A profession is an occupation founded upon specialized educational training, the purpose of, to supply disinterested objective counsel and service to others, for a direct and definite compensation, wholly apart from expectation of other business gain. The term is a truncation of the term "liberal profession", which is, in turn, an Anglicization of the French term "profession libérale". Borrowed by English users in the 19th century, it has been re-borrowed by international users from the late 20th, though the class overtones of the term do not seem to survive retranslation: "liberal professions" are, according to the European Union's Directive on Recognition of Professional Qualifications "those practiced on the basis of relevant professional qualifications in a personal and professionally independent capacity by those providing intellectual and conceptual services in the interest of the client and the public", it has been said. Medieval and early modern tradition recognized only three professions: divinity and law – the so-called "learned professions".
Major milestones which may mark an occupation being identified as a profession include: an occupation becomes a full-time occupation the establishment of a training school the establishment of a university school the establishment of a local association the establishment of a national association of professional ethics the establishment of state licensing lawsApplying these milestones to the historical sequence of development in the United States shows surveying achieving professional status first, followed by medicine, actuarial science, dentistry, civil engineering, logistics and accounting. With the rise of technology and occupational specialization in the 19th century, other bodies began to claim professional status: mechanical engineering, veterinary medicine, nursing, librarianship and social work, each of which could claim, using these milestones, to have become professions by 1900. Just as some professions rise in status and power through various stages, others may decline. Disciplines formalized more such as architecture, now have long periods of study associated with them.
Although professions may enjoy high status and public prestige, not all professionals earn high salaries, within specific professions there exist significant inequalities of compensation. A profession arises when any trade or occupation transforms itself through "the development of formal qualifications based upon education and examinations, the emergence of regulatory bodies with powers to admit and discipline members, some degree of monopoly rights." Any regulation of the professions was self-regulation through bodies such as the College of Physicians or the Inns of Court. With the growing role of government, statutory bodies have taken on this role, their members being appointed either by the profession or by government. Proposals for the introduction or enhancement of statutory regulation may be welcomed by a profession as protecting clients and enhancing its quality and reputation, or as restricting access to the profession and hence enabling higher fees to be charged, it may be resisted as limiting the members' freedom to innovate or to practice as in their professional judgement they consider best.
An example was in 12, when the British government proposed wide statutory regulation of psychologists. The inspiration for the change was a number of problems in the psychotherapy field, but there are various kinds of psychologist including many who have no clinical role and where the case for regulation was not so clear. Work psychology brought especial disagreement, with the British Psychological Society favoring statutory regulation of "occupational psychologists" and the Association of Business Psychologists resisting the statutory regulation of "business psychologists" – descriptions of professional activity which it may not be easy to distinguish. Besides regulating access to a profession, professional bodies may set examinations of competence and enforce adherence to an ethical code. There may be several such bodies for one profession in a single country, an example being the accountancy bodies of the United Kingdom, all of which have been given a Royal Charter, although their members are not considered to hold equivalent qualifications, which operate alongside further bodies.
Another example of a regulatory body that governs a profession is the Hong Kong Professional Teachers Union, which governs the conduct, rights and duties of salaried teachers working in educational institutions in Hong Kong. The engineering profession is regulated in some countries with a strict licensing system for Professional Engineer that controls the practice but not in others where titles and qualifications are regulated Chartered Engineer but practice is not regulated. Individuals are required by law to be qualified by a local professional body before they are permitted to practice in that profession. However, in some countries, individuals may not be required by law to be qualified by such a professional body in order to practice, as is the case for accountancy in the United Kingdom. In such c
Neurodevelopmental disorder is a mental disorder. A narrower use of the term refers to a disorder of brain function which affects emotion, learning ability, self-control and memory and which unfolds as the individual grows. Neurodevelopmental disorders tend to last for a person's entire lifetime. Disorders considered neurodevelopmental are definetely of one of these types: Intellectual disability or intellectual and developmental disability called mental retardation Autism spectrum disorders, such as Asperger's syndrome or Kanner syndrome Motor disorders including developmental coordination disorder and stereotypic movement disorder Tic disorders including Tourette's syndrome Traumatic brain injury Communication and language disorders Genetic disorders, such as fragile-X syndrome, Down syndrome, attention deficit hyperactivity disorder, schizotypal disorder, hypogonadotropic hypogonadal syndromes Disorders due to neurotoxicants like fetal alcohol spectrum disorder, Minamata disease caused by mercury, behavioral disorders including conduct disorder etc. caused by other heavy metals, such as lead, platinum etc. hydrocarbons like dioxin, PBDEs and PCBs, medications and illegal drugs, like cocaine and others.
