mental health act essay

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The Mental Health Act 

This section is about detention under the Mental Health Act 1983. This is sometimes called ‘sectioning’. We explain why you may be detained, and what rights you have. This information is for adults in England who are affected by mental illness and their loved ones and carers. It's also for anyone interested in the subject. 

We are a trusted information creator  and accredited by the Patient Information Forum (PIF). See this 46 second video for why this is important: www.youtube.com/watch?v=wq0KWzxrEuw

About the Act

What is a mental disorder, how can i be detained, what support can i get, sections 2, 3, 4 & 5, what happens next, useful contacts, further reading.

Contact us:

• The Mental Health Act says when you can be detained in hospital and treated against your wishes.
• You can be detained if professionals think your mental health puts you or others at risk, and you need to be in hospital.
• If you are detained, NHS staff may be able to give you treatment, even if you don’t want it.
• There are different sections of the Mental Health Act. These are used for different reasons.
• When you are detained, you have the right to appeal, and the right to get help from an independent advocate.

Need more advice?

What is the mental health act.

The Mental Health Act says when you can be taken to hospital, kept there, and treated against your wishes. This can only happen if you have a mental disorder that puts you, or others, at risk.

You should only be detained under the Mental Health Act if there are no other ways to keep you, or others, safe.

Being detained under the Mental Health Act is sometimes called being ‘sectioned’, because the law has different sections.

Your rights under the Mental Health Act depend on which section you are detained under.

This page does not cover criminal law sections. You can find more information about:

• Section 35 by clicking here .
• Section 36 by clicking here .
• Section 37 by clicking here .
• Section 37/41 by clicking here.
• Section 38 by clicking here .
• Section 47/49 by clicking here .
• Section 48/49 by clicking here .

You can only be detained if you have a ‘mental disorder’. The Mental Health Act does not say exactly what can be classed as a ‘mental disorder’. So, when they’re using the Mental Health Act, health professionals will decide if someone’s mental health meets this definition.

You cannot be detained for drug or alcohol addiction. But you can be detained if alcohol or drugs cause mental health problems. For example, if you have used cannabis and this has made you experience dangerous delusions. This is known as drug-induced psychosis.

You can find more information about:

• Drugs, alcohol and mental health by clicking here .
• Cannabis and mental health by clicking here .

Who decides if I need to be detained? And how do they do this?

Usually, 3 professionals will assess you. And they have to agree that you need to be detained. But this may not be the case if the situation is urgent.

The 3 people are normally:

• an approved mental health professional (AMHP),
• a doctor who has special training in mental disorders, called a ‘section 12 approved doctor’, and
• another doctor.

If possible, at least 1 of the doctors should have met you before.

The AHMP can only agree for you to be detained if they have seen you in the past 14 days.

The doctors must either have seen you at the same time, or within 5 days of each other.

If all 3 people agree that you need to be detained, the AMHP will apply to a local hospital for a bed.

Your nearest relative can also apply for you to be detained, but this is rare. You can find out more about nearest relatives below.

What is an AMHP?

AMHPs are mental health professionals who carry out certain duties under the Mental Health Act. They are given specialist training to do this.

An AMHP might be a:

• social worker,
• occupational therapist, or
• psychologist.

A doctor cannot be an AMHP.

Where am I assessed?

This depends on where you are. The assessment might take place where you live, in a public place, in a police station, or in hospital.

The AMHP should introduce themselves, and the doctors, to you. They should explain why they have come to see you.

The AMHP can apply to court for a warrant if you refuse to let them in. Or if they think it’s necessary for another reason. A warrant lets the police enter your home to take you somewhere safe. This is called a ‘section 135’. If the place that you live can be considered a safe place, you may be kept there whilst an assessment is arranged.

If you are in a public place, the police can take you to a safe place under ‘section 136’. A safe place might be:

• where you live,
• a hospital, or
• a police station.
• Section 135 by clicking here .
• Section 136 by clicking here .

How will the professionals assess me?

When you are in a safe place, the professionals will decide if you need to be detained. They will ask you questions and think about all your circumstances. They may ask you:

• how you are feeling,
• if you have plans to harm yourself or others,
• about your lifestyle, daily routine, and living conditions,
• if you have been taking your medication, and if you have been using drugs or alcohol.

Professionals will assess the risk you are to yourself. And to other people. To assess the risk professionals may ask questions like:

• Are you or anyone else in danger of being harmed?
• How and when did your behaviour change?
• Are you being aggressive? If so, how?
• Have you tried to harm yourself or others? If so, how and when did it happen? Have you harmed yourself or others in the past?
• Have you stopped eating, drinking or bathing?
• What might realistically happen if you’re not detained?

What happens when I am detained?

If you are not already in hospital, the AMHP will arrange for you to go there as soon as possible. Sometimes the police will go with you.

But you should not be taken to hospital until a bed has been found for you. And it has been agreed with the hospital that they can accept you. So sometimes you may remain in the community with supervision until this happens.

It is likely that you will be taken to a specialist ward for people with mental health problems. This may be called an ‘acute inpatient ward’ or a ‘psychiatric intensive care unit’ (PICU). In most hospitals, the door to the ward will be locked.

Sometimes the hospital might be far away from where you live. But guidance says that the AMHP should try to find you a hospital bed as close as is ‘reasonably possible’ to where you would like to be.

In hospital, you will be introduced to your ‘responsible clinician’. This is the person who is in charge of your care and treatment. They are usually a psychiatrist, but they can be other professionals too.

What is a nearest relative?

The ‘nearest relative’ is a legal term used in the Mental Health Act. It is not the same as your next of kin.

Your nearest relative has certain rights if:

• they are worried about your mental health,
• you are detained under the Mental Health Act, or
• professionals are thinking about detaining you under the Mental Health Act.

The nearest relative can ask an AMHP to arrange a Mental Health Act assessment. If the AMHP decides not to detain you, the nearest relative has a right to have their reasons in writing.

You can find more information about ‘Nearest Relative’ by clicking here .

What are my rights if I’m detained?

When you’re detained you must be told which section you’re under, and what your rights are.

You should also be given information on:

• how to make a complaint,
• how to apply for a tribunal,
• how to get an advocate to help you, and
• how to get legal advice.

Your team should think about your needs when telling you of your rights. You may need the information to be written in an simpler way. Or in a language you understand better. Or explained in a way that makes sense to you.

Can I leave the hospital if I am detained under section?

Your responsible clinician may give you “section 17 leave”. This allows you to leave the hospital for a brief period of time, if your responsible clinician agrees. This might be for a specific occasion, such as attending a family wedding. If there are concerns whilst you are out in the community, you may be taken back to hospital. This is also known as ‘recall’.

Can hospital staff restrain me?

Restraint means that staff can use force against you. Restraint can be used by hospital staff when they are trying to stop you, or someone else, from getting hurt.

When you are in hospital you must be told your rights about being restrained.

Staff must be trained in how they can restrain you safely. The hospital must keep a detailed record of when they have used restraint on you. Unless the restraint was ‘negligible’. ’Negligible’ means smaller uses of force. However, the Secretary of State has not yet published what may be considered as ‘negligible’.

