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Josh Slocum's avatar

It is so demoralizing to read how bad it really is. This is inhumane and itself conducive to ill mental and somatic health--it couldn't be more obvious.

Perhaps we should remember what the best sanitariums were or tried to be. Grand architecture (and the architecture matters, not just the art inside. The brutalist style of these facilities is bad for the mind and soul.), lush grounds, gardens, including those patients could work a small allotment on, libraries, etc.

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Josh Briscoe's avatar

I, too, have worked in some pretty run down psychiatric units. None of this will change unless incentive structures change. That won’t change unless we reframe (or at least augment) our biologically reductionistic model of psychiatric care. Hospital admin, psych leadership, and payors need an understanding of the human that needs fresh air, art, and good food. It’s not such an easy technical fix without that understanding.

Arguing with insurance companies about whether a patient needed to be admitted to the hospital was one of the worst parts of my job as an inpatient psychiatrist. Insofar as the insurance company acted in good faith at all (which I suspect they often didn’t), it was predicated on the belief that we could somehow rapidly modify neurobiology with medication. Even for psychotic or manic patients, though, the milieu, in the ways you describe, mattered as much or more, particularly for those who were recurrently admitted.

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