The development of the nervous system including the brain is orchestrated regulated, genetically encoded process with clear influence from the environment. This suggests that any deviation from this program early in life can result in neurodevelopmental disorders and, depending on specific timing, might lead to distinct pathology in life; because of that, there are many causes of neurodevelopmental disorder, which can range from deprivation and metabolic diseases, immune disorders, infectious diseases, nutritional factors, physical trauma, toxic and environmental factors. Some neurodevelopmental disorders—such as autism and other pervasive developmental disorders—are considered multifactorial syndromes with many causes but more specific neurodevelopmental manifestation. Deprivation from social and emotional care causes severe delays in cognitive development. Studies with children growing up in Romanian orphanages during Nicolae Ceauşescu's regime reveal profound effects of social deprivation and language deprivation on the developing brain.
These effects are time dependent. The longer children stayed in the greater the consequences. By contrast, adoption at an early age mitigated some of the effects of earlier institutionalization. A prominent example of a genetically determined neurodevelopmental disorder is Trisomy 21 known as Down syndrome; this disorder results from an extra chromosome 21, although in uncommon instances it is related to other chromosomal abnormalities such as translocation of the genetic material. It is characterized by short stature, epicanthal folds, abnormal fingerprints, palm prints, heart defects, poor muscle tone and mental retardation. Less known genetically determined neurodevelopmental disorders include Fragile X syndrome. Fragile X syndrome was first described in 1943 by J. P. Martin and J. Bell, studying persons with family history of sex-linked "mental defects". Rett syndrome, another X-linked disorder, produces severe functional limitations. Williams syndrome is caused by small deletions of genetic material from chromosome 7.
The most common recurrent Copy Number Variannt disorder is 22q11.2 deletion syndrome, followed by Prader-Willi syndrome and Angelman syndrome. Immune reactions during pregnancy, both maternal and of the developing child, may produce neurodevelopmental disorders. One typical immune reaction in infants and children is PANDAS, or Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infection. Another disorder is Sydenham's chorea, which results in more abnormal movements of the body and fewer psychological sequellae. Both are immune reactions against brain tissue. Susceptibility to these immune diseases may be genetically determined, so sometimes several family members may suffer from one or both of them following an epidemic of Strep infection. Systemic infections can result in neurodevelopmental consequences, when they occur in infancy and childhood of humans, but would not be called a primary neurodevelopmental disorder per se, as for example HIV Infections of the head and brain, like brain abscesses, meningitis or encephalitis have a high risk of causing neurodevelopmental problems and a disorder.
For example, measles can progress to subacute sclerosing panencephalitis. A number of infectious diseases can be transmitted congenitally, can cause serious neurodevelopmental problems, as for example the viruses HSV, CMV, Zika virus, or bacteria like Treponema pallidum in congenital syphilis, which may progress to neurosyphilis if it remains untreated. Protozoa like Plasmodium or Toxoplasma which can cause congenital toxoplasmosis with multiple cysts in the brain and other organs, leading to a variety of neurological deficits; some cases of schizophrenia may be related to congenital infections though the majority are of unknown causes. Metabolic disorders in either the mother or the child can cause neurodevelopmental disorders. Two examples are phenylketonuria. Many such inherited diseases may directly affect the child's metabolism and neural development but less they can indirectly affect the child during gestati
Doctor of Medicine
A Doctor of Medicine is a medical degree, the meaning of which varies between different jurisdictions. In the United States and other countries, the MD denotes a professional graduate degree awarded upon graduation from medical school. In the United Kingdom and other countries, the MD is a research doctorate, higher doctorate, honorary doctorate or applied clinical degree restricted to those who hold a professional degree in medicine. In 1703, the University of Glasgow's first medical graduate, Samuel Benion, was issued with the academic degree of Doctor of Medicine. University medical education in England culminated with the MB qualification, in Scotland the MD, until in the mid-19th century the public bodies who regulated medical practice at the time required practitioners in Scotland as well as England to hold the dual Bachelor of Medicine and Bachelor of Surgery degrees. North American medical schools switched to the tradition of the ancient universities of Scotland and began granting the MoD title rather than the MB beginning in the late 18th century.
