The acronym IMD stands for Institute of Mental Disease. This is a fairly recent re-naming of what used to be called a mental hospital, a mental institution, psychiatric hospital, or in the last century: Insane Asylum.  Once attached to the word “insane”, there are now certainly plenty of negative connotations with the word “asylum.” Its original meaning and usage was more akin to a refuge, providing safe haven, shelter and protection, such as “refugees seeking asylum” in another country.

Over the last sixty years in the Unites States the number of IMD’s or psychiatric hospitals has been greatly reduced. The Federal government created out-patient community clinics, starting in the 1960’s, which absolved the states from providing in-patient state hospitals. Decade after decade, the state psychiatric hospitals systematically have been closed by 90%. This includes the long term psychiatric hospitals, where someone seriously and chronically mentally ill may have needed to stay indefinitely.

Our lawmakers have increasingly voted in favor of a person having the right to be as psychotic as they want to be. As a result, we have a high percentage of mentally ill people currently living on the streets. Those not living on the streets may be isolating in the home of relatives, many live in Board and Cares, and some do live on their own. In any one of these alternative housing scenarios, some mentally ill people are not getting the attention and treatment they need and deserve.

Nowadays, spending time in an IMD might only last a few months to a year on average.  When a seriously mentally ill person fits the legal criteria for being “gravely ill” or “a danger to self and others,” they may get hospitalized by law enforcement or by mental health professionals authorized to make these involuntary hospitalizations happen.  Once admitted into a community hospital (if it has a psychiatric ward), decisions will be made regarding when and where the person will be discharged. Please keep in mind that I am referring to seriously mental illness and not all mentally ill people.

If it is determined that the person with SMI (serious mental illness) cannot safely recover and maintain stability at home or in an open Board and Care facility, they may end up going to an IMD. This can only happen if the person gets conserved during in the initial hospitalization.   Chances of getting conserved are remote, even when a person needs to be.  The reasons why will be the topic of another article.

The IMD is a locked facility and those who stay there may earn privileges, such as being able to come and go from the IMD for short excursions, like going out to lunch with a trusted family member. Aside from that, the patients in the IMD must remain on-site until they are formally discharged.

These IMD’s are not happy, cheerful places, even though some IMD’s will try to provide some homey touches.  Most IMDs, however, will look like a regular hospital, with hospital bedrooms, and a familiar looking nurse’s station.  They have commercial kitchens and a dining hall for the patients, with at least one lounging area.

Some IMD’s have outdoor spaces and patios for the patients to get some sunshine, while others do not have any outside space except perhaps a narrow, gated area where patients can take smoke breaks.

Some IMD’s will offer other recreational amenities, like a ping pong table, arts & crafts room and television room.  Other IMD’s only have group or community rooms for programs which the patients are required to attend.  These larger group rooms are for programs related to medication management, money management, anger management, 12-step meetings, and various other classes.

Each person in an IMD will be monitored by a team of mental health professionals, but not everyone gets therapeutic counseling. An IMD would seem to be the obvious place for someone to meet regularly with a therapist, but it doesn’t always happen if the person does not have private insurance or Medicare.  Instead, the patient might only briefly speak with a psychiatrist on a monthly basis to assess their medication.  Gone are the days when people would sit for an hour talking to their psychiatrist. Most psychiatrists only spend five to fifteen minutes with their patient and leave the actual counseling to a psychologist.

In many cases, a lower functioning person with schizophrenia may not even desire to speak with their doctors and many have to be cajoled into attending the various group programs.   This is a somber time for many patients as they try to regain stability and insight into why they are even in the IMD.

Author: Kartar Diamond

From the Mental Health Blog Series

Photo by Adhy Savala