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Psychiatric hospital

A psychiatric hospital, also known as a mental hospital, is an inpatient facility specifically designed to treat individuals with serious mental disorders, such as schizophrenia, bipolar disorder, and severe depression. Historically, these institutions evolved from separate wards in private hospitals in the early 18th century to dedicated asylums implementing "moral treatment" in the 19th century. Over time, however, psychiatric hospitals faced significant criticism due to overcrowding, underfunding, and allegations of human rights violations, particularly during the era of institutionalization.

The mid-20th century saw a shift towards deinstitutionalization, largely influenced by the advent of antipsychotic medications and the belief that community-based care could better serve patients. This trend led to the closure of numerous state psychiatric hospitals, with a significant reduction in available inpatient care. As of 2019, the U.S. faced a critical shortage of these facilities, with only 620 non-federal psychiatric hospitals providing limited beds and often prohibitive costs for care. Consequently, individuals experiencing severe mental health crises frequently encounter challenges accessing appropriate treatment and may end up in emergency rooms, jails, or homelessness. Although modern alternatives, such as day treatment centers and short-term inpatient units, exist, the need for long-term care in psychiatric hospitals remains a pressing issue in mental health care today.

Full Article

Once called a lunatic asylum, a psychiatric hospital, also known as a mental hospital, is an inpatient treatment center for patients with serious mental disorders such as schizophrenia, bipolar disorder, and severe depression. A move toward deinstitutionalization in the 1950s and 1960s and the passage of the Community Mental Health Centers Act of 1963 (which was aimed at moving care from large state institutions to community-based centers) contributed to the closure of most state psychiatric hospitals in the United States in the following decades, alongside a few later court decisions, state civil-commitment laws (which varied by state), and financial incentives for states to close hospitals. In the mid-2020s, there were 656 nonfederal psychiatric hospitals in the country, a number not sufficient to provide care for those who need it. Furthermore, since many of these facilities are private, the cost is out of reach for many people with mental illnesses.

History

The history of the psychiatric hospital dates back to the early eighteenth century, when individuals with mental illnesses began to receive care in separate wards in private hospitals and almshouses, which were residences for low-income individuals built by charitable organizations. Prior to the establishment of these wards, patients with severe mental illnesses were cared for at home by their families. However, some patients with serious mental illnesses could be prone to violence and pose a danger to their caregivers.

Moral Treatment

In the nineteenth century, those with psychiatric disorders began to be institutionalized in asylums where they received “moral treatment,” which centered on the idea that individuals with mental health conditions might eventually be cured if they were treated with kindness and learned to think rationally using a part of their brain not affected by the psychiatric disorder. These asylums were constructed in peaceful country settings to encourage relaxation and recreation. The Friends Asylum, established by the Quaker community in Philadelphia in 1813, was the first asylum to implement moral treatment. Unlike later asylums, however, the Friends Asylum was run by a lay staff and not medical professionals. Soon, other similar institutions run by physicians were established, such as the Bloomingdale Insane Asylum in New York City in 1821 and the Institute of the Pennsylvania Hospital in Philadelphia in 1841. The latter incorporated the philosophies of Thomas Kirkbride, who was the medical superintendent there. Kirkbride developed a prototype for public institutions based on moral treatment. His plan called for no more than 250 patients per facility, which would have areas where patients had access to sunshine and fresh air. Facilities following Kirkbride’s plan were often large, elaborate Victorian-era buildings with extensive grounds.

State Facilities

Psychiatric facilities following the Kirkbride prototype were significantly better than those of the past but were only available to patients who could afford them; the cost to stay in these facilities was too high for low-income individuals with mental illnesses.

Dorothea Dix, a New England schoolteacher who became an advocate for individuals with mental health conditions, witnessed the terrible conditions to which the patients from impoverished families were subjected. Dix lobbied for forty years for the US government to provide psychiatric facilities for low-income individuals. By the 1870s, the US government funded the construction of thirty-two state psychiatric hospitals.

