Giving Asylum? The Ethics of Long-Term, Structured Care for People with Severe, Refractory Mental Illness

There are hundreds of thousands of individuals in the US who have serious mental illness. Most of these individuals thrive in the community, but there remains a population who do not. Because the number of long-term psychiatric hospital beds has largely evaporated over the past 50 years, they often cycle between homelessness, acute care, and prison. Of the 2.5 million individuals incarcerated in the US, close to 20% are diagnosed with a serious mental illness. How did we get to this point? How can we correct what has become a moral stain on our society? In this talk, Dr. Sisti will argue that we need to seriously consider the reestablishment of psychiatric hospitals to provide long term care. Dr. Sisti refers not the kinds of institutions that shocked our moral sensibilities in the 1960s and 1970s, but to ones that may serve to help individuals overcome crisis or manage chronic conditions and begin or continue a life in recovery. In the parlance of the early reformers of mental health care, “asylums” were originally established to serve this purpose—they were meant to be a place of sanctuary, safety, and healing. Today we may refer to them as recovery centers or structured care settings. They offer an ethically preferable option to the current and rather disturbing state of affairs, and we need more of them.
Dominic Sisti, PhD, is Director of the Scattergood Program for Applied Ethics of Behavioral Health Care and Assistant Professor in the Department of Medical Ethics & Health Policy and Department of Psychiatry at University of Pennsylvania Perelman School of Medicine.
Recorded March 23, 2016