and true therapy treatment can retraumatize people. Often incorrect diagnoses are given and put on your records. Doctors will often ignore orders from your home doctors to overmedicate you after only knowing you for a month. Also, people are often punished and imprisoned in psych wards for being suicidal against their will, because it's presented as the only option when this can make you more suicidal. And suicide shouldn't be treated this way. It shouldn't be punished. It just makes people more afraid to speak out and talk about their true thoughts and struggles. A better alternative is something like the Wildflower Alliance, an online group where you can talk about your suicidal thoughts without fear of the cops getting called on you. Statistics show psych wards aren't effective as actual lasting treatment:
High Rates of Readmission (Recidivism)
- Frequent Rehospitalization: Studies indicate that 28–30% of patients with schizophrenia experience repeated hospitalizations and emergency admissions.
- Failure of Long-Term Impact: Research into long-term rehabilitation indicates that a significant proportion of patients "move backward," with many requiring repeated, ongoing, or increased levels of care, while only about 10% of certain cohorts achieve fully independent living.
- Ineffectiveness of Compulsory Treatment: Studies on Community Treatment Orders (CTOs) and involuntary, mandated, or short-term, high-frequency inpatient care show no significant superiority over standard care in reducing hospital readmission rates, improving social functioning, or reducing symptoms.
High Risk of Post-Discharge Suicide
- Severe Short-Term Risk: Inpatient psychiatric hospitalization is associated with a dramatic surge in suicide risk immediately following discharge. The risk within 7 days is estimated to be 300 times higher, and within 30 days 200 times higher than the general population rate.
- Short Stays Correlate with Risk: Evidence suggests that patients with stays shorter than 7 days have a 3-fold higher risk of suicide within the first week post-discharge compared to longer stays.
Iatrogenic Effects (Harm Caused by Treatment)
- Traumatic Experiences: Inpatient stays are frequently described by patients as traumatizing, dehumanizing, and invalidating. In some cases, the experience causes lasting trauma, leading to PTSD symptoms and a fear that inhibits future, potentially needed, access to support.
- Destabilization: Involuntary hospitalization has been linked to increased instability, including a decrease in employment and earnings, as well as an increased likelihood of using homeless shelters.
- Neglect and Coercion: A "safety funnel" approach—driven by lack of funding and staffing—often leads to a reliance on seclusion and restraint, which can exacerbate existing, or create new, psychological distress. Limitations in Providing Long-Term Recovery
- Acute Focus vs. Cure: Modern inpatient psychiatric stays are short, averaging about seven days, with the primary goal being immediate safety, not "cure." These, therefore, are not designed for long-term therapeutic change.
Well, if psych wards are so unhelpful and only hurt people with mental illness rather than help them, why isn't there a better alternative? Because of funding mostly, and stigma. And also because psych wards in hospitals are funded by the government, and especially during the current administration, reform isn't really a priority for the government. Mental illness has always been feared by fascists, they can easily paint us as dangerous, thus calling any group they don't like, mentally ill as if it's synonymous with a dangerous other they can't control; that they fear and want you to as well. But mentally ill people are just people with struggles, not dangerous. All human beings have struggles. Their struggles are not cries for attention or lies to get out of hard work, but real struggles just as everyone else has, and just like everyone struggles, Mentally Ill People's struggles sometimes require them to need extra help, more than they can get from their friends. But just because an alternative hasn't been funded and implemented nationwide, that doesn't mean they aren't out there. Many alternative libration- based treatment centers, Ketamine therapy, and all kinds of places and treatment centers have shown remarkable success in what happens when a person's freedom and personhood is put above punishment and profit. Sadly, they are less accessible because almost every hospital has a psych wing in it, but still people are working on solutions that I would like to highlight here.
Key Characteristics of Alternatives to Psych Wards:
- Voluntary Admission: Patients choose to be there, increasing engagement.
- Peer Support: Staff with lived experience provide empathy and hope.
- Trauma-Informed: Approaches focus on safety and understanding, not just symptom reduction.
- Independence: Clients retain personal items and often have the ability to come and go.
Here are some that deserve your attention this year:
Assertive Community Treatment (ACT)
ACT teams comprise experts such as psychiatrists, nurses, social workers, and substance abuse specialists who work together to provide treatment and support within the community. ACT designs tailored care plans to ensure engagement with individuals dealing with mental illnesses like schizophrenia or bipolar disorder.
Peer Run Respite Centers
These are operated based on the principles of experience and peer support among individuals who have faced challenges in their own mental health journeys. These facilities offer stays where people can seek solace, temporary care, emotional support, and camaraderie in a secure environment facilitated by their peers.
Crisis Intervention Teams (CIT)
Crisis intervention teams consist of law enforcement officers trained in the techniques to effectively manage health crises while minimizing harm or legal repercussions. These trained officers collaborate with health professionals to handle crisis situations that require immediate, specialized attention.
Intensive Outpatient Programs (IOP)
Intensive outpatient programs deliver evidence-based therapy and treatment approaches to individuals while allowing them to continue their daily routines. IOPs are especially beneficial for individuals in need of treatment and do not require constant supervision.
Supportive Housing
An example in NYC, is the Dorm, an independent living apartment building for mentally ill and disabled adults. Having access to affordable housing is crucial for promoting well-being and overall health. Supportive housing programs offer a place to live with services like counseling, job support, and access to healthcare providers helping individuals lead lives in a supportive community.
Emotional Support Helplines
Emotional support hotlines are vital for connecting people in distress with trained volunteers or professionals who provide listening and advice over the phone. These helplines offer anonymous and non-judgmental assistance 24/7, serving as useful resources during tough times.
Also, encourage a non-carceral approach to mental health among you and your family and friends. Encourage use of the Wildflower Alliance instead of telling the wrong person you're suicidal (therapists, school and work counselors are often required to send you to a psych ward against your will if you say the wrong thing about your painful thoughts, even if you have no plan to act on it). Use Wildflower Alliance. Instead of calling the cops or your friend in crisis, call a warm line for a mental health professional.
Above all, a replacement needs the mass funding of the police and of abusive treatment centers like most religious treatment, the troubled teen industry, etc. to be implemented worldwide so all people regardless of income and location can access care just like how psych wards are in every hospital. It needs to be insured so you won't be fired or fail classes in school for receiving treatment. Treatment should be focused on helping you as a person and what you want. Not just your diagnosis. Above all, freedom and personal liberty must be prioritized above all else. You must be allowed to leave at any time; otherwise it's a prison. You must be allowed to refuse medication and be informed, not coerced, and have a say in your own treatment. That needs to be the baseline of all psych ward replacements. Otherwise if we don't learn from the mistakes from what doesn't work in our society now, how can we ever hope to create a working, long lasting solution?
Right now Donald Trump is sending homeless people to psych wards against their will. Whether or not they're mentally ill, just to get rid of them. So if you claim to want better treatment for all our mentally ill and mad brothers and sisters, let's move out of the dark age, and leave psych wards behind. Let us put our money and our compassion into solutions of the future.
Sources:
https://www.sciencedirect.com/science/article/pii/S0020748924002360
https://mind.help/innovative-alternatives-to-psychiatric-hospitalization-you-should-know/
https://psychiatryonline.org/doi/10.1176/appi.ps.201900259
https://wildfloweralliance.org/peer-support-line/
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