The Columbia University College of Physicians and Surgeons in New York was the first American university to grant the MD degree instead of the MB. Early medical schools in North America that granted the Doctor of Medicine degrees were Columbia, Harvard, McGill; these first few North American medical schools that were established were founded by physicians and surgeons, trained in England and Scotland. A feminine form, "Doctress of Medicine" or Medicinae Doctrix, was used by the New England Female Medical College in Boston in the 1860s. In most countries having a Doctor of Medicine degree does not mean that the individual will be allowed to practice medicine. A doctor must go through a residency for at least four years and take some form of licensing examination in their jurisdiction. In Afghanistan, medical education begins after high school. No pre-medicine courses or bachelor's degree is required. Eligibility is determined through the rank applicants obtain in the public university entrance exam held every year throughout the country.
Entry to medical school is competitive, only students with the highest ranks are accepted into medical programs. The primary medical degree is completed in 7 years. According to the new medical curriculum, during the 12th semester, medical students must complete research on a medical topic and provide a thesis as part of their training. Medical graduates are awarded a certificate in general medicine, regarded "MD" and validated by the "Ministry of Higher Education of Afghanistan". All physicians are to obtain licensing and a medical council registration number from the "Ministry of Public Health" before they begin to practice, they may subsequently specialize in a specific medical field at medical schools offering the necessary qualifications. After graduation, students may complete residency; the MD specification: Before the civil wars in Afghanistan, medical education used to be taught by foreign professors or Afghan professors who studied medical education abroad. The Kabul medical institute certified the students as "Master of Medicine".
After the civil wars, medical education has changed, the MD certification has been reduced to "Medicine Bachelor". In Argentina, the First Degree of Physician or Physician Diplomate is equivalent to the North American MD Degree with six years of intensive studies followed by three or four years of residency as a major specialty in a particular empiric field, consisting of internships, social services and sporadic research. Only by holding a Medical Title can the postgraduate student apply for the Doctor degree through a Doctorate in Medicine program approved by the National Commission for University Evaluation and Accreditation. Australian medical schools have followed the British tradition by conferring the degrees of Bachelor of Medicine and Bachelor of Surgery to its graduates whilst reserving the title of Doctor of Medicine for their research training degree, analogous to the PhD, or for their honorary doctorates. Although the majority of Australian MBBS degrees have been graduate programs since the 1990s, under the previous Australian Qualifications Framework they remained categorized as Level 7 Bachelor's degrees together with other undergraduate programs.
The latest version of the AQF includes the new category of Level 9 Master's degrees which permits the use of the term'Doctor' in the styling of the degree title of relevant professional programs. As a result, various Australian medical schools have replaced their MBBS degrees with the MD to resolve the previous anomalous nomenclature. With the introduction of the Master's level MD, universities have renamed their previous medical research doctorates; the University of Melbourne was the first to introduce the MD in 2011 as a basic medical degree, has renamed its research degree to Doctor of Medical Science. In French-speaking Belgium, the medical degree awarded after six years of study is "Docteur en Médecine". Physicians would have to register with the Ordre des Medicins to practice medicine in the country. At the end of the six-year medical programs from Bulgarian medical schools, medical students are awarded the academic degree Master in Medicine and the professional title Physician - Doctor of Medicine.
