Cane Hill Asylum, London
Credit: Peter Trimming, CC BY-SA 2.0, via Wikimedia Commons
The WHO defines health as “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity,” but this definition has been criticized for ignoring the fact that mental health struggles are part of the human experience.
Like all minority groups, mentally ill people face prejudice and discriminatory measures. They have historically been ostracized from society, using methods from lobotomization to extract “the stone of madness” to overmedicating individuals against their will. In many countries, the “asylum model” was the gold standard, where people were involuntarily detained in psychiatric institutions that often mistreated or abused those held in their care.
Cutting the Stone
Credit: Hieronymus Bosch, Public domain, via Wikimedia Commons
The History of Mental Health Care is a Bleak One
For much of the 19th and 20th centuries, many countries did not have a legal framework outlining the specific conditions for psychiatric commitment, so individuals were often committed involuntarily under vague or arbitrary definitions of mental illness. As a result, many of these institutions were overcrowded or underfunded. In some cases, this led to human rights abuses of people being overly medicated, unnecessarily strapped or constrained, and forced to undergo inhumane treatments like electroshock therapy.
Differing Mental States: All Human
Today, however, those inhumane methods have been largely rejected in favor of “deinstitutionalization.” Deinstitutionalization aims to restore dignity and freedom to individuals with mental illness by approaching their care without restricting them to psychiatric facilities. For example, Argentina’s 2010 National Mental Health Law redefined mental health care in the country to acknowledge the complexity of mental health conditions and prioritize community-based treatment and support. The emphasis was instead placed on human rights, patient autonomy, social inclusion, and accessibility.
Though Argentina was aiming for a full deinstitutionalization model (giving a 10-year deadline to close all psychiatric institutions by 2020), this does not mean that psychiatric institutions are closed in the country. Rather, they are now considered the last option to be used only in cases of immediate risk to the patient.
In the 1960s, Canada also began its process of deinstitutionalization, favoring fully voluntary admissions and developing standards to restrict involuntary admissions in all provinces. The country also aimed at a community-based approach alongside a prevention system for substance abuse. This shift led to supportive housing initiatives and community-led mental health programs. Unfortunately, many patients were ultimately discharged without adequate follow-up care, and as a result, 10.5% of psychiatric discharges led to homelessness due to the lack of structured support.
Autonomy and Support are the Path Forward
That’s why it is important to find legal contexts that support patient autonomy and protect human rights while also providing structure for those who need it to thrive. The segregation of mentally ill people as a primary response does not make sense in a society that has tools like psychoeducation and various psychological and psychiatric treatments.
If we perpetuate the idea that not being in a complete state of well-being is “wrong,” then segregation becomes imminent. Although a strong community-based approach seems like a good way to have a more mindful and effective approach to mental health, we must also develop facility systems and professional training to align actual mental health practices with the laws.
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