Economic factors and psychiatric hospital beds – an analysis of historical trends

Ceccherini-Nelli, Alfonso; Priebe, Stefan

doi:10.1108/03068290710826396

Cited by 18 publications

(14 citation statements)

References 18 publications

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“…Notably, the results of the random-effects model show a significant variation in the magnitude and direction of the association between countries. This variation cannot sufficiently be explained by socioeconomic indicators such as the GINI coefficient, GDP, or unemployment rates alone [ 18 ]. These results corroborate previous observations that the consequences of deinstitutionalization of the mental health system vary across countries likely due to specific features of their social welfare and health care system, national traditions, socio-cultural context, and the level of available resources [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

Psychiatric Hospital Bed Numbers and Prison Population Sizes in 26 European Countries: A Critical Reconsideration of the Penrose Hypothesis

et al. 2015

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BackgroundRecently, there has been a revived interest in the validity of the Penrose hypothesis, which was originally postulated over 75 years ago. It suggests an inverse relationship between the numbers of psychiatric hospital beds and the sizes of prison population. This study aims to investigate the association between psychiatric hospital beds and prison populations in a large sample of 26 European countries between 1993 and 2011.MethodsThe association between prison population sizes and numbers of psychiatric hospital beds was assessed by means of Spearman correlations and modeled by a mixed random coefficient regression model. Socioeconomic variables were considered as covariates. Data were retrieved from Eurostat, the statistical office of the European Union.OutcomesMean Spearman correlation coefficients between psychiatric beds and prison population showed a significant negative association (-0.35; p = <0.01). However, in the mixed regression model including socioeconomic covariates there were no significant fixed parameter estimates. Meanwhile, the covariance estimates for the random coefficients psychiatric beds (σ2 = 0.75, p = <0.01) and year (σ2 = 0.0007, p = 0.03) yielded significant results.InterpretationThese findings do not support the general validity of the Penrose hypothesis. Notably, the results of the mixed-model show a significant variation in the magnitude and direction of the association of psychiatric hospital bed numbers and the prison population sizes between countries. In this sense, our results challenge the prevalent opinion that a reduction of psychiatric beds subsequently leads to increasing incarcerations. These findings also work against the potential stigmatization of individuals suffering from mental disorders as criminals, which could be an unintentional byproduct of the Penrose hypothesis.

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Section: Discussionmentioning

confidence: 99%

Psychiatric Hospital Bed Numbers and Prison Population Sizes in 26 European Countries: A Critical Reconsideration of the Penrose Hypothesis

et al. 2015

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“…With respect to the number of psychiatric hospital beds, a recent analysis of time series from the 19th and 20th centuries in Italy, England, and the United States has suggested macroeconomic factors as a main driver for more investments in hospital beds or reductions in their numbers (10). Similar analyses would be welcome for new forms of institutionalized care, but they require series of reliable data, which cannot be obtained for most countries, especially for the crucial categories of residential care and supervised and supported housing.…”

Section: Discussionmentioning

confidence: 99%

Mental Health Care Institutions in Nine European Countries, 2002 to 2006

Priebe¹,

Frottier²,

Gaddini³

et al. 2008

Psychiatric Services

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“…7,8 Further research pointed toward a potential role of the economy and suggested that both the numbers of psychiatric beds and the sizes of prison populations might be driven by macroeconomic factors. 9,10 Since the 1960s, the numbers of psychiatric beds decreased substantially in most Western countries. It has been suggested that, with regard to deinstitutionalization, the United States failed to reinvest the funding that would have been spent on mental hospitals in new services in the community.…”

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Psychiatric Hospital Beds and Prison Populations in South America Since 1990

et al. 2015

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IMPORTANCE In 1939, English mathematician, geneticist, and psychiatrist Lionel Sharples Penrose hypothesized that the numbers of psychiatric hospital beds and the sizes of prison populations were inversely related; 75 years later, the question arises as to whether the hypothesis applies to recent developments in South America. OBJECTIVE To explore the possible association of changes in the numbers of psychiatric hospital beds with changes in the sizes of prison populations in South America since 1990. DESIGN, SETTING, AND PARTICIPANTS We searched primary sources for the numbers of psychiatric hospital beds in South American countries since 1990 (the year that the Latin American countries signed the Caracas Declaration) and compared these changes against the sizes of prison populations. The associations between the numbers of psychiatric beds and the sizes of prison populations were tested using fixed-effects regression of panel data. Economic variables were considered as covariates. Sufficiently reliable and complete data were obtained from 6 countries: Argentina, Bolivia, Brazil, Chile, Paraguay, and Uruguay. MAIN OUTCOMES AND MEASURES The numbers of psychiatric beds and the sizes of prison populations. RESULTS Since 1990, the numbers of psychiatric beds decreased in all 6 countries (ranging from −2.0% to −71.9%), while the sizes of prison populations increased substantially (ranging from 16.1% to 273.0%). Panel data regression analysis across the 6 countries showed a significant inverse relationship between numbers of psychiatric beds and sizes of prison populations. On average, the removal of 1 bed was associated with 5.18 more prisoners (95% CI, 3.10-7.26; P = .001), which was reduced to 2.78 prisoners (95% CI, 2.59-2.97; P < .001) when economic growth was considered as a covariate. The association between the numbers of psychiatric beds and the sizes of prison populations remained practically unchanged when income inequality was considered as a covariate (−4.28 [95% CI, −5.21 to −3.36]; P < .001). CONCLUSIONS AND RELEVANCE Since 1990, the numbers of psychiatric beds have substantially decreased in South America, while the sizes of the prison populations have increased against a background of strong economic growth. The changes appear to be associated because the numbers of beds decreased more extensively when and where the sizes of prison populations increased. These findings are consistent with and specify the assumption of an association between the numbers of psychiatric beds and the sizes of prison populations. More research is needed to understand the drivers of the capacities of psychiatric hospitals and prisons and to explore reasons for their association.

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Economic factors and psychiatric hospital beds – an analysis of historical trends

Cited by 18 publications

References 18 publications

Psychiatric Hospital Bed Numbers and Prison Population Sizes in 26 European Countries: A Critical Reconsideration of the Penrose Hypothesis

Psychiatric Hospital Bed Numbers and Prison Population Sizes in 26 European Countries: A Critical Reconsideration of the Penrose Hypothesis

Mental Health Care Institutions in Nine European Countries, 2002 to 2006

Psychiatric Hospital Beds and Prison Populations in South America Since 1990

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