The Need for Asylum for the Chronically Mentally Ill

Abstract

Our society highly values autonomy, independence, and freedom. In our model programs for the chronically mentally ill (CMI), we aim for these values and, in the process, may be doing a disservice to those people who cannot attain them. This article proposes that even the best in community care is not enough protection for many CMI. We need to do a better job of discriminating between who can and who cannot benefit from model community programs. We also need to develop a whole continuum of care that accepts the dependency of CMI people, and their various levels of functioning, as well as the progress, deterioration, and inevitable fluctuations that occur. Emphasis is placed on the need for sanctuary and asylum for many that only permanent housing of some kind can provide.

Understanding psychiatric institutionalization: a conceptual review

“…Linked to this, psychiatric institutionalization has been seen as providing protection and care to patients who are chronically mentally ill [46,48-51]. It has been highlighted that even the best community care does not offer enough care and protection for the many chronically mentally ill and the need for sanctuary and asylum can only be provided as an institution of some kind [48]. Wasow claimed that institutionalization does not necessarily cause dependency; rather it provides a permanent, structured, supervised housing for the chronically mentally ill [48].…”

“…It has been highlighted that even the best community care does not offer enough care and protection for the many chronically mentally ill and the need for sanctuary and asylum can only be provided as an institution of some kind [48]. Wasow claimed that institutionalization does not necessarily cause dependency; rather it provides a permanent, structured, supervised housing for the chronically mentally ill [48]. In addition, institutional care protects this vulnerable population from the prejudice and the hostility that they might experience in the larger society.…”

Shifting meaning of asylum

“…Recent nursing and medical publications have identified questions concerning the term. The apparent disjointedness of the ‘three solitudes’ has raised the question as to which – the community or the institution – is responsible for giving asylum to the mentally ill (Lamb 1979, Wasow 1986, 1993, Munetz et al . 1996, Scull 1996, Tomlinson et al .…”

“…More recently, it is still common for ‘asylum’ to refer to designated physical places: jails (Shenson et al . 1990), board‐and‐care homes (Lamb 1979), emergency departments (Shaner 1989, Weissberg 1991), permanent, structured, supervised housing (Wasow 1986), family homes (Bollini & Mollica 1989) and hospitals (Tomlinson & Carrier 1996). However, in the literature I reviewed, asylum can also be defined by its functions: provision of a peaceful environment; protection from harm and escape from pressure (Bachrach 1984, Wing 1990, Furlong 1996).…”

Major mental illness, housing, and supports: The promise of community integration.

“…On one hand, investigators in the field debate the failure of deinstitutionalization and the need for asylum (e.g., Wasow, 1986;Zipple, Carling, & McDonald, 1987), the crisis ofhomelessness (Bachrach, 1984;Baxter & Hopper, 1984), the low quality of community and hospital programs (Torrey & Wolfe, 1988), and the orientation toward maintenance rather than rehabilitation (Anthony & Blanch, 1989). Meeting these needs is a significant public policy challenge.…”