Psychiatric hospital care - a case of the more things change, the more they remain the same

Abstract

Each year since 1990 trainee approved social workers in Merseyside have spent time observing local psychiatric wards from the viewpoint of patients. The exercise has been characterised by reports of institutional aimlessness, poor staff-patient relations, a narrow approach to mental health problems and a lack of attention to civil and human rights, in common with accounts from other places and other periods. This paper asks why so much recent policy change has made so little difference to institutional psychiatry and highlights the recent lack of theorising or research about the nature and purpose of hospital-based mental health treatment. With government policy inclined towards an increase in psychiatric beds it is argued that the aims, methods, quality and outcomes of hospital treatment require investigation, with particular attention to the social relations of mental health service delivery and the tendency to prioritise regulation and control over care and choice.