A return of mental asylums is being proposed by bioethicists at the University of Pennsylvania. Stacey Burling, Inquirer Staff Writer has the story.

Penn bioethicists call for return of mental asylums

In a paper that is bound to generate controversy, three University of Pennsylvania bioethicists argue in a medical journal this week for the return of the mental asylum.

The nation, they say, has too few inpatient beds for people with serious mental illnesses. As a result, very sick people are winding up homeless or in prison, nursing homes, and hospital emergency departments.

Dominic Sisti, director of Penn’s Scattergood Program for the Applied Ethics of Behavioral Healthcare and lead author of the new paper, used words like appalling and shocking to describe the current state of affairs, which he sees as both morally wrong and financially shortsighted.

His article, titled “Improving Long-term Psychiatric Care, Bring Back the Asylum,” appeared in Tuesday’s Journal of the American Medical Association. It was coauthored by Andrea Segal and bioethics department chair Ezekiel Emanuel, who recently explored the downside of old age in another attention-grabbing essay, “Why I Hope to Die at 75.”

“We’re hoping to reappropriate the term to get back to its original meaning, which is a place of safety, sanctuary, and healing, or at least dignified healing for people who are very sick.”

He said he anticipates some “pushback.”

Michael Brody provides it. He is president and CEO of the Mental Health Association of Southeastern Pennsylvania, which has long advocated for community care for people with mental illnesses.

To him, the word asylum is “code for reinstitutionalization of people and segregating them,” he said. “Ultimately what happens when these asylums are re-created is, people get lost, ignored, segregated, and forgotten. . . . They have no ticket back into the community.”

He thinks government dollars would be better spent on alternatives like Pennsylvania’s long-term structured residences (LTSRs). These smaller facilities provide structure and support, but allow closer ties to neighborhoods. Even the most seriously mentally ill usually do not need the level of care provided in hospitals all the time, Brody said.