Harsh Criticism

At the time, professionals considered institutionalization the best way to treat and care for patients with mental illnesses. Additionally, institutionalization provided an option to families that were struggling to care for their loved ones with serious psychiatric disorders. However, state psychiatric hospitals came under fire in the 1850s after widespread reports that they were underfunded, understaffed, and overcrowded. States were not prepared to fund the large number of patients needing admission to these facilities.

Mental hospitals were accused of keeping patients in unhealthy and dangerous conditions and violating their human rights. Contributing to the overcrowding was the admission of many older patients into state facilities. In some cases, local governments classified some adults with dementia and related conditions as having a mental illness to avoid having to pay for the care of the older adults in almshouses or public hospitals. This practice continued even though older patients with dementia did not respond well to institutionalization.

The superintendents of psychiatric hospitals responded by opening training schools for nurses within their facilities in the 1860s and 1870s, a practice that had yielded positive results in Europe. Unlike those in traditional hospitals, training schools in asylums admitted men, which substantially increased the number of trained caregivers. While helpful, these efforts were not enough to alter the negative perception of psychiatric hospitals.

By the 1900s, most psychiatrists contended that institutionalization should be used only as a last resort. Furthermore, state funding was inadequate to properly maintain the enormous structures erected under Kirkbride’s plan, which led to the closure of some state psychiatric hospitals. By the twentieth century, the remaining state psychiatric hospitals were extremely overcrowded. For example, Weston State Hospital (formerly Trans-Allegheny Lunatic Asylum) in West Virginia housed more than 2,400 patients at its peak in the 1950s, even though it was designed to house only 250.

Deinstitutionalization

By the mid-1950s, a trend toward deinstitutionalization and outpatient treatment began, in part because of the availability of antipsychotic drugs to treat serious mental illnesses such as schizophrenia and bipolar disorder. It was also believed that community-based mental health treatments were better for patients than being in an asylum. Psychiatrists thought patients would have a better quality of life if they were living at home and treated in their communities.

The Community Mental Health Centers Act of 1963 contributed significantly to the closure of many of the remaining state psychiatric hospitals. The act imposed strict requirements for admission to a state psychiatric hospital. Generally, only individuals considered an imminent danger to themselves and others could be institutionalized.

While the trend toward deinstitutionalization continued into the twenty-first century, it was not without its share of criticisms. Studies showed that individuals with mental illnesses living in private homes did not receive proper medical care and often suffered from poor health and loneliness. When families cannot care for individuals with mental health conditions, they are moved to nursing homes, which are usually not equipped to handle psychiatric disorders.

In the twenty-first century, only a few state psychiatric hospitals remain open. Patients with mental illnesses more often receive short-term care and are then discharged, sometimes to homelessness.

Overview

Between 1955 and 2016, the number of state-funded psychiatric beds in the United States decreased by more than 95 percent. This caused a severe shortage of inpatient care facilities and mental health professionals in the mid and late 2010s. While some patients responded well to deinstitutionalization and community-based programs, others with serious and chronic psychiatric disorders needed long-term inpatient care. However, getting such care was difficult, if not impossible. Before being released, many patients in state psychiatric institutions were given new medications and placed in community-care programs but wound up homeless. Others ended up in jail or prison, which the psychiatric community dubs “the nation’s largest healthcare facilities.”

According to the American Hospital Association (AHA), by the mid-2020s, there were approximately 656 non-federal psychiatric hospitals in the United States. However, those who manage to find a bed may not be able to pay for it. In 2024, a major mental health parity rule was issued, which aimed to make insurance coverage for mental health care comparable to coverage for other medical care. However, inpatient psychiatric care can be very expensive, and even when insurance covers treatment, patients may still face network restrictions, prior-authorization barriers, or high out-of-pocket costs. Many low-income patients rely on Medicaid for mental health care, but a legal provision (the Institutions for Mental Diseases [IMD] exclusion) limits the federal government from paying for long-term institutional care.

Because of this, those experiencing a severe mental health crisis must go to an emergency room, where the staff may not be specifically trained to treat them. Sometimes, patients with mental illnesses are “boarded” in emergency rooms or jails until a bed is available in a psychiatric hospital. During this time, they may spend extended periods restrained or in isolation.

