The glass-walled asylum: A description of a lay residential community for the severely mentally ill

Abstract

Background: Since the closure of the mental hospitals, there has been an acknowledged failure to provide secure, long-term residential care for patients at the most severe end of the psychiatric spectrum.

Aims: This paper describes an unusual care setting that caters for this most vulnerable population and aims to situate this within a broad historical and political context.

Methods: An ethnographic study was conducted using participant observation and semi-structured interviews.

Results: The paper argues that the current failure in the provision of asylum results from a false dichotomy between asylum and “a normal life” that can be traced to the work of Goffman and other twentieth-century critics of the mental hospital. It shows that these two are not necessarily irreconcilable: that it is possible to be fully committed to the principles of integration and normalization, whilst also creating a safe, highly supportive and bounded environment.

Conclusions: The time is ripe for a rethinking of the concept of asylum for the mentally ill and for an examination of innovative settings that fulfil this function.

Declaration of interest: The study was funded by The Community of St Antony and St Elias. Unless otherwise stated, the views expressed in this paper are those of the author alone, who has no personal connection with the Community.

• Asylum
• moral treatment
• new long-stay population
• residential care
• ethnography