If a police officer is going to a mental health unit to help staff in an emergency, the officer must take a body camera and keep it recording at all times if ‘reasonably practicable’. ‘Reasonably practicable’ means that they should always do this, unless there is a good reason why they cant.

Every year the Secretary of State has to look at the recordings and examine them. They will then write a report about the use of restraint in hospitals. They also make sure that statistics are published about the use of force by staff who work in mental health units.

You can read more about these statistics on the following link: www.digital.nhs.uk/data-and-information/publications/statistical/mental-health-act-statistics-annual-figures

Can I avoid being detained?

People often get detained because their mental health is putting them or others at risk, and they won’t accept treatment. Taking steps to improve your mental health can reduce the chance of being detained.

If it is likely you will be assessed soon, think about the possibility of accepting treatment, and reducing risky behaviour. During the assessment, you may want to explain how things are going for you, and what support you already have.

If the professionals think you are at risk, talk to them about other options for reducing these risks.

The professionals should listen to what you have to say, and consider all alternatives to detaining you. These alternatives might be receiving treatment from your local crisis team in the community. Or you agreeing to go to hospital as an informal patient. Being an informal patient is sometimes called ‘being a voluntary patient’.

If you want a friend or family member with you during a Mental Health Act assessment, let the approved mental health professional (AMHP) know.

Being taken to hospital against your will can be stressful and upsetting. You may feel that you need a lot of support.

Friends, family, and carers

Your friends and family can visit you in hospital if you want. There may be set visiting times.

There may be situations when doctors can stop someone visiting you. But they would need to show that this is necessary for safety or security reasons. And they should explain these reasons to you. If a doctor stops someone visiting you, when it’s not necessary, it could be a breach of your rights.

While you’re in hospital, you should be able to keep in touch with your family by telephone, email, or social media.

Emotional support lines

You may want to talk to someone about the way you feel. Ask the ward staff if you can use a phone to call a listening service, like Samaritans. Their number is in the Useful Contacts section at the end of this page.

Independent mental health advocate (IMHA)

You can get help from an IMHA if you are under sections 2 or 3 of the Mental Health Act.

IMHAs help you to tell staff about your concerns and help you understand what your rights are. They can also help you to understand your treatment. They are independent of the hospital staff.

Hospital staff should tell you about how to get help from an IMHA as soon as possible after you are detained.

If you think you would find it helpful to speak to an IMHA, ask staff about how to get in touch with one. You may have to ring a number to make an appointment. IMHAs can meet with you in private, if you would like them to.

You can’t get help from an IMHA if you are:

• under an emergency section (section 4),
• under holding powers of the Mental Health Act (section 5), or
• in a place of safety under police powers (section 135 or 136).

If you are under sections 2 or 3, and you think you should not have been detained, you can appeal to a tribunal. A solicitor can help you do this. This help should be free under legal aid.

Civil Legal Advice can tell you more about legal aid and help you to find a solicitor. Their number is in the ‘Useful Contacts’ section at the bottom of this page.

There may also be a list of solicitors on the ward. You can ask the staff on your ward if they have a list available.

• Going into hospital by clicking here .
• Going into hospital - for carers, friends, and relatives by clicking here .
• Legal advice by clicking here .

I have been detained under section 2 – detention for assessment. What does this mean?

Under section 2, you can be kept in hospital for up to 28 days. This section gives doctors time to:

• assess what type of mental disorder you have,
• decide if you need any treatment, and
• decide how treatment will affect your health.

An approved mental health professional (AMHP) is more likely to use section 2 than section 3 if:

• you have never been assessed in hospital before, or
• you have not been assessed for a long time.

A psychiatrist may offer you treatment. If you refuse treatment, the staff may be able to give it to you without your permission.

For more information on how you will be detained please see the previous section above.

When can I be detained under section 2?

You can be detained if:

• you have a mental disorder, and,
• you are unwell enough to need to be in hospital for an assessment, and
• professionals think you should be in hospital for your own health or safety, or to protect other people.

How long can I be kept in hospital under section 2?

Under section 2, you can be kept in hospital up to 28 days. But this doesn’t mean you will be in hospital for that long. Your doctor should discharge you from section 2 if you don’t meet the criteria for detention anymore.

Hospital staff cannot extend a section 2. If you need treatment in hospital for longer, you will need to go on to a section 3.

You can stay on a section 2 longer than 28 days if the county court is thinking about changing your nearest relative.

What are my rights while I am detained under section 2?

You have the following rights when you are under section 2.

• To appeal to a tribunal during the first 14 days.
• To appeal to the hospital managers.
• To see an independent mental health advocate (IMHA), who can help you to understand your rights, and get your voice heard.
• Discharge from the Mental Health Act by clicking here .
• Advocacy by clicking here .

Can the hospital staff give me treatment I don’t want?

Yes. But the staff should ask you to accept treatment first. If you are unhappy about your treatment, talk to the person in charge of your care (your responsible clinician). An independent mental health advocate (IMHA) may also be able to help.

Staff can only give you some treatments, like electro-convulsive therapy (ECT), if certain criteria are met. However, this is rare.

You can find more information about ‘Electro-convulsive therapy’ by clicking here .

Who can discharge me from section 2?

You can be discharged by:

• your responsible clinician,
• the hospital managers,
• your nearest relative, and
• the tribunal.

If your doctor thinks you should stay in hospital longer than 28 days, and you won’t agree to this, they may put you on a section 3. Or you may be discharged to the care of your local community mental health team. Your doctor will discuss this with you.

I have been detained under section 3 – detention for treatment.What does this mean?

Under section 3, you can be detained in hospital for treatment for up to 6 months. But it can be extended for longer.

When can I be detained under section 3?

• you are unwell enough to be in hospital,
• professionals think you should be in hospital for your own health or safety, or to protect other people,
• appropriate treatment is available for you, and
• you will not get this treatment unless you are detained.

How long can I be kept in hospital under section 3?

To start with, you can be detained for up to 6 months. But this does not mean that you will be kept for this long. Your doctor can discharge you earlier, if they think you are well enough.

If your doctor thinks you need to stay in hospital at the end of the first 6 months, they can renew your section for another 6 months. After that, they can renew it for 1 year at a time.

If your responsible clinician thinks your section should be renewed, professionals have to assess you in the 2 months before it ends. They will then write a report for the hospital managers, who have to agree that you should remain detained.

What are my rights while I am detained under section 3?

You have the following rights when you’re under section 3.

• You can appeal to a tribunal once in the first 6 months.
• If your section is renewed, you can appeal once every time it is renewed.
• You can ask the hospital managers to discharge you.
• You can ask for the help of an independent mental health advocate (IMHA). They can help you to understand your rights, and to get your voice heard.

You can be treated against your will for 3 months. After 3 months, staff can only treat you without your consent if a ‘second opinion approved doctor’ (SOAD) approves the treatment.

If you are unhappy about your treatment, you should talk to your responsible clinician. An independent mental health advocate (IMHA) may be able to help.

Staff can only give you some treatments, like electro-convulsive therapy (ECT), if certain criteria are met. This is rare.

Who can discharge me from section 3?

• the professional in charge of your care (known as your ‘responsible clinician’),

When you leave hospital, you will get free aftercare. This is known as section 117 aftercare. It is likely that mental health services will plan your care under the ‘Care Programme Approach’.

