Sussman S
Department of Psychiatry, University of Western Ontario, London.
Can J Psychiatry. 1998 Apr;43(3):260-4. doi: 10.1177/070674379804300304.
Humane treatment and care of mentally ill people can be viewed from a historical perspective. Intramural (the institution) and extramural (the community) initiatives are not mutually exclusive.
The evolution of the psychiatric institution in Canada as the primary method of care is presented from an historical perspective. A province-by-province review of provisions for mentally ill people prior to asylum construction reveals that humanitarian motives and a growing sensitivity to social and medical problems gave rise to institutional psychiatry. The influence of Great Britain, France, and, to a lesser extent, the United States in the construction of asylums in Canada is highlighted. The contemporary redirection of the Canadian mental health system toward "dehospitalization" is discussed and delineated.
Early promoters of asylums were genuinely concerned with alleviating human suffering, which led to the separation of mental health services from the community and from those proffered to the criminal and indigent populations. While the results of the past institutional era were mixed, it is hoped that the "care" cycle will not repeat itself in the form of undesirable community alternatives.
Severely psychiatrically disabled individuals can be cared for in the community if appropriate services exist.
