Commitment debate fueled by the perception of the psychiatric hospital

It seems that wherever you go these days, the industry is hotly debating liberty versus privacy. I am sure the Murphy Bill has a lot to do with that. The industry sees an epidemic of untreated mental illness and wants to solve it on a public health level. Meanwhile, privacy advocates see people “incarcerated against their will.” It is a very thorny problem.

At a recent conference, I asked several behavioral healthcare providers this simple question: “Why don’t people want to be committed?” It might seem obvious to you, but try to actually answer the question. Chemotherapy is a highly intrusive process that dramatically changes your life while you are going through the treatments. Nobody suggests that we shouldn’t treat cancer because it is inconvenient for the patient. Dialysis treatment offers a lifetime of lifestyle limitations. Nobody suggests that we shouldn’t treat diabetes. An involuntary commitment is a hospital stay. Why would anyone object to going to the hospital to be treated for their illness?

When I ask people what image comes to mind when they think of a psychiatric hospital, the most common response is the movie  “One Flew Over the Cuckoo’s Nest.” Would you want your loved one in a hospital like that? Perhaps part of the problem is the perception of inpatient treatment as that of “insane asylums” where patients are mistreated, or of secure facilities where patients are locked up never to go home again. Take a look at the facilities where we treat these patients. Does the look and feel suggest that society cares about these patients? I don’t think so.

A recent study from the Treatment Advocacy Center found that over 100,000 new psychiatric inpatient beds are needed in the United States. Before we build them, let’s think about what they should feel like. All over the country, beautiful new heart and cancer hospitals are being built. What would it take to bring that level of care and resources to the mental health community? How much easier would it be to implement a public health policy that treats as many mentally ill people as possible if they wanted the treatment? How much easier would it be to make people well, in a place where they believe it is possible?

Design can’t solve all our problems, but it can solve some of them. Let’s make good design a priority in psychiatric treatment and improve outcomes and perceptions. Let’s help people on the road to recovery.