• Section 117 aftercare by clicking here .
• Care Programme Approach (CPA) by clicking here .

I have been detained under section 4 – detention in an emergency. What does this mean?

Section 4 is used in emergencies, where only 1 doctor is available at short notice. Unlike a section 2 or 3, you can be detained with a recommendation from only 1 doctor. You must have been seen by a doctor in the last 24 hours. The doctor will write a report that says you should be detained.

You can be kept for up to 72 hours. This gives the hospital time to arrange a full assessment.

When can I be detained under section 4?

You can be detained under section 4 if:

• you have a mental disorder,
• it is urgent and necessary for you to be in hospital, and
• finding another doctor would cause an "undesirable delay".

How long can I be kept in hospital under section 4?

You can be detained for up to 72 hours. But this does not mean that you will be kept for this long. A second doctor should assess you as soon as possible. They will decide if the section 4 should be changed to a section 2. The AMHP does not need to make another application to change the section 4 to a section 2.

Can I be treated against my will under section 4?

You can refuse treatment. Staff can only treat you without your consent if:

• you do not have the mental capacity to make a decision about treatment, and
• the treatment is in your best interests.

You can find more information about ‘Mental capacity and mental illness’ by clicking here .

Who can discharge me from section 4?

You can be discharged by the professional in charge of your care in hospital. They are called your responsible clinician.

I have been detained under Section 5 – holding powers. What does this mean?

Section 5 allows a doctor or nurse to stop you from leaving hospital. They may do this if you are in hospital voluntarily, and you want to leave. But they think you are too unwell to leave.

If you are in hospital voluntarily, and you are on a locked ward, staff either have to:

• let you leave when you want to, or
• use their section 5 powers.

If they stop you from leaving without using section 5, this is against the law.

Staff should only use section 5 when it is not possible or safe to use sections 2, 3, or 4.

Doctor’s holding power – section 5(2)

A doctor can hold you in hospital for up to 72 hours. The doctor should write a report explaining why you need to be detained and send this to the hospital managers.

Nurse’s holding power – section 5(4)

A mental health or learning disability nurse can keep you in hospital for up to 6 hours if:

• they need to immediately stop you leaving hospital, for your own health or safety, or for the protection of others, and
• it is not possible to find a doctor who can section you under section 5(2).

How long can I be detained for?

Under section 5(2) You can be held for up to 72 hours. The doctor cannot renew or extend it. An approved mental health professional (AMHP) and doctors must assess you as soon as possible to see if you should be detained under section 2 or 3.

Under section 5(4) A nurse can keep you in hospital for up to 6 hours. This is not renewable. The holding power ends as soon as a doctor arrives.

The doctor may transfer you onto a section 2, 3, or 5(2). Or you may continue as a voluntary patient.

Can I be treated against my will under section 5?

If you have the capacity to make your own decisions, staff cannot treat you without your consent, unless they move you to a section 2 or 3.

When does the section end?

Section 5 ends when:

• the time runs out, or
• you are detained under a different section.

If the time runs out, and the staff have not detained you under another section, you should be able to leave.

You must be discharged from the Mental Health Act when you don’t meet the criteria to be detained anymore. For example, if you are in hospital because your health puts you at risk, you can be discharged when this risk is low enough.

You can choose to stay in hospital voluntarily, if hospital staff agree that you need to be there.

Most people will not have completely recovered from their illness when they leave hospital. If staff think you are ready to leave, they should plan what will happen next. This is called ‘discharge planning’.

Your doctors should start planning your discharge as soon as possible, and you should be involved. Discharge planning should be part of your care plan. Your care plan depends on what staff think will be best for you, and what you want. It might say:

• where you will live,
• what medication will help you,
• what social support you will have, and
• which mental health services can help.

You can find more information about ‘Discharge from the Mental Health Act’ by clicking here .

When you leave hospital, professionals should plan your care under the ‘Care Programme Approach’ (CPA), if there’s a high risk that your mental health will get worse without ongoing care.

If you have been in hospital under section 3, you are entitled to free aftercare under section 117.

Community Treatment Order (CTO)

A CTO means that you can leave hospital, but you stay under the Mental Health Act. You have to meet conditions to stay in the community. You may be taken back to hospital if you don’t meet the conditions in the CTO, or you become unwell. A CTO can sometimes be called ‘supervised community treatment’.

You might be put on a CTO if you are discharged from section 3. You can’t be put on a CTO if you are under section 2, or if you are not detained.

You can find more information about ‘Community Treatment Order’ by clicking here.

Samaritans This is a national helpline that gives confidential emotional support for people who are distressed. Local branches offer telephone support and, sometimes, face-to-face support.

Telephone : 116 123. Open 24 hours per day, 7 days a week. Email : [email protected] Website : www.samaritans.org

Civil Legal Advice Civil Legal Advice can help you to find a solicitor who works under legal aid.

Telephone : 0345 345 4 345. Open Monday-Friday 9am-8pm, and Saturday 9am-12.30pm. Website : www.gov.uk/check-legal-aid

The Equality Humans Right Commission (EHRC) has many useful guides on their website. You can find more information about your rights when detained under the Mental Health Act in England on their website.

Website : www.equalityhumanrights.com/en/publication-download/your-rights-when-detained-under-mental-health-act-england

Mental Health Act - Code of Practice This is a document written by the government, working with an Expert Reference Group of service users and carers. It explains how healthcare professionals should apply the Mental Health Act.

Website : www.gov.uk/government/uploads/system/uploads/attachment_data/file/435512/MHA_Code_of_Practice.PDF

Easy read of Code of Practice website : www.assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/421541/MHA_Code_EasyRead.pdf

• Community Treatment Orders (CTOs) by clicking here.
• Complaints by clicking here .
• Going into hospital- for carers, friends, and relatives by clicking here .
• Nearest relative by clicking here .

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Last updated January 2021 Next update March 2025

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Mental Health Parity Act Analysis Essay

Patients with mental illness have been regarded as a vulnerable population in a healthcare setting for a long time. The reason for their inequity is the lack of a legal framework to address the mental health issues, the absence of awareness to treat it, and the financial burden of therapy. However, the recent developments in policymaking have implemented significant changes to improve people’s quality of care in regards to psychiatric illnesses. One of such fundamental changes made to facilitate eliminating barriers to healthcare is the Mental Health Parity Act of 2008. It has been introduced to minimize the distinctions between physical and psychological well-being, as well as enable patients to seek treatment for both aspects of their welfare equally. More specifically, the given regulation obliges insurance to cover behavioral therapy equally to a surgical and physical one. Thus, every insurance coverage enables a person to seek treatment for both psychological and physical issues without any distinction.

This policy has a drastic effect on vulnerable populations and their access to mental health services. According to the research done by Goldberg and Lin (2017), there has been at least a “10% increase in psychiatric therapy prevalence and more than 75% of medication prescription” (p. 35). Furthermore, people seeking psychological treatment have more than tripled since the policy’s implementation, which signifies a need for behavioral health equity. As evident from the statistic given above, the regulation has significantly contributed to improving emotional well-being among patients by enabling them to seek relevant medical care. This policy has also been the first step in battling the stigma surrounding the behavioral illness. As Thalmayer et al. (2017) state, negative stereotypes and stigmatization of people with mental illness have been the primary barrier to change when reducing the financial and social burden of depression. With the introduction of the policy, a major ethical shift in perception has been made in terms of normalizing psychological treatment and therapy, which allowed more people in need to address their problems medically and be able to afford it.