After 6 years of general medical education, all students will graduate with
Emergency psychiatry is the clinical application of psychiatry in emergency settings. Conditions requiring psychiatric interventions may include attempted suicide, substance abuse, psychosis, violence or other rapid changes in behavior. Psychiatric emergency services are rendered by professionals in the fields of medicine, nursing and social work; the demand for emergency psychiatric services has increased throughout the world since the 1960s in urban areas. Care for patients in situations involving emergency psychiatry is complex. Individuals may arrive in psychiatric emergency service settings through their own voluntary request, a referral from another health professional, or through involuntary commitment. Care of patients requiring psychiatric intervention encompasses crisis stabilization of many serious and life-threatening conditions which could include acute or chronic mental disorders or symptoms similar to those conditions. Symptoms and conditions behind psychiatric emergencies may include attempted suicide, substance dependence, alcohol intoxication, acute depression, presence of delusions, panic attacks, significant, rapid changes in behavior.
Emergency psychiatry treat these symptoms and psychiatric conditions. In addition, several lethal medical conditions present themselves with common psychiatric symptoms. A physician's or a nurse's ability to identify and intervene with these and other medical conditions is critical; the place where emergency psychiatric services are delivered are most referred to as Psychiatric Emergency Services, Psychiatric Emergency Care Centers, or Comprehensive Psychiatric Emergency Programs. Mental health professionals from a wide area of disciplines, including medicine, nursing and social work in these settings alongside psychiatrists and emergency physicians; the facilities, sometimes housed in a psychiatric hospital, psychiatric ward, or emergency department, provide immediate treatment to both voluntary and involuntary patients 24 hours a day, 7 days a week. Within a protected environment, psychiatric emergency services exist to provide brief stay of two or three days to gain a diagnostic clarity, find appropriate alternatives to psychiatric hospitalization for the patient, to treat those patients whose symptoms can be improved within that brief period of time.
Precise psychiatric diagnoses are a secondary priority compared with interventions in a crisis setting. The functions of psychiatric emergency services are to assess patients' problems, implement a short-term treatment consisting of no more than ten meetings with the patient, procure a 24-hour holding area, mobilize teams to carry out interventions at patients' residences, utilize emergency management services to prevent further crises, be aware of inpatient and outpatient psychiatric resources, provide 24/7 telephone counseling. Since the 1960s, the demand for emergency psychiatric services has endured a rapid growth due to deinstitutionalization both in Europe and the United States. Deinstitutionalization, in some locations, has resulted in a larger number of mentally ill people living in the community. There have been increases in the number of medical specialties, the multiplication of transitory treatment options, such as psychiatric medication; the actual number of psychiatric emergencies has increased especially in psychiatric emergency service settings located in urban areas.
Emergency psychiatry has involved the evaluation and treatment of unemployed and other disenfranchised populations. Emergency psychiatry services have sometimes been able to offer accessibility and anonymity. While many of the patients who have used psychiatric emergency services shared common sociological and demographic characteristics, the symptoms and needs expressed have not conformed to any single psychiatric profile; the individualized care needed for patients utilizing psychiatric emergency services is evolving, requiring an always changing and sometimes complex treatment approach. As of 2000, the World Health Organization estimated one million suicides in the world each year. There are countless more suicide attempts. Psychiatric emergency service settings exist to treat the mental disorders associated with an increased risk of completed suicide or suicide attempts. Mental health professionals in these settings are expected to predict acts of violence patients may commit against themselves though the complex factors leading to a suicide can stem from many sources, including psychosocial, interpersonal and religious.
