According to the National Institute of Mental Health, a serious mental illness is a mental, emotional, or behavioral condition leading to substantial impairment in a person’s ability to function in their daily life and activities. This may include major depressive disorder, schizophrenia, bipolar disorder, obsessive-compulsive disorder (OCD), and post-traumatic stress disorder (PTSD).

History of Mental Hospitals

The first institution for the mentally ill was Eastern State Hospital in Williamsburg, Virginia, established in 1768. The 1800s were a period of increasingly institutionalized care of the mentally ill. By the end of the century, every state in the U.S. had one or more mental hospitals. Mental hospitals in the U.S. have gone through major transformations since their introduction. The earliest facilities were primarily places to keep people with mental health symptoms out of sight and out of mind. This continued into the 20th century, with approximately 560,000 people living in mental hospitals by 1955. During the mid-1800s, reformers such as Dorthea Dix played an important role in advocating for a more humane approach to treating people with mental health problems. Rather than acting as a warehouse for the mentally ill, today’s mental hospitals are focused on offering treatment and supportive care for people with psychiatric conditions.

Types of Mental Hospitals

The term ‘mental hospital’ is frequently used to describe either a psychiatric hospital or psychiatric ward.

Psychiatric hospitals: This hospital focuses specifically on mental health treatment. These facilities are staffed by psychiatrists, other doctors, nurses, and other healthcare professionals.  Psychiatric wards: A psych ward or behavioral health ward is a specialized unit in a general hospital that offers psychiatric services.

There are other mental health facilities that offer less intensive or less acute psychiatric services and support. These include:

Outpatient or day treatment hospitals: These hospitals offer medication management, therapy, and skills training on an outpatient basis. People stay at the facility for most or all of the day and return to their homes at night. They may be used to transition out of inpatient care, but some evidence suggests these facilities may often be effective when used in place of inpatient hospitalization in some cases. Residential treatment facilities: These facilities offer long-term mental health services. They are live-in health care centers that may be used to treat behavioral concerns, mental disorders, and substance use problems.

An inpatient hospital is the highest level of care designed to treat the most severe symptoms. Residential treatment can provide medium-level care and often acts as a transition from an inpatient setting. Outpatient care is a less intensive level of care where people receive treatment as needed but still lead their personal and professional lives outside of treatment.

Reasons for Admission to a Mental Hospital

Reasons a person may be admitted to a mental hospital include:

Experiencing symptoms of psychosis Having symptoms of mania Having thoughts of suicide or suicidal urges Being unable to perform daily living tasks such as eating, bathing, or sleeping Experiencing thoughts of harming others Engaging in behaviors that put the self or others in danger

Sometimes, an admission to a mental hospital occurs if there are significant changes to someone’s medications or treatments that might be destabilizing and unsafe without having close supervision during this time. Admission may begin in the emergency room department of a general hospital. Emergency room practitioners may refer an individual to a mental health hospital for further evaluation and treatment if a person presents with serious mental health symptoms. In other cases, a person may voluntarily visit an admission or intake center at a mental hospital for an evaluation. If a mental health provider feels that the individual would benefit from inpatient admission, that person may sign a consent form to agree to be hospitalized. Sometimes people are admitted to mental hospitals on an involuntary basis. Involuntary admission may occur if:

The individual poses a danger to themselves or others If they are unable to provide for their own basic needsThere is a risk of harm to their mental well-being if they do not receive care

The length of time a person can be involuntarily committed and who can make a request to have somewhat committed against their will varies based on state laws. 

Impact of Mental Hospitals

A mental hospital can play an essential role in comprehensive mental health treatment for individuals experiencing severe mental illness. One review found that inpatient and community rehabilitation mental health services decreased the need for inpatient psychiatric services over the long term. For many people, a stay in a mental hospital provides a period of stabilization and intensive care that allows them to regain a certain degree of functioning. While goals vary for each person and situation, treatment will often involve providing a safe environment, treating acute symptoms with medications and psychotherapy, and coordinating increased outpatient supports.

Potential Pitfalls

While mental hospitals can provide useful assistance to people experiencing serious mental health symptoms or severe psychological distress, they are not the right choice for every person or situation. Some potential downsides include:

Cost

Inpatient hospitalization is a considerable expense. Although insurance or governmental programs may pay for psychiatric hospitalization, for many people, the cost may serve as a barrier to treatment. 

Lack of Access

In addition to the high cost of inpatient treatment, admission criteria may exclude some people who need mental assistance. As one review noted, this often leads to people becoming trapped in a cycle of emergency room presentation and incarceration.

The concept of involuntary psychiatric treatment has long been a polarizing topic. Some critics have also opposed the existence of any form of involuntary admission to a psychiatric facility. 

Post-Hospitalization Risks

Transitioning to outpatient care can also be challenging, particularly if few treatment resources are available. One study found that the initial period after leaving a mental hospital is marked by an increased risk for suicide, particularly among people with significant depressive symptoms. Because of this increased risk, people need ongoing support from friends, family, inpatient healthcare providers, and outpatient practitioners. Follow-up visits in the individual’s home, if feasible, may help reduce suicide risk following hospitalization.

Other Options Can Be Effective

While mental hospitals can provide important care, some critics have noted a lack of solid evidence to demonstrate that hospitalization is more effective than other treatment approaches. One study, for example, found that for certain outcome measures acute psychiatric day hospitals were as effective as inpatient mental hospitals. However, there is evidence that inpatient facilities can successfully help people with severe mental illness and effectively reduce the long-term costs of caring for those with such conditions. The average length of stay for inpatient psychiatric hospitalization in the United States is around 10 days, although lengths of stay can vary considerably.