Options other than long-term care in a psychiatric hospital include day treatment centers where patients may receive medication management and therapy and attend classes on managing their condition. Short-term mental health inpatient units are available in some hospitals. These wards typically handle emergencies such as suicide risk.


Bibliography

D’Antonio, Patricia. “History of Psychiatric Hospitals.” Penn Nursing, University of Pennsylvania School of Nursing, www.nursing.upenn.edu/nhhc/nurses-institutions-caring/history-of-psychiatric-hospitals. Accessed 19 Mar. 2026.

“Fast Facts on U.S. Hospitals, 2026.” American Hospital Association, www.aha.org/statistics/fast-facts-us-hospitals. Accessed 19 Mar. 2026.

Geller, Jeffrey. “The Rise and Demise of America’s Psychiatric Hospitals: A Tale of Dollars Trumping Sense.” Psychiatric News, vol. 54, no. 6, 14 Mar. 2019, doi:10.1176/appi.pn.2019.3b29. Accessed 19 Mar. 2026.

“Mental Institutions.” Brought to Life Science Museum, 13 June 2018, broughttolife.sciencemuseum.org.uk/broughttolife/themes/menalhealthandillness/mentalinstitutions. Accessed 19 Mar. 2026.

Pan, Deanna. “TIMELINE: Deinstitutionalization and Its Consequences.” Mother Jones, 29 Apr. 2013, www.pbs.org/wgbh/pages/frontline/shows/asylums/special/excerpt.html. Accessed 19 Mar. 2026.

Raphelson, Samantha. “How the Loss of US Psychiatric Hospitals Led to a Mental Health Crisis.” National Public Radio, 30 Nov. 2017, www.npr.org/2017/11/30/567477160/how-the-loss-of-u-s-psychiatric-hospitals-led-to-a-mental-health-crisis. Accessed 19 Mar. 2026.

“Requirements Related to the Mental Health Parity and Addiction Equity Act.” The Federal Register, 23 Sept. 2024, www.federalregister.gov/documents/2024/09/23/2024-20612/requirements-related-to-the-mental-health-parity-and-addiction-equity-act. Accessed 19 Mar. 2026.

Ruffalo, Mark L. “The American Mental Asylum: A Remnant of History.” Psychology Today, 12 Jan. 2026, www.psychologytoday.com/us/blog/freud-fluoxetine/201807/the-american-mental-asylum-remnant-history. Accessed 19 Mar. 2026.

Torrey, E. Fuller, et al. “The Shortage of Public Hospital Beds for Mentally Ill Persons.” Psychiatric Services, vol. 65, no. 4, 2014, www.ncbi.nlm.nih.gov/pmc/articles/PMC4195636/. Accessed 19 Mar. 2026.

Full Article

Once called a lunatic asylum, a psychiatric hospital, also known as a mental hospital, is an inpatient treatment center for patients with serious mental disorders such as schizophrenia, bipolar disorder, and severe depression. A move toward deinstitutionalization in the 1950s and 1960s and the passage of the Community Mental Health Centers Act of 1963 (which was aimed at moving care from large state institutions to community-based centers) contributed to the closure of most state psychiatric hospitals in the United States in the following decades, alongside a few later court decisions, state civil-commitment laws (which varied by state), and financial incentives for states to close hospitals. In the mid-2020s, there were 656 nonfederal psychiatric hospitals in the country, a number not sufficient to provide care for those who need it. Furthermore, since many of these facilities are private, the cost is out of reach for many people with mental illnesses.

History

The history of the psychiatric hospital dates back to the early eighteenth century, when individuals with mental illnesses began to receive care in separate wards in private hospitals and almshouses, which were residences for low-income individuals built by charitable organizations. Prior to the establishment of these wards, patients with severe mental illnesses were cared for at home by their families. However, some patients with serious mental illnesses could be prone to violence and pose a danger to their caregivers.