These mental health professionals will use any resources available to them to determine risk factors, make an overall assessment, decide on any necessary treatment. Aggression can be the result of both internal and external factors that create a measurable activation in the autonomic nervous system; this activation can become evident through symptoms such as the clenching of fists or jaw, slamming doors, hitting palms of hands with fists, or being startled. It is estimated that 17% of visits to psychiatric emergency service settings are homicidal in origin and an additional 5% involve both suicide and homicide. Violence is associated with many conditions such as acute intoxication, acute psychosis, paranoid personality disorder, antisocial personality disorder, narcissistic personality disorder and borderline personality disorder. Additional risk factors have been identified which may lead to violent behavior; such risk factors may include prior arrests, presence of hallucinations, delusions or other neurological impairment, being uneducated, etc. Mental health professionals complete violence risk ass
Mental status examination
The mental status examination or mental state examination is an important part of the clinical assessment process in psychiatric practice. It is a structured way of observing and describing a patient's psychological functioning at a given point in time, under the domains of appearance, behavior and affect, thought process, thought content, cognition and judgment. There are some minor variations in the subdivision of the MSE and the sequence and names of MSE domains; the purpose of the MSE is to obtain a comprehensive cross-sectional description of the patient's mental state, when combined with the biographical and historical information of the psychiatric history, allows the clinician to make an accurate diagnosis and formulation, which are required for coherent treatment planning. The data are collected through a combination of direct and indirect means: unstructured observation while obtaining the biographical and social information, focused questions about current symptoms, formalised psychological tests.
The MSE is not to be confused with the Mini–Mental State Examination, a brief neuro-psychological screening test for dementia. The MSE derives from an approach to psychiatry known as descriptive psychopathology or descriptive phenomenology, which developed from the work of the philosopher and psychiatrist Karl Jaspers. From Jaspers' perspective it was assumed that the only way to comprehend a patient's experience is through his or her own description, as distinct from an interpretive or psychoanalytic approach which assumes the analyst might understand experiences or processes of which the patient is unaware, such as defense mechanisms or unconscious drives. In practice, the MSE is a blend of empathic descriptive phenomenology and empirical clinical observation, it has been argued that the term phenomenology has become corrupted in clinical psychiatry: current usage, as a set of objective descriptions of a psychiatric patient, is incompatible with the original meaning, concerned with comprehending a patient's subjective experience.
The mental status examination is a core skill of qualified health personnel. It is a key part of the initial psychiatric assessment in an out-patient or psychiatric hospital setting, it is a systematic collection of data based on observation of the patient's behavior while the patient is in the clinician's view during the interview. The purpose is to obtain evidence of symptoms and signs of mental disorders, including danger to self and others, that are present at the time of the interview. Further, information on the patient's insight and capacity for abstract reasoning is used to inform decisions about treatment strategy and the choice of an appropriate treatment setting, it is carried out in the manner of an informal enquiry, using a combination of open and closed questions, supplemented by structured tests to assess cognition. The MSE can be considered part of the comprehensive physical examination performed by physicians and nurses although it may be performed in a cursory and abbreviated way in non-mental-health settings.
Information is recorded as free-form text using the standard headings, but brief MSE checklists are available for use in emergency situations, for example by paramedics or emergency department staff. The information obtained in the MSE is used, together with the biographical and social information of the psychiatric history, to generate a diagnosis, a psychiatric formulation and a treatment plan. Clinicians assess the physical aspects such as the appearance of a patient, including apparent age, height and manner of dress and grooming. Colorful or bizarre clothing might suggest mania, while unkempt, dirty clothes might suggest schizophrenia or depression. If the patient appears much older than his or her chronological age this can suggest chronic poor self-care or ill-health. Clothing and accessories of a particular subculture, body modifications, or clothing not typical of the patient's gender, might give clues to personality. Observations of physical appearance might include the physical features of alcoholism or drug abuse, such as signs of malnutrition, nicotine stains, dental erosion, a rash around the mouth from inhalant abuse, or needle track marks from intravenous drug abuse.
Observations can include any odor which might suggest poor personal hygiene due to extreme self-neglect, or alcohol intoxication. Weight loss could signify a depressive disorder, physical illness, anorexia nervosa or chronic anxiety. Attitude known as rapport or cooperation, refers to the patient's approach to the interview process and the quality of information obtained during the assessment. Abnormalities of behavior called abnormalities of activity, include observations of specific abnormal movements, as well as more general observations of the patient's level of activity and arousal, observations of the patient's eye contact and gait. Abnormal movements, for example choreiform, athetoid or choreoathetoid movements may indicate a neurological disorder. A tremor or dystonia may indicate a neurological condition or the side effects of antipsychotic medication; the patient may have tics. There are a range of abnormalities of movement which are typical of catatonia, such as echopraxia, waxy flexibility and paratonia.
