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Psychiatric beds and prison populations in 17 Latin American countries between 1991 and 2017: rates, trends and an inverse relationship between the two indicators

Published online by Cambridge University Press:  10 August 2020

Mathias Siebenförcher ,
Francesco D. Fritz ,
Matías Irarrázaval ,
Andrés Benavides Salcedo Open the ORCID record for Andrés Benavides Salcedo [Opens in a new window] ,
Corinne Dedik ,
Ana Fresán Orellana ,
Alejandro Herrera Ramos ,
J. Nicolás Ivan Martínez-López ,
Carla Molina  and
Fany Alejandra Rivas Gomez
...Show all authors
Mathias Siebenförcher
Affiliation:
Department of Psychiatry, Medical Faculty Charité – Universitätsmedizin, Berlin, Germany Department of Psychiatry and Mental Health, Medical Faculty, Universidad de Chile, Santiago, Chile
Francesco D. Fritz
Affiliation:
Department of Psychiatry, Medical Faculty Charité – Universitätsmedizin, Berlin, Germany Department of Psychiatry and Mental Health, Medical Faculty, Universidad de Chile, Santiago, Chile
Matías Irarrázaval
Affiliation:
Department of Psychiatry and Mental Health, Medical Faculty, Universidad de Chile, Santiago, Chile Millennium Institute for Research in Depression and Personality, Santiago, Chile
Andrés Benavides Salcedo
Affiliation:
Ministry of Public Health, Quito, Ecuador
Corinne Dedik
Affiliation:
Centro de Investigaciones Económicas Nacionales, City of Guatemala, Guatemala
Ana Fresán Orellana
Affiliation:
Instituto Nacional de Psiquiatría Ramón de la Fuente Muñíz, Mexico City, Mexico
Alejandro Herrera Ramos
Affiliation:
Universidad Nacional Autónoma de Honduras, Tegucigalpa, Honduras
J. Nicolás Ivan Martínez-López
Affiliation:
Instituto Nacional de Psiquiatría Ramón de la Fuente Muñíz, Mexico City, Mexico
Carla Molina
Affiliation:
Department of Psychiatry, Hospital Universitario de Los Andes, Mérida, Venezuela
Fany Alejandra Rivas Gomez
Affiliation:
Universidad Nacional Autónoma de Honduras, Tegucigalpa, Honduras
Guillermo Rivera
Affiliation:
Department of Psychology, Universidad Privada de Santa Cruz de la Sierra, Santa Cruz de la Sierra, Bolivia
Ignacio Sandia Saldivia
Affiliation:
Department of Psychiatry, Universidad de Los Andes, Mérida, Venezuela
Julio Torales
Affiliation:
Department of Psychiatry, Universidad Nacional de Asunción, San Lorenzo, Paraguay
Natalia Trujillo Orrego
Affiliation:
Mental Health Group, National Faculty of Public Health, Universidad de Antioquia, Medellín, Colombia
Andreas Heinz
Affiliation:
Department of Psychiatry, Medical Faculty Charité – Universitätsmedizin, Berlin, Germany
Adrian P. Mundt*
Affiliation:
Medical Faculty, Universidad Diego Portales, Santiago, Chile Medical Faculty, Universidad San Sebastián, Puerto Montt, Chile
*
Author for correspondence: Adrian P. Mundt, E-mail: adrian.mundt@mail.udp.cl
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Abstract

Background

In 1990, Latin American countries committed to psychiatric reforms including psychiatric bed removals. Aim of the study was to quantify changes in psychiatric bed numbers and prison population rates after the initiation of psychiatric reforms in Latin America.

Methods

We searched primary sources to collect numbers of psychiatric beds and prison population rates across Latin America between the years 1991 and 2017. Changes of psychiatric bed numbers were compared against trends of incarceration rates and tested for associations using fixed-effects regression of panel data. Economic variables were used as covariates. Reliable data were obtained from 17 Latin American countries: Argentina, Bolivia, Brazil, Chile, Colombia, Costa Rica, Ecuador, Honduras, Guatemala, Mexico, Nicaragua, Panama, Paraguay, Peru, El Salvador, Uruguay and Venezuela.

Results

The number of psychiatric beds decreased in 15 out of 17 Latin American countries (median −35%) since 1991. Our findings indicate the total removal of 69 415 psychiatric beds. The prison population increased in all countries (median +181%). Panel data regression analyses showed a significant inverse relationship −2.70 (95% CI −4.28 to −1.11; p = 0.002) indicating that prison populations increased more when and where more psychiatric beds were removed. This relationship held up when introducing per capita income and income inequality as covariates −2.37 (95% CI −3.95 to −0.8; p = 0.006).

Conclusions

Important numbers of psychiatric beds have been removed in Latin America. Removals of psychiatric beds were related to increasing incarceration rates. Minimum numbers of psychiatric beds need to be defined and addressed in national policies.