Moral Treatment

In the nineteenth century, those with psychiatric disorders began to be institutionalized in asylums where they received “moral treatment,” which centered on the idea that individuals with mental health conditions might eventually be cured if they were treated with kindness and learned to think rationally using a part of their brain not affected by the psychiatric disorder. These asylums were constructed in peaceful country settings to encourage relaxation and recreation. The Friends Asylum, established by the Quaker community in Philadelphia in 1813, was the first asylum to implement moral treatment. Unlike later asylums, however, the Friends Asylum was run by a lay staff and not medical professionals. Soon, other similar institutions run by physicians were established, such as the Bloomingdale Insane Asylum in New York City in 1821 and the Institute of the Pennsylvania Hospital in Philadelphia in 1841. The latter incorporated the philosophies of Thomas Kirkbride, who was the medical superintendent there. Kirkbride developed a prototype for public institutions based on moral treatment. His plan called for no more than 250 patients per facility, which would have areas where patients had access to sunshine and fresh air. Facilities following Kirkbride’s plan were often large, elaborate Victorian-era buildings with extensive grounds.

State Facilities

Psychiatric facilities following the Kirkbride prototype were significantly better than those of the past but were only available to patients who could afford them; the cost to stay in these facilities was too high for low-income individuals with mental illnesses.

Dorothea Dix, a New England schoolteacher who became an advocate for individuals with mental health conditions, witnessed the terrible conditions to which the patients from impoverished families were subjected. Dix lobbied for forty years for the US government to provide psychiatric facilities for low-income individuals. By the 1870s, the US government funded the construction of thirty-two state psychiatric hospitals.

Harsh Criticism

At the time, professionals considered institutionalization the best way to treat and care for patients with mental illnesses. Additionally, institutionalization provided an option to families that were struggling to care for their loved ones with serious psychiatric disorders. However, state psychiatric hospitals came under fire in the 1850s after widespread reports that they were underfunded, understaffed, and overcrowded. States were not prepared to fund the large number of patients needing admission to these facilities.

Mental hospitals were accused of keeping patients in unhealthy and dangerous conditions and violating their human rights. Contributing to the overcrowding was the admission of many older patients into state facilities. In some cases, local governments classified some adults with dementia and related conditions as having a mental illness to avoid having to pay for the care of the older adults in almshouses or public hospitals. This practice continued even though older patients with dementia did not respond well to institutionalization.

The superintendents of psychiatric hospitals responded by opening training schools for nurses within their facilities in the 1860s and 1870s, a practice that had yielded positive results in Europe. Unlike those in traditional hospitals, training schools in asylums admitted men, which substantially increased the number of trained caregivers. While helpful, these efforts were not enough to alter the negative perception of psychiatric hospitals.

By the 1900s, most psychiatrists contended that institutionalization should be used only as a last resort. Furthermore, state funding was inadequate to properly maintain the enormous structures erected under Kirkbride’s plan, which led to the closure of some state psychiatric hospitals. By the twentieth century, the remaining state psychiatric hospitals were extremely overcrowded. For example, Weston State Hospital (formerly Trans-Allegheny Lunatic Asylum) in West Virginia housed more than 2,400 patients at its peak in the 1950s, even though it was designed to house only 250.

Deinstitutionalization

By the mid-1950s, a trend toward deinstitutionalization and outpatient treatment began, in part because of the availability of antipsychotic drugs to treat serious mental illnesses such as schizophrenia and bipolar disorder. It was also believed that community-based mental health treatments were better for patients than being in an asylum. Psychiatrists thought patients would have a better quality of life if they were living at home and treated in their communities.

The Community Mental Health Centers Act of 1963 contributed significantly to the closure of many of the remaining state psychiatric hospitals. The act imposed strict requirements for admission to a state psychiatric hospital. Generally, only individuals considered an imminent danger to themselves and others could be institutionalized.

While the trend toward deinstitutionalization continued into the twenty-first century, it was not without its share of criticisms. Studies showed that individuals with mental illnesses living in private homes did not receive proper medical care and often suffered from poor health and loneliness. When families cannot care for individuals with mental health conditions, they are moved to nursing homes, which are usually not equipped to handle psychiatric disorders.

In the twenty-first century, only a few state psychiatric hospitals remain open. Patients with mental illnesses more often receive short-term care and are then discharged, sometimes to homelessness.