Stereotypies or mannerisms may be a feature of chronic autism. More global beh
A psychologist studies normal and abnormal mental states, cognitive and social processes and behavior by observing and recording how individuals relate to one another and to their environments. To become a psychologist, a person completes a graduate university degree in psychology, but in most jurisdictions, members of other behavioral professions can evaluate, diagnose and study mental processes. Psychologists can be seen as practicing within two general categories of psychology: applied psychology which includes "practitioners" or "professionals", research-orientated psychology which includes "scientists", or "scholars"; the training models endorsed by the American Psychological Association require that applied psychologists be trained as both researchers and practitioners, that they possess advanced degrees. Psychologists have one of two degrees; the PhD prepares a psychologist to conduct scientific research for a career in academia. Both PsyD and PhD programs can prepare students to be licensed psychologists, training in these types of programs prepares graduates to take state licensing exams.
Within the two main categories are many further types of psychologists as reflected by the 56 professional classifications recognized by the APA, including clinical and educational psychologists. Such professionals work with persons in a variety of therapeutic contexts. People think of the discipline as involving only such clinical or counseling psychologists. While counseling and psychotherapy are common activities for psychologists, these applied fields are just two branches in the larger domain of psychology. There are other classifications such as industrial and community psychologists, whose professionals apply psychological research and techniques to "real-world" problems of business, social benefit organizations and academia. Clinical and counseling psychologists can offer a range of professional services, including: Providing psychological treatment Administering and interpreting psychological assessment and testing Conducting psychological research Teaching Developing prevention programs Consulting Program administration Providing expert testimony In practice and counseling psychologists might work with individuals, families, or groups in a variety of settings, including private practices, mental health organizations, schools and non-profit agencies.
Most clinical and counseling who engage in research and teaching do so within a college or university setting. Clinical and counseling psychologists may choose to specialize in a particular field. Common areas of specialization, some of which can earn board certification, include: Specific disorders Neuropsychological disorders Child and adolescent psychology Family and relationship counseling Health psychology Sport psychology Forensic psychology Industrial and organizational psychology Educational psychologyClinical and counseling psychologists receive training in a number of psychological therapies, including behavioral, humanistic, existential and systemic approaches, as well as in-depth training in psychological testing, to some extent, neuropsychological testing. Although clinical and counseling psychologists and psychiatrists share the same fundamental aim—the alleviation of mental distress—their training and methodologies are different; the most significant difference is that psychiatrists are licensed physicians, and, as such, psychiatrists are apt to use the medical model to assess mental health problems and to employ psychotropic medications as a method of addressing mental health problems.
Psychologists do not prescribe medication, although in some jurisdictions they do have prescription privileges. In five US states, psychologists with post-doctoral clinical psychopharmacology training have been granted prescriptive authority for mental health disorders. Clinical and counseling psychologists receive extensive training in psychological test administration, scoring and reporting, while psychiatrists are not trained in psychological testing; such tests help to inform treatment planning. For example, in a medical center, a patient with a complicated clinical presentation, being seen by a psychiatrist might be referred to a clinical psychologist for psychological testing to help the psychiatrist determine the diagnosis and treatment. In addition, psychologists spend several years in graduate school being trained to conduct behavioral research. While this training is available for physicians via dual MD/Ph. D. programs, it is not included in standard medical education, although psychiatrists may develop research skills during their residency or a psychiatry fellowship.