As it concerns the perspective of healthcare providers, the policy has been helpful in terms of enabling workers to provide much-needed psychological help to patients regardless of the patients’ insurance. While this policy has implemented a positive change, it has also uncovered an underlying ethical issue within healthcare. According to Goldberg and Lin (2017), “patient race/ethnicity, practice setting, physician specialty, and primary source of payment were associated with the diverging likelihood of being prescribed depression treatment” (p. 36). This finding indicates that people of particular socioeconomic, racial, and ethnic backgrounds are less likely to receive treatment even if it is covered by their insurance.

Social determinants of health are prevalent in psychiatric treatment, and healthcare professionals should be able to recognize and address hidden biases that are present both within their individual and institutional levels of care. While the Mental Health Parity Act enabled medical professionals to help patients in need, it also highlighted other fundamental ethical issues (Thalmayer et al., 2017). As a measure to address the rising costs of healthcare expenses and the widening gap of health disparities, the Patient Protection and Affordable Care Act supplemented the initial policy in 2010. It reinforced the purpose of the Mental Health Parity Act and ensured that people could seek the treatment they need regardless of costs (Thalmayer et al., 2017). This regulation further helped to contribute to the destruction of mental health stigma and reinforced the ethicality of equal access to care.

Goldberg, D., & Lin, H. (2017). Effects of the mental health parity and addictions equality act on depression treatment choice in primary care facilities. The International Journal of Psychiatry in Medicine, 52 (1), 34-47. Web.

Thalmayer, A., Friedman, S., Azocar, F., Harwood, J., & Ettner, S. (2017). The Mental Health Parity and Addiction Equity Act (MHPAEA) evaluation study: Impact on quantitative treatment limits. Psychiatric Services, 68 (5), 435-442. Web.

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Mental Health Essay

Introduction

Mental health, often overshadowed by its physical counterpart, is an intricate and essential aspect of human existence. It envelops our emotions, psychological state, and social well-being, shaping our thoughts, behaviors, and interactions. With the complexities of modern life—constant connectivity, societal pressures, personal expectations, and the frenzied pace of technological advancements—mental well-being has become increasingly paramount. Historically, conversations around this topic have been hushed, shrouded in stigma and misunderstanding. However, as the curtains of misconception slowly lift, we find ourselves in an era where discussions about mental health are not only welcomed but are also seen as vital. Recognizing and addressing the nuances of our mental state is not merely about managing disorders; it's about understanding the essence of who we are, how we process the world around us, and how we navigate the myriad challenges thrown our way. This essay aims to delve deep into the realm of mental health, shedding light on its importance, the potential consequences of neglect, and the spectrum of mental disorders that many face in silence.

Importance of Mental Health

Mental health plays a pivotal role in determining how individuals think, feel, and act. It influences our decision-making processes, stress management techniques, interpersonal relationships, and even our physical health. A well-tuned mental state boosts productivity, creativity, and the intrinsic sense of self-worth, laying the groundwork for a fulfilling life.

Negative Impact of Mental Health

Neglecting mental health, on the other hand, can lead to severe consequences. Reduced productivity, strained relationships, substance abuse, physical health issues like heart diseases, and even reduced life expectancy are just some of the repercussions of poor mental health. It not only affects the individual in question but also has a ripple effect on their community, workplace, and family.

Mental Disorders: Types and Prevalence

Mental disorders are varied and can range from anxiety and mood disorders like depression and bipolar disorder to more severe conditions such as schizophrenia.

• Depression: Characterized by persistent sadness, lack of interest in activities, and fatigue.
• Anxiety Disorders: Encompass conditions like generalized anxiety disorder, panic attacks, and specific phobias.
• Schizophrenia: A complex disorder affecting a person's ability to think, feel, and behave clearly.

The prevalence of these disorders has been on the rise, underscoring the need for comprehensive mental health initiatives and awareness campaigns.

Understanding Mental Health and Its Importance

Mental health is not merely the absence of disorders but encompasses emotional, psychological, and social well-being. Recognizing the signs of deteriorating mental health, like prolonged sadness, extreme mood fluctuations, or social withdrawal, is crucial. Understanding stems from awareness and education. Societal stigmas surrounding mental health have often deterred individuals from seeking help. Breaking these barriers, fostering open conversations, and ensuring access to mental health care are imperative steps.

Conclusion: Mental Health

Mental health, undeniably, is as significant as physical health, if not more. In an era where the stressors are myriad, from societal pressures to personal challenges, mental resilience and well-being are essential. Investing time and resources into mental health initiatives, and more importantly, nurturing a society that understands, respects, and prioritizes mental health is the need of the hour.

• World Leaders: Several influential personalities, from celebrities to sports stars, have openly discussed their mental health challenges, shedding light on the universality of these issues and the importance of addressing them.
• Workplaces: Progressive organizations are now incorporating mental health programs, recognizing the tangible benefits of a mentally healthy workforce, from increased productivity to enhanced creativity.
• Educational Institutions: Schools and colleges, witnessing the effects of stress and other mental health issues on students, are increasingly integrating counseling services and mental health education in their curriculum.

In weaving through the intricate tapestry of mental health, it becomes evident that it's an area that requires collective attention, understanding, and action.

  Short Essay about Mental Health

Mental health, an integral facet of human well-being, shapes our emotions, decisions, and daily interactions. Just as one would care for a sprained ankle or a fever, our minds too require attention and nurture. In today's bustling world, mental well-being is often put on the back burner, overshadowed by the immediate demands of life. Yet, its impact is pervasive, influencing our productivity, relationships, and overall quality of life.

Sadly, mental health issues have long been stigmatized, seen as a sign of weakness or dismissed as mere mood swings. However, they are as real and significant as any physical ailment. From anxiety to depression, these disorders have touched countless lives, often in silence due to societal taboos.

But change is on the horizon. As awareness grows, conversations are shifting from hushed whispers to open discussions, fostering understanding and support. Institutions, workplaces, and communities are increasingly acknowledging the importance of mental health, implementing programs, and offering resources.

In conclusion, mental health is not a peripheral concern but a central one, crucial to our holistic well-being. It's high time we prioritize it, eliminating stigma and fostering an environment where everyone feels supported in their mental health journey.

Frequently Asked Questions

• What is the primary focus of a mental health essay?

Answer: The primary focus of a mental health essay is to delve into the intricacies of mental well-being, its significance in our daily lives, the various challenges people face, and the broader societal implications. It aims to shed light on both the psychological and emotional aspects of mental health, often emphasizing the importance of understanding, empathy, and proactive care.

• How can writing an essay on mental health help raise awareness about its importance?

Answer: Writing an essay on mental health can effectively articulate the nuances and complexities of the topic, making it more accessible to a wider audience. By presenting facts, personal anecdotes, and research, the essay can demystify misconceptions, highlight the prevalence of mental health issues, and underscore the need for destigmatizing discussions around it. An impactful essay can ignite conversations, inspire action, and contribute to a more informed and empathetic society.

• What are some common topics covered in a mental health essay?