Keywords

Deinstitutionalizationglobal healthhealth care reformmental health servicesprisoners

Information

Type
Original Article
Information
Psychological Medicine , Volume 52 , Issue 5 , April 2022 , pp. 936 - 945
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Copyright
Copyright © The Author(s), 2020. Published by Cambridge University Press

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References

Allison, S., Bastiampillai, T., Licinio, J., Fuller, D. A., Bidargaddi, N., & Sharfstein, S. S. (2018). When should governments increase the supply of psychiatric beds? Molecular Psychiatry, 23(4), 796–800. doi:10.1038/mp.2017.139.CrossRefGoogle ScholarPubMed
Almanzar, S., Katz, C. L., & Harry, B. (2015). Treatment of mentally ill offenders in nine developing Latin American countries. Journal of the American Academy of Psychiatry and the Law, 43(3), 340–349.Google ScholarPubMed
Andreoli, S. B., Almeida-Filho, N., Martin, D., Mateus, M. D. M. L., & Mari, J. d. J. (2007). Is psychiatric reform a strategy for reducing the mental health budget? The case of Brazil. Brazilian Journal of Psychiatry, 29, 43–46.CrossRefGoogle ScholarPubMed
Baranyi, G., Scholl, C., Fazel, S., Patel, V., Priebe, S., & Mundt, A. P. (2019). Severe mental illness and substance use disorders in prisoners in low-income and middle-income countries: A systematic review and meta-analysis of prevalence studies. Lancet Global Health, 7(4), E461–E471. doi:10.1016/S2214-109x(18)30539-4.CrossRefGoogle ScholarPubMed
Bastiampillai, T., Sharfstein, S. S., & Allison, S. (2016). Increase in US suicide rates and the critical decline in psychiatric beds. JAMA, 316(24), 2591–2592. doi:10.1001/jama.2016.16989.CrossRefGoogle ScholarPubMed
Benavides, A., Chuchuca, J., Klaic, D., Waters, W., Martin, M., & Romero-Sandoval, N. (2019). Depression and psychosis related to the absence of visitors and consumption of drugs in male prisoners in Ecuador: A cross sectional study. BMC Psychiatry, 19(1), 248. doi:10.1186/s12888-019-2227-z.CrossRefGoogle Scholar
Caldas de Almeida, J. M., & Horvitz-Lennon, M. (2010). Mental health care reforms in Latin America: An overview of mental health care reforms in Latin America and the Caribbean. Psychiatric Services, 61(3), 218–221. doi:10.1176/ps.2010.61.3.218.CrossRefGoogle ScholarPubMed
de Leon Villalba, F. J. (2017). Imprisonment and human rights in Latin America: An introduction. The Prison Journal, 98(1), 17–39. doi:10.1177/0032885517743442.CrossRefGoogle Scholar
Elpers, J. R., & Crowell, A. (1982). How many beds – an overview of resource planning. Hospital and Community Psychiatry, 33(9), 755–761.Google ScholarPubMed
Fazel, S., & Seewald, K. (2012). Severe mental illness in 33 588 prisoners worldwide: Systematic review and meta-regression analysis. British Journal of Psychiatry, 200(5), 364–373. doi:10.1192/bjp.bp.111.096370.CrossRefGoogle ScholarPubMed
Fazel, S., Zetterqvist, J., Larsson, H., Langstrom, N., & Lichtenstein, P. (2014). Antipsychotics, mood stabilisers, and risk of violent crime. Lancet, 384(9949), 1206–1214. doi:10.1016/S0140-6736(14)60379-2.CrossRefGoogle ScholarPubMed
Gabrysch, C., Fritsch, R., Priebe, S., & Mundt, A. P. (2019). Mental disorders and mental health symptoms during imprisonment: A three-year follow-up study. PLoS ONE, 14(3), e0213711. doi:10.1371/journal.pone.0213711.CrossRefGoogle ScholarPubMed
Glick, I. D., Sharfstein, S. S., & Schwartz, H. I. (2011). Inpatient psychiatric care in the 21st century: The need for reform. Psychiatric Services, 62(2), 206–209. doi:10.1176/ps.62.2.pss6202_0206.CrossRefGoogle ScholarPubMed
Hathazy, P., & Müller, M.-M. (2015). The rebirth of the prison in Latin America: Determinants, regimes and social effects. Crime, Law and Social Change, 65(3), 113–135. doi:10.1007/s10611-015-9580-8.CrossRefGoogle Scholar
Heinz, A. J., Beck, A., Meyer-Lindenberg, A., Sterzer, P., & Heinz, A. (2011). Cognitive and neurobiological mechanisms of alcohol-related aggression. Nature Reviews Neuroscience, 12(7), 400–413. doi:10.1038/nrn3042.CrossRefGoogle ScholarPubMed
Lamb, H. R., & Weinberger, Ln (2016). Rediscovering the concept of asylum for persons with serious mental illness. Journal of the American Academy of Psychiatry and the Law, 44(1), 106–110.Google ScholarPubMed
