The term institutionalisation can both be used to the process of committing an individual to a mental hospital or prison or to institutional syndrome. Committal to a mental institution is very much a thing of the past but occurs in a small number of cases taking the psychiatric population as a whole. Being too ill to look after themselves they may become dependant on professional staff to care for their needs. On leaving hospital people who can’t adjust to independent living (after say a long period in hospital) can be said to suffer from institutional syndrome. This basically means they are unable to adjust to independence and need community health services such as a place in a hostel to get by. Prison speaks for itself and the subject of the article excludes prison. There are many symptoms of institutionalisation but I will endeavour to gloss over these for the moment and make some salient points.
The first thing I would like to point to, is the neglect a person may experience because of being either taken for granted or being viewed as someone who can’t be helped. This can happen in hospital or in a hostel and can be devastating for the individual over a long period of time. There can be a lack of communication in the long run which can make the situation worse. The service user can face alienation, lack of stimulation and poor self esteem and particularly a lack of ability to communicate in a meaningful way. This last point manifests itself in poor social life and life skills such as self advocacy. Some professionals may say that neglect is a form of abuse by the system.
There is a strong link between suicide and institutionalisation. Continued isolation (a factor in institutionalisation) and neglect can leave a service user prone to suicidal feelings. Very often the service user is institutionalised through trauma and this can lead to a fear of being a person in his own right. The part to play of a service user’s personality in diagnosis can lead to bias and someone who enters the institutionalised syndrome with a weak personality can be mistaken for a person who can’t look after himself leading to the syndrome manifesting itself.
What kind of special symptoms would a person suffering from this ‘syndrome’ experience you may ask?
Self stigmatisation is one. Very often institutionalised people will feel negatively about themselves. They may have low self esteem.
The feeling of being overwhelmed is also common and along with a low stress threshold can make it difficult for the service user to function normally.
Dosage of medication can be relatively high compared to other service users and hence recovery impeded, considering that the first step to recovery is usually a reduction in medication.
Fear of a change by the service user in his routine and the boredom of a menial daily existence (a very simple routine) can be seen as part of the syndrome.
Mild depression can accompany being lethargic, which results from the service user’s relative inactivity and the motivation to do things can be absent.
Most people who are institutionalised don’t really enjoy life. They struggle from day to day and find it hard to appreciate the good points in their lives.
Inability to communicate at a normal level and relate to a wider world can afflict the service user. This last point should be taken in the light of an over reliance on a psychiatrist, to talk about problems the person may have.
Losing touch with family and becoming distant from them, can be a symptom of the syndrome. Very often when a service user becomes either depressed or lethargic and they find it hard to develop relationships with family and friends.
Developing variety in one’s routine can be absent and the grind of a constant and unchanging routine can manifest itself into the institutionalised syndrome. This is particularly relevant to a person who has a bi-polar illness. The normal symptoms of psychiatric illness can also be present and a normal healthy sleeping pattern may be absent.
Symptoms aside some people find adapting to hostel life quite easy and don’t necessarily become institutionalised but others don’t, particularly if they have been in hospital for a long time. Boredom may set in and inactivity can contribute to the condition. It is very important to prepare a care plan for the person leaving hospital and a daily activity schedule. Treats such a day out at the seaside or the cinema, can help the service user perk up a bit. A subsidised holiday can bring respite from the mundane.
Lastly I would like to say that if a person is institutionalised, staff will need to put in an extra effort to care in a positive way for this person. Close contact with the person should be encouraged and daily monitoring of his /her condition should be made. A doctor may not see the things in a short meeting, a nurse may see in the client’s everyday life.
If you’ve been affected by any of the issues in Paul’s story, or if you need to speak with someone, click through for a list of organisations that can help
See Change understands that there are many perspectives on mental health problems and the experience of being unwell. See Change encourages the publication of material that promotes understanding of mental health problems, the experience of being unwell, and recovery. The opinions expressed by contributors to the Make a Ripple campaign are those of the author, and do not necessarily represent the views of See Change.