Answer: Common topics in a mental health essay might include the definition and importance of mental health, the connection between mental and physical well-being, various mental disorders and their symptoms, societal stigmas and misconceptions, the impact of modern life on mental health, and the significance of therapy and counseling. It may also delve into personal experiences, case studies, and the broader societal implications of neglecting mental health.

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100+ argumentative essay topics on mental health | example & outline, bob cardens.

• September 2, 2022
• Essay Topics and Ideas

Argumentative Essay Topics on Mental Health. Mental health is an important and often overlooked topic. In this article, we’ll explore some argumentative essay topics related to mental health .

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Argumentative Essay Topics about Mental Health

1. Is there a connection between mental health and physical health? 2. How does mental illness affect a person’s ability to function in society? 3. What are the most effective treatments for mental illness? 4. Are there any effective prevention strategies for mental illness? 5. What is the relationship between mental health and substance abuse? 6. How does poverty affect mental health? 7. What are the most common mental disorders? 8. What are the consequences of untreated mental illness? 9. What are the risk factors for developing mental illness? 10. How can mental illness be effectively diagnosed?

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Argumentative essay topics about depression

1. Depression is a real mental health condition.

2. Depression is more than just feeling sad.

3. Depression can lead to serious physical health problems.

4. Depression is treatable with medication and therapy.

5. People with depression can lead happy, fulfilling lives.

6. Untreated depression can be deadly.

7. Depression is often misunderstood and stigmatized.

8. Depression is not a sign of weakness or a character flaw.

9. Anyone can develop depression, even people who seem to have it all together.

10. There is no single cause of depression, but there are risk factors that can make someone more likely to develop the condition.

Argumentative Essay Topics on Mental Health. Mental health is an important and often overlooked topic. In this article, we’ll explore some argumentative essay topics related to mental health.

Argumentative essay about mental health in schools

1. Mental health should be taught in schools. 2. There should be more support for mental health in schools. 3. Mental health should be taken more seriously in schools. 4. Schools should do more to prevent mental health problems. 5. Schools should do more to help students with mental health problems. 6. Mental health problems are increasing in schools. 7. school counselors are not trained to deal with mental health issues 8. most school don’t have a mental health policy 9. lack of awareness about mental health among school staff 10. stigma and discrimination against mental health patients

Argumentative essay on mental health stigma

Argumentative essay topics about mental health can be very controversial and sensitive. However, there are many people who are open to discussing these topics and raising awareness about mental health. Here are twenty argumentative essay topics about mental health that you can use for your next essay.

1. How does society view mental health? 2. Do we need to break the stigma around mental health? 3. How can we better support those with mental health conditions? 4. What is the link between mental health and addiction? 5. How does trauma affect mental health? 6. What are the most effective treatments for mental health conditions? 7. Are there any natural remedies for mental health conditions? 8. How does diet affect mental health? 9. How does exercise affect mental health? 10. What is the link between sleep and mental health? 11. What are the warning signs of a mental health condition? 12. When should someone seek professional help for a mental health condition? 13. How can family and friends support someone with a mental health condition? 14. What are the most common myths about mental health? 15. How does stigma impact those with mental health conditions?

16. How can we destigmatize mental health? 17. What is the link between mental health and violence? 18. How does mental health affect overall health? 19. What are the most common mental health disorders? 20. What are the most effective treatments for mental health disorders?

Mental health debate topics for students

1. The definition of mental health 2. The different types of mental illness 3. The causes of mental illness 4. The treatments for mental illness 5. The side effects of mental illness 6. The impact of mental illness on society 7. The cost of mental health care 8. Mental health in the workplace 9. Mental health in the media 10. Stigma and discrimination against those with mental illness 11. The impact of trauma on mental health 12. Mental health during pregnancy and postpartum 13. Children’s mental health 14. Geriatric mental health 15. Global perspectives on mental health 16. Religion and mental health 17. Cultural competence in mental health care 18. Social media and mental health 19.Nutrition and mental health

20. Exercise and mental health

Expository essay topics about mental illness

1. How does mental illness affect one’s ability to work? 2. What are the most common types of mental illness? 3. How can mental illness be prevented? 4. What are the most effective treatments for mental illness? 5. How does mental illness impact relationships? 6. What are the financial costs of mental illness? 7. How does stigma affect those with mental illness? 8. What are the most common myths about mental illness? 9. How does mental illness differ from addiction? 10. What are the early warning signs of mental illness?

Debates about mental health

1. The definition of mental health is contested and argued by professionals in the field. 2. Some people argue that mental health is a social construction, while others believe that it is a real and valid medical condition. 3. Mental health is often stigmatized in society, and those who suffer from mental illness are often seen as weak or crazy. 4. Mental health is often viewed as something that can be cured, when in reality it is a lifelong battle for many people. 5. Mental illness is often seen as an individual responsibility to deal with, when in reality it affects not just the individual but also their families and loved ones. 6. It is often said that people with mental illness are not able to function in society, when in fact many people with mental illness are high-functioning individuals. 7. Mental health is often viewed as an all-or-nothing proposition, when in reality there is a spectrum of mental health conditions that range from mild to severe. 8. People with mental illness are often treated differently than other people, and they are often discriminated against. 9. There is a lot of misinformation about mental health, and this leads tomisunderstanding and fear. 10. Mental health is a complex issue, and there is no one-size-fits-all solution to addressing it.

Persuasive topics related to mental health

1. The link between mental health and physical health. 2. The benefits of therapy and counseling. 3. The importance of early intervention for mental health issues. 4. The impact of trauma on mental health. 5. The correlation between mental health and substance abuse. 6. The connection between mental health and chronic illness. 7. The relationship between mental health and chronic pain. 8. Mental health in the workplace. 9. Mental health in the military. 10. Mental health in schools. 11. Children’s mental health issues. 12. Teens and mental health issues. 13. Elderly mental health issues. 14. Cultural issues and mental health. 15. Religion and mental health. 16. The stigma of mental illness. 17. Mental health awareness and education. 18. Mental health advocacy. 19. Funding for mental health services. 20. Access to mental health care.

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Vol 5, No 1 (2024)

• By Sections

Celebrating a Storied History: Moscow Preobrazhenskaya Mental Hospital Marks its 245 th Anniversary

• Authors: Burygina L.A. 1 , Golubev S.A. 1 , Filipchenko O.V. 1
• Mental-health Clinic No. 4 named after P. B. Gannushkin
• Issue: Vol 4, No 1 (2023)
• Pages: 64-72
• Section: INFORMATION
• URL: https://consortium-psy.com/jour/article/view/3704
• DOI: https://doi.org/10.17816/CP3704

About the authors

Supplementary files.

In 2022, Mental-health Clinic No. 4 named after P. B. Gannushkin, one of the oldest mental health institutions in Russia known as Preobrazhenskaya Hospital before the October Revolution of 1917, celebrated its 245 th anniversary. The history of the hospital reflects all stages of the evolution of the basic principles and aspects of mental health care in Russia. On many occasions, the institution served as a platform for eminent researchers and clinicians to achieve scientific breakthroughs and their application in practice. This article is a review of the major milestones in the history of the hospital. It highlights the great achievements of its psychiatrists and presents some previously unpublished archival documents that offer a new perspective on the history of Preobrazhenskaya Hospital.