Psychologists from Psy. D. Programs tend to have more training and experience in clinical practice than those from Ph. D. programs. Psychiatrists, as licensed physicians, have been trained more intensively in other areas, such as internal medicine and neurology, may bring this knowledge to bear in identifying and treating medical or neurological conditions that present with psychological symptoms such as depression, anxiety, or
Psychiatric hospitals known as mental hospitals, mental health units, mental asylums or asylums, are hospitals or wards specializing in the treatment of serious mental disorders, such as major depressive disorder and bipolar disorder. Psychiatric hospitals vary in their size and grading; some hospitals may specialize only in short outpatient therapy for low-risk patients. Others may specialize in the temporary or permanent care of residents who, as a result of a psychological disorder, require routine assistance, treatment, or a specialized and controlled environment. Patients are admitted on a voluntary basis, but people whom psychiatrists believe may pose a significant danger to themselves or others may be subject to involuntary commitment. Psychiatric hospitals may be referred to as psychiatric wards or units when they are a subunit of a regular hospital. Modern psychiatric hospitals evolved from, replaced the older lunatic asylums; the treatment of inmates in early lunatic asylums was sometimes brutal and focused on containment and restraint.
With successive waves of reform, the introduction of effective evidence-based treatments, most modern psychiatric hospitals provide a primary emphasis on treatment, attempt where possible to help patients control their own lives in the outside world, with the use of a combination of psychiatric drugs and psychotherapy. An exception is in Japan, where many psychiatric hospitals still use physical restraints on patients, tying them to their beds for days or months at a time. A crisis stabilization unit is in effect an emergency department for psychiatry dealing with suicidal, violent, or otherwise critical individuals. Open units are psychiatric units. Another type of psychiatric hospital is medium term. In the United Kingdom, both crisis admissions and medium term care are provided on acute admissions wards. Juvenile or adolescent wards are sections of psychiatric hospitals or psychiatric wards set aside for children or adolescents with mental illness. Long-term care facilities have the goal of treatment and rehabilitation back into society within a short time-frame.
Another institution for the mentally ill is a community-based halfway house. Modern psychiatric hospitals evolved from, replaced the older lunatic asylums; the development of the modern psychiatric hospital is the story of the rise of organized, institutional psychiatry. Hospitals known as bimaristans were built in Persia beginning around the early 9th century, with the first in Baghdad under the leadership of the Abbasid Caliph Harun al-Rashid. While not devoted to patients with psychiatric disorders, they contained wards for patients exhibiting mania or other psychological distress; because of cultural taboos against refusing to care for one's family members, mentally ill patients would be surrendered to a bimaristan only if the patient demonstrated violence, incurable chronic illness, or some other debilitating ailment. Psychological wards were enclosed by iron bars owing to the aggression of some of the patients. Western Europe would adopt these views on with the advances of physicians like Philippe Pinel at the Bicêtre Hospital in France and William Tuke at the York Retreat in England.
They advocated the viewing of mental illness as a disorder that required compassionate treatment that would aid in the rehabilitation of the victim. The arrival in the Western world of institutionalisation as a solution to the problem of madness was much an advent of the nineteenth century; the first public mental asylums were established in Britain. Nine counties first applied. In 1828, the newly appointed Commissioners in Lunacy were empowered to license and supervise private asylums; the Lunacy Act 1845 made the construction of asylums in every country compulsory with regular inspections on behalf of the Home Secretary. The Act required asylums to have a resident physician. At the beginning of the nineteenth century there were a few thousand "sick people" housed in a variety of disparate institutions throughout England, but by 1900 that figure had grown to about 100,000; this growth coincided with the growth of alienism known as psychiatry, as a medical specialism. The treatment of inmates in early lunatic asylums was sometimes brutal and focused on containment and restraint.
In the late 19th and early 20th centuries, terms such as "madness," "lunacy" or "insanity"—all of which assumed a unitary psychosis—were split into numerous "mental diseases," of which catatonia and dementia praecox were the most common in psychiatric institutions. In 1961 sociologist Erving Goffman described a theory of the "total institution" and the process by which it takes efforts to maintain predictable and regular behavior on the part of both "guard" and "captor," suggesting that many of the features of such institutions serve the ritual function of ensuring that both classes of people know their function and social role, in other words of "institutionalizing" them. Asylums was a key text in the development of deinstitutionalization. With successive waves of reform and the introduction of effective evidence-based treatments, modern psychiatric hospitals provide a primary emphasis on treatment.