Overview

Between 1955 and 2016, the number of state-funded psychiatric beds in the United States decreased by more than 95 percent. This caused a severe shortage of inpatient care facilities and mental health professionals in the mid and late 2010s. While some patients responded well to deinstitutionalization and community-based programs, others with serious and chronic psychiatric disorders needed long-term inpatient care. However, getting such care was difficult, if not impossible. Before being released, many patients in state psychiatric institutions were given new medications and placed in community-care programs but wound up homeless. Others ended up in jail or prison, which the psychiatric community dubs “the nation’s largest healthcare facilities.”

According to the American Hospital Association (AHA), by the mid-2020s, there were approximately 656 non-federal psychiatric hospitals in the United States. However, those who manage to find a bed may not be able to pay for it. In 2024, a major mental health parity rule was issued, which aimed to make insurance coverage for mental health care comparable to coverage for other medical care. However, inpatient psychiatric care can be very expensive, and even when insurance covers treatment, patients may still face network restrictions, prior-authorization barriers, or high out-of-pocket costs. Many low-income patients rely on Medicaid for mental health care, but a legal provision (the Institutions for Mental Diseases [IMD] exclusion) limits the federal government from paying for long-term institutional care.

Because of this, those experiencing a severe mental health crisis must go to an emergency room, where the staff may not be specifically trained to treat them. Sometimes, patients with mental illnesses are “boarded” in emergency rooms or jails until a bed is available in a psychiatric hospital. During this time, they may spend extended periods restrained or in isolation.

Options other than long-term care in a psychiatric hospital include day treatment centers where patients may receive medication management and therapy and attend classes on managing their condition. Short-term mental health inpatient units are available in some hospitals. These wards typically handle emergencies such as suicide risk.


Bibliography

D’Antonio, Patricia. “History of Psychiatric Hospitals.” Penn Nursing, University of Pennsylvania School of Nursing, www.nursing.upenn.edu/nhhc/nurses-institutions-caring/history-of-psychiatric-hospitals. Accessed 19 Mar. 2026.

“Fast Facts on U.S. Hospitals, 2026.” American Hospital Association, www.aha.org/statistics/fast-facts-us-hospitals. Accessed 19 Mar. 2026.

Geller, Jeffrey. “The Rise and Demise of America’s Psychiatric Hospitals: A Tale of Dollars Trumping Sense.” Psychiatric News, vol. 54, no. 6, 14 Mar. 2019, doi:10.1176/appi.pn.2019.3b29. Accessed 19 Mar. 2026.

“Mental Institutions.” Brought to Life Science Museum, 13 June 2018, broughttolife.sciencemuseum.org.uk/broughttolife/themes/menalhealthandillness/mentalinstitutions. Accessed 19 Mar. 2026.

Pan, Deanna. “TIMELINE: Deinstitutionalization and Its Consequences.” Mother Jones, 29 Apr. 2013, www.pbs.org/wgbh/pages/frontline/shows/asylums/special/excerpt.html. Accessed 19 Mar. 2026.

Raphelson, Samantha. “How the Loss of US Psychiatric Hospitals Led to a Mental Health Crisis.” National Public Radio, 30 Nov. 2017, www.npr.org/2017/11/30/567477160/how-the-loss-of-u-s-psychiatric-hospitals-led-to-a-mental-health-crisis. Accessed 19 Mar. 2026.

“Requirements Related to the Mental Health Parity and Addiction Equity Act.” The Federal Register, 23 Sept. 2024, www.federalregister.gov/documents/2024/09/23/2024-20612/requirements-related-to-the-mental-health-parity-and-addiction-equity-act. Accessed 19 Mar. 2026.

Ruffalo, Mark L. “The American Mental Asylum: A Remnant of History.” Psychology Today, 12 Jan. 2026, www.psychologytoday.com/us/blog/freud-fluoxetine/201807/the-american-mental-asylum-remnant-history. Accessed 19 Mar. 2026.

Torrey, E. Fuller, et al. “The Shortage of Public Hospital Beds for Mentally Ill Persons.” Psychiatric Services, vol. 65, no. 4, 2014, www.ncbi.nlm.nih.gov/pmc/articles/PMC4195636/. Accessed 19 Mar. 2026.

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