INTRODUCTION

In 2022, Mental-health Clinic No. 4 named after P. B. Gannushkin, one of the oldest mental health institutions in Russia known as Preobrazhenskaya Hospital before the October Revolution, celebrated its 245 th anniversary. This represents the number of years since Catherine the Great signed a decree establishing the Moscow House of Invalids, where several dozen beds were set aside for the mentally ill. The document, issued in 1777 [ 1 ], laid the foundation not only for Moscow’s first specialized institution that could accommodate patients with mental disorders, but also, without exaggeration, for the entire field of Russian psychiatry.

The implementation of the Pinel reform in Russia, the introduction of the concept of “moral treatment”, the first scientific conferences and open clinical discussions, all these stages in the evolution of the basic principles and aspects of mental health care have found their reflection in the history of Preobrazhenskaya Hospital over the past 245 years. This is why Vasily Gilyarovsky poetically referred to the Hospital as “the cradle of Russian psychiatry” [ 2 ].

Each page in the history of Preobrazhenskaya Hospital is not only an impressive list of achievements and innovations, but also a unique gallery of distinguished names [ 3–7 ]. It served as a basis for the greatest medical luminaries of the time, such as V. F. Sabler, V. R. Butzke, V. A. Gilyarovsky, N. N. Bazhenov, A. V. Snezhnevsky, D. E. Melekhov, T. I. Yudin, S. G. Zhislin, and G. Y. Avrutsky, from which to make their scientific discoveries and validate them in practice; this was also the place where such luminaries of Russian psychiatry as S. S. Korsakov, A. U. Frese, E. K. Krasnushkin, P. E. Snesarev, A. S. Tiganov, and I. Y. Gurovich, and many others, began their medical careers.

It is a well-known and undisputed fact that Preobrazhenskaya Hospital was the first (and almost only one until the end of the 19 th century) psychiatric hospital to appear in Moscow. But historians and researchers in psychiatry have spent more than 100 years trying to dig up documents that could allow them to determine the exact year of its founding.

Starting in the second half of the 19 th century, the question has frustrated many eminent physicians of Preobrazhenskaya Hospital, including S. I. Steinberg [ 8 ], I. V. Konstantinovsky [ 9 ], N. N. Bazhenov [ 10 ], M. A. Dzhagarov [ 11 ], and A. B. Alexandrovsky [ 12 ]. Their work can now help us to form a fairly comprehensive view of how the State and society gradually, step by step, developed an awareness of what such an independent institution as a psychiatric hospital was all about. They painstakingly assembled scattered documents and facts to finally pinpoint with certainty the day it all began and the events that could be considered key milestones in the hospital’s history.

FROM FIRST MENTIONS TO 19th CENTURY REFORM

The first building that hosted Preobrazhenskaya Hospital, originally known as Moscow Dolgauz, opened its doors on June 15, 1808. In the 20 th century, it became routine to trace all anniversaries of the institution back to that date. But is that right? Could the mere fact that the hospital acquired its own building be considered the seminal event of the first inpatient psychiatric hospital in Moscow?

On July 13, 1777, Catherine the Great signed a decree mandating the opening of the House of Invalids in Moscow, with one of its “wards” dedicated to the care of the mentally ill. This is the date that, 100 years later, the doctors at Preobrazhenskaya Hospital referred to as the starting point in the history of their institution [ 8 ]. One of their main arguments was the fact that, on May 17, 1792, Catherine the Great issued a decree [ 1 ] establishing for the first time the position of Special Doctor at the mental health hospital. Hence, this decree confirms that this type of social institution for people with mental disorders already existed in 1792.

According to the decree signed by Catherine the Great, the primary role in the observation of patients was assigned to the warden, who was in charge not only of the guards (retired soldiers), but also of the doctor responsible for the professional supervision of patients. In reality, however, the staff physician had to juggle work at the mental health hospital with his duties in the nursing home, the hospice, and the almshouse. As a result, his attention was limited to those patients who had a chance of recovery [ 13 ].

When assessing the efforts of the first doctors at the mental health hospital, such as F. Raschke, then C. Pouliard, A. Blimmer, J. Karas (and all this happened long before the hospital had its own building), N. N. Bazhenov wrote in his book about Preobrazhenskaya Hospital: “It is important to note that even then there was a firm belief that the insane person was a patient, with all that such a conclusion entailed, including examination by a physician, admission to the mental health hospital for treatment (no matter how crude and primitive that treatment might have been), and finally discharge when the physician was satisfied that the goal of admission (a cure) had been achieved” [ 10 ].

Other doctors at Preobrazhenskaya Hospital also left their mark in the history of Russian psychiatry of the 19 th century. For example, Zinovy Ivanovich Kibalchich, Chief Doctor of the hospital in 1811–1828, left us a documented description of the prevailing realities in a mental hospital at the beginning of the 19 th century. In his 1821 article “Report on the House of the Insane in Moscow and the Methods of Treatment Used There” published in the Journal of the Imperial Philanthropic Society (issue No. 11, 1821), he not only described in detail Moscow Dolgauz and the methods of treatment used there, but he was also one of the first to point out the existence of mental disorders that are now referred to as “borderline conditions” [ 14 ].

Vasily Fedorovich Sabler, chief doctor of Preobrazhenskaya Hospital in 1828–1871, was a true “revolutionary” in the early history of psychiatric care in Russia (Figure 1).

Figure 1. Vasily Fedorovich Sabler (1797–1877) — chief doctor of Preobrazhenskaya Hospital in 1828–1871.

A brilliant clinician and talented scientist, V. F. Sabler provided evidence for the nosological independence of progressive paralysis, described its accompanying mental and neurological disorders, and developed humanistic principles of individual approach to patients. He was one of the first to hypothesize that some forms of illness can evolve into others, and that severe somatic illness accompanied by high body temperature (fever) can contribute to the cure of psychosis.

In the history of Preobrazhenskaya Hospital, V. F. Sabler played an equally prominent role as an outstanding manager. With a radical reform of the hospital’s management system, he ensured that the Chief Doctor would become the actual head of the institution. He supervised all areas of the hospital’s activities and prepared reports on the clinic that were published in the press (including in Europe).

This administrative reform marked a dramatic shift in attitudes toward the mentally ill. V. F. Sabler was greatly influenced by Philippe Pinel’s concept, which led him to completely overhaul the patient management system, finally replacing the chains used on violent patients with straitjackets and restraint chairs with straps.

It was the first instance when treatment was given priority over charity. This included the first patient histories (known as “case sheets”, see Figure S1 in the Supplementary) and prescription books. Depending on the course of their disease, patients were categorized as acute or chronic and treated using a different therapeutic approaches.

The new emphasis was not only on the medical observation of the patients, but also on their moral challenges and re-education. Patients were no longer seen as “dangerous madmen” but as “unreasonable children” who needed proper care and exercise. That is why occupational therapy was considered so important. According to the instruction “On the Exercises for the Sick People Placed at the Mental Health Hospital” published in 1834, each patient was assigned a strictly individual occupation. It was then that Preobrazhenskaya Hospital established a sewing shop, a tailor’s shop, a shoemaker’s shop, a dyer’s shop, a paint shop, a plasterer’s shop, and a vegetable garden. The women could also knit socks and embroider canvas.

V. F. Sabler initiated the effort to draft legislation on the mentally ill, which provided the impetus to address a long overdue problem in the patient examination process. For centuries, medical matters had been handled by officials with no expertise in diagnosing mental illness, and during the reign of Nicholas I, the authorities began committing patients to institutions “pending further orders” rather than “pending recovery”, as had always been the case. It was not until February 18, 1835, that a decree was issued establishing a procedure for forensic psychiatric examination that required convincing evidence of mental illness from credible medical experts.

In 1841, the so-called “special patient examination procedure” was introduced and implemented for the first time at Preobrazhenskaya Hospital. If in St. Petersburg the “lunatics” continued to be transported to the Provincial Board, in Moscow the “subjects” were now sent to Preobrazhenskaya Hospital for “expert examination” and placed in a ward specially purposed for such subjects in a section of St. Catherine’s Almshouse. Membership in the Patient Examination Committee was also established at that time and did not change until 1917. It included the hospital doctor, his/her assistant, the provincial marshal of the nobility, the chief of the district police or the head of the city. Patients were discharged only after a new examination, which could take place at the end of a two-year “observation” period, and this period could be shortened only by special decision of the Senate.

The hospital owes both its name, Preobrazhenskaya, and the confirmation of its new official status as a medical institution to V. F. Sabler. It was he who on May 31, 1838, petitioned Emperor Nicholas I to sign a decree renaming the Moscow Dolgauz as the Preobrazhenskaya Mental Hospital.

Assessing the changes that took place in the hospital during the first hundred years of its existence, historians of psychiatry are quite right to note that as early as the middle of the 19 th century Preobrazhenskaya Hospital had made the transition from a “charity house” to an in-patient psychiatric institution and had evolved into “the center of not only practical but also scientific psychiatry, which became the tradition of the Moscow psychiatric school, distinguishing it from the St. Petersburg psychiatric school” [ 7 ].

These changes, most of which were introduced during V. F. Sabler’s leadership, allowed Samuil Ivanovich Shteinberg (the hospital’s chief doctor in 1872–1877) to begin work on the institution’s first collection of scientific papers in the run-up to the centennial of Preobrazhenskaya Hospital in 1877. The preserved documents (“Preobrazhenskaya Hospital Office File on the Centennial Anniversary...”) show that the preparations for this anniversary had begun well in advance. As early as in February 1876, the chief physician, S. I. Shteinberg, wrote a letter to the trustees of Preobrazhenskaya Hospital with a detailed plan of the celebration. A circular letter was sent to the staff instructing S. S. Korsakov, N. I. Derzhavin, and V. R. Butzke to begin preparing articles identifying the major milestones in the history and development of the hospital (Figure S2 in the Supplementary).

In the 1870s and 1880s, the hospital attracted a cadre of brilliant and exceptionally gifted young physicians who introduced the most advanced methods of patient care into existing medical practice. First of all, this applies to Sergey Sergeyevich Korsakov, the founder of the nosological branch of psychiatry, the creator of the Moscow scientific school and the author of a classic course in psychiatry [ 4 , 5 ]. His name is closely connected with the history of the “therapeutic revolution” at Preobrazhenskaya Hospital. The energy and reputation of S. S. Korsakov helped to complete and irretrievably establish “moral treatment” at the hospital and the “open door” policy (from 1889), followed by out-of-hospital care, which radically changed the entire approach to patients.

20 th CENTURY: TRANSFORMATIONS AND ACHIEVEMENTS

Looking back, it is impossible to ignore one obvious fact: almost all the chief doctors of Preobrazhenskaya Hospital in the period before the Russian Revolution of 1917 acted as reformers of the entire Russian psychiatric care system. An honorable place in this gallery of illustrious figures is occupied by Nikolai Nikolaevich Bazhenov, chief doctor of the hospital in 1904–1917 (Figure 2).

Figure 2. Nikolai Nikolaevich Bazhenov (1857–1923) — chief doctor of the hospital in 1904–1917.

Preobrazhenskaya Hospital owes its vast expansion and the introduction of the then — revolutionary system of “advanced care” to this fascinating figure of Russian psychiatry, outstanding clinician, ingenious manager, and respected teacher.

In the new “advanced care” system, the uneducated wardens and nannies were replaced by young medical interns and sisters of mercy. The doors to the wards were unlocked, the bars on the windows were replaced with tempered glass, and the straitjackets were displayed as museum pieces [ 15–17 ]. To ensure that patients were under continuous and competent supervision, the interns were required to live in the hospital, rotate on round-the-clock duty, welcome new admissions, and complete patient histories and observation diaries. All direct patient care was assigned to mid-level medical staff. Thirty-two sisters of mercy washed and fed the patients, gave them baths, accompanied them on walks, etc. Each ward had a head nurse who distributed medications, served lunch and dinner, was in charge of laundry, and performed other household duties. Nannies and servants were assigned only janitorial duties. In the spirit of those times, the hospital widely applied a system of moral influence, a prototype of today’s psychosocial therapy that included respectful treatment and support of patients, their socialization, and involvement in various activities.

At the beginning of the 20 th century, with N. N. Bazhenov’s contribution, the hospital was transformed into a research and treatment institution, which became a center of advanced psychiatric knowledge. The scope of N. N. Bazhenov’s innovations is quite impressive: in just a few years the clinic, where at the turn of the century treatment of patients resembled more that in a prison than in a medical institution, was transformed into a modern hospital, on par with the best that Europe could offer [ 15–17 ].

Preobrazhenskaya Hospital was also the place where the Law on the Mentally Ill, a revolutionary act for its time, was proposed 80 years before the adoption of the Russian Federal Law on Psychiatric Care in 1992. The legal principles outlined by N. N. Bazhenov at the first congress of the Russian Union of Neuropathologists and Psychiatrists in 1911 are still relevant today:

“The following issues need to be brought to the forefront of mental health care and legislated:

a) The principle of extending state care to all mentally ill people in the country, and specifying the measures to implement this task and the central and local authorities responsible for these tasks.

b) Conditions for allowing treatment at home in the patient’s own family.

c) Sufficient safeguards must be in place to ensure that the principles of inviolability of the person and individual liberty can only be violated when the mental illness of the person in question makes this imperative” [ 18 ].

N. Bazhenov is also connected with the first commemoration of the foundation of the hospital celebrated in the 20 th century. In December 1909 the 100 th anniversary of the opening of the first building hosting Preobrazhenskaya Hospital on Matrosskaya Tishina Street was commemorated in gushing but solemn fashion, with the participation of the general public.

By that time the clinic had already received a plot of 11 dessiatins of land with the two and three-story buildings of the former Kotov factory (known as “Kotov’s Half”) (Figure 3).

Figure 3. Kotov factory. Photo of the beginning of the 20 th century.

The factory buildings were refurbished, and a dormitory for the staff was equipped with ventilation, plumbing, and even central heating, which allowed N. N. Bazhenov to write proudly that “now Preobrazhenskaya Hospital has such premises for the staff that few Russian or even Western European hospital institutions can boast of” [ 10 ].

However, the problem of overcrowding could be solved only by the construction of new buildings on Kotov’s Half, which required additional funds. So, N. N. Bazhenov decided to organize a gala evening for the city’s dignitaries on the former Kotov estate.

The day of the anniversary celebration was packed with events, including a solemn liturgy and breakfast for 300 guests; in the afternoon, there was a large concert by professional musicians from Moscow; a festive tea ceremony for patients, distribution of anniversary souvenirs, such as cups with the hospital insignia; and in the evening a banquet for 200 guests was held at the Kotov’s cottage located in a picturesque setting on the border of the Preobrazhenskaya and Sokolnicheskaya groves.

In addition to the concert, the highlight of the “cultural program” was the exhibition, for which N. N. Bazhenov selected not only everyday objects from psychiatric hospitals of different centuries (straitjacket, restraint chair, and “case sheets”), but also the creative works of patients (paintings and caricatures, wood and paper crafts, embroidery, and knitting). The models of Preobrazhenskaya Hospital and the Eiffel Tower were particularly popular with the public, because of their size and resemblance to the originals.

In addition to the gala dinner, the guests were treated to a theatrical performance, which included an act from the play “The Marriage of Krechinsky”, with a reference to Preobrazhenskaya Hospital, and, at the end of the evening, fireworks from an area near the buildings in Kotov’s Half — N. N. Bazhenov did not miss a single opportunity to draw the attention of the patrons and city authorities to the matter of financing the future construction. In 1910–1914, his work culminated in the successful completion of three new buildings and repairs to the old factory facilities on Kotov’s Half.

But let’s take a closer look at the year of this anniversary: Why was it celebrated in 1909? For a long time, 1809 was mistakenly considered the year in which the first specialized hospital for the mentally ill was opened. It was mentioned both in the Historical Essay on the Imperial St. Catherine’s Almshouse by V. Molnar [ 13 ] and in the Historical Essay on Preobrazhenskaya Hospital by I. V. Konstantinovsky [ 9 ]. For this reason, the anniversary was celebrated in 1909 and the following plaque was installed on the facade of the building: “1809–1909: To the centenary of the Preobrazhenskaya Mental Hospital, the first in Moscow designed specifically for psychiatric purposes”.

Only later, while working on the manuscript of his book “The Moscow Dolgauz” or “Essays on the History of Preobrazhenskaya Hospital” did N. N. Bazhenov study the documents in the hospital archives and found out that the new mental health hospital in Preobrazhenskoye was opened earlier, in June 1808, when 53 patients from the house of the former Secret Expedition were transferred to the building on Matrosskaya Tishina 1 [ 10 ].

By the beginning of the 20 th century, the records had cemented all three major milestones in the history of the establishment of Preobrazhenskaya Hospital: 1777, 1808, and 1838. One might think that this would have settled the question of the first dates for future celebrations once and for all.

However, the revolution of 1917 and the subsequent division of the hospitals sowed confusion into the “question of anniversaries”. In the spirit of Soviet traditions, Preobrazhenskaya Hospital was stripped of its former name in 1920 and became Moscow City Hospital No. 1. What’s more, in 1931, it was divided into two independent medical institutions with different goals and missions. The hospitals kept changing names, numbers, internal organizational structure, and overall scope of activities, and only relatively recently, in 2017, did the two hospitals return to their historical roots by merging under the name of P.B. Gannushkin Mental-health Clinic No. 4 (Figure 4).

Figure 4. The history of the renaming of the hospital in the 20 th century.

Over the next 100 years, Kotov’s half of Preobrazhenskaya Hospital acquired a different, but equally illustrious, name — Gannushkin Hospital. In the second half of the 20 th century, it maintained its position as an advanced center of research and practice, with many pioneering milestones in the history of Russian psychiatry:

– It developed the system of maintenance therapy, which is so important in preventing relapses.

– For the first time in the USSR, it began to use insulin shock therapy (under the direction of M. Y. Sereisky), as well as electroconvulsive therapy (with the contribution of G. A. Rotshtein).

– It also marked the beginning of the “psychopharmacological treatment era in psychiatry” with the trials of many medications that were subsequently integrated into mainstream clinical practice.

RECENT DEVELOPMENTS

Reflecting on the title of this article, “Celebrating a Storied History”, one may note that in 2022 the institution historically known as Preobrazhenskaya Hospital will celebrate its anniversary for the first time in more than a century since that memorable evening organized by N. N. Bazhenov at the former Kotov estate. How does Gannushkin Hospital, the illustrious heir to the great traditions established by Preobrazhenskaya Hospital, look at the new generation in the year of its 245 th anniversary?

More recently, just 3–4 years ago, it got a facelift after extensive repair and construction work to restore the buildings dating back to the early 20 th century. Most importantly, the reorganization allowed for more streamlined psychiatric care, created a common information space, rationalized territorial localization, and brought patient treatment and routing patterns into a consolidated format.

With four specialized clinics in operation since 2020, the hospital now has several new structural units, including a clinic for affective and suicidal disorders, a clinic for borderline conditions, a clinic for first psychotic episodes, a clinic for pharmacoresistant conditions, and a clinic for mental disorders that are compounded by substance abuse. The Mental Health Counseling Center, opened in 2021, provides outpatient care for individuals suffering from various mental disorders including somatoform, stress-related, and neurotic disorders.

Today Gannushkin Hospital boasts a center for complex diagnostics, a clinical and diagnostic department with specialized clinics (such as dentistry, ophthalmology, gynecology, ENT, ultrasound), an anesthesiology and intensive care unit, a clinical and diagnostic laboratory, a psychological and psychotherapeutic center, a social and legal assistance center, as well as a physiotherapy department (including a transcranial magnetic stimulation room and xenon therapy room), pharmacy, X-ray rooms, and a physiotherapy room.

At the moment, the hospital has 9 outpatient branches known as Psychoneurological Dispensaries (PNDs), some of which have a history spanning more than 100 years. 2 Three Memory Clinics were founded on the basis of PND. These medical and rehabilitation units are designed to help elderly patients with early signs of dementia and mild cognitive decline.

The staff of the oldest psychiatric hospital in Moscow has carefully passed down to younger generations traditions that combine the utmost sense of humanity and the highest level of professionalism in helping patients with mental disorders. These traditions are the cornerstone that enables the team at Mental-health Clinic No. 4 named after P. B. Gannushkin to live its mission every day by providing personalized and comprehensive mental health care based on the principles of partnership and trust, with the aim of restoring and maintaining a high quality of life for its patients.

Authors’ contribution: All the authors made a significant contribution to the article.

Funding: The research was carried out without additional funding.

Conflict of interest: The authors declare no conflicts of interest.

Supplementary data

Supplementary material related to this article can be found in the online version at doi: 10.17816/CP3704

1 The house on Myasnitskaya Street, formerly owned by the Secret Expedition, was transferred to the Public Charity Office in the early 19 th century. This is where the patients of the House of Invalids and the Madhouse were accommodated in 1801.

2 PND No. 8, for example, was founded in 1919 and made psychiatric history as the prototype of the emerging district-level psychiatric care in Soviet Russia.

Larisa A. Burygina

Cand. Sci (Med.), Director

Sergey A. Golubev

Dr. Sci (Med.) , Deputy Medical Director

Oksana V. Filipchenko

Cand. Arts, Head of Information and Analysis Department

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