Lancet. (2011). The need for asylum. Lancet, 378(9785), 1. doi:10.1016/s0140-6736(11)60999-9.Google Scholar
Lancet. (2013). Improving inpatient mental health care in the UK. Lancet, 382(9893), 660. doi:10.1016/S0140-6736(13)61761-4.CrossRefGoogle Scholar
Large, M. M., & Nielssen, O. (2009). The Penrose hypothesis in 2004: Patient and prisoner numbers are positively correlated in low-and-middle income countries but are unrelated in high-income countries. Psychology and Psychotherapy, 82(Pt 1), 113–119. doi:10.1348/147608308X320099.CrossRefGoogle ScholarPubMed
Larrobla, C., & Botega, N. J. (2000). Psychiatric care policies and deinstitutionalization in South America. Actas Españolas de Psiquiatria, 28(1), 22–30.Google ScholarPubMed
Moberg, T., Stenbacka, M., Tengstrom, A., Jonsson, E. G., Nordstrom, P., & Jokinen, J. (2015). Psychiatric and neurological disorders in late adolescence and risk of convictions for violent crime in men. BMC Psychiatry, 15, 299. doi:10.1186/s12888-015-0683-7.CrossRefGoogle ScholarPubMed
Monahan, J., Vesselinov, R., Robbins, P. C., & Appelbaum, P. S. (2017). Violence to others, violent self-victimization, and violent victimization by others among persons With a mental illness. Psychiatric Services, 68(5), 516–519. doi:10.1176/appi.ps.201600135.CrossRefGoogle ScholarPubMed
Müller, M.-M. (2018). Governing crime and violence in Latin America. Global Crime, 19(3–4), 171–191. doi:10.1080/17440572.2018.1543916.CrossRefGoogle Scholar
Mundt, A. P., Baranyi, G., Gabrysch, C., & Fazel, S. (2018). Substance use during imprisonment in low- and middle-income countries. Epidemiologic Reviews, 40(1), 70–81. doi:10.1093/epirev/mxx016.CrossRefGoogle ScholarPubMed
Mundt, A. P., Chow, W. S., Arduino, M., Barrionuevo, H., Fritsch, R., Girala, N., … Priebe, S. (2015a). Psychiatric hospital beds and prison populations in South America since 1990: Does the Penrose hypothesis apply? JAMA Psychiatry, 72(2), 112–118. doi:10.1001/jamapsychiatry.2014.2433.CrossRefGoogle Scholar
Mundt, A. P., Chow, W. S., & Priebe, S. (2015b). Testing the Penrose hypothesis-reply. JAMA Psychiatry, 72(7), 736. doi:10.1001/jamapsychiatry.2015.0217.CrossRefGoogle Scholar
Mundt, A. P., Franciskovic, T., Gurovich, I., Heinz, A., Ignatyev, Y., Ismayilov, F., … Priebe, S. (2012). Changes in the provision of institutionalized mental health care in post-communist countries. PLoS ONE, 7(6), e38490. doi:10.1371/journal.pone.0038490.CrossRefGoogle ScholarPubMed
Mundt, A. P., Kastner, S., Larrain, S., Fritsch, R., & Priebe, S. (2016). Prevalence of mental disorders at admission to the penal justice system in emerging countries: A study from Chile. Epidemiology and Psychiatric Sciences, 25(5), 441–449. doi:10.1017/S2045796015000554.CrossRefGoogle Scholar
OECD. (2016). Society at a Glance 2016: OECD Social Indicators. Retrieved from https://www.oecd-ilibrary.org/content/publication/9789264261488-endoi:10.1787/9789264261488-en.CrossRefGoogle Scholar
Penrose, L. S. (1939). Mental disease and crime: Outline of a comparative study of European statistics. British Journal of Medical Psychology, 18, 1–15. doi:10.1111/j.2044-8341.1939.tb00704.x.CrossRefGoogle Scholar
Priebe, S., Badesconyi, A., Fioritti, A., Hansson, L., Kilian, R., Torres-Gonzales, F., … Wiersma, D. (2005). Reinstitutionalisation in mental health care: Comparison of data on service provision from six European countries. BMJ, 330(7483), 123–126.CrossRefGoogle ScholarPubMed
Priebe, S., Frottier, P., Gaddini, A., Kilian, R., Lauber, C., Martinez-Leal, R., … Wright, D. (2008). Mental health care institutions in nine European countries, 2002 to 2006. Psychiatric Services, 59(5), 570–573. doi:10.1176/appi.ps.59.5.570.CrossRefGoogle ScholarPubMed
Sisti, D. A., Segal, A. G., & Emanuel, E. J. (2015). Improving long-term psychiatric care: Bring back the asylum. JAMA, 313(3), 243–244. doi:10.1001/jama.2014.16088.CrossRefGoogle ScholarPubMed
Sisti, D. A., Sinclair, E. A., & Sharfstein, S. S. (2018). Bedless psychiatry-rebuilding behavioral health service capacity. JAMA Psychiatry, 75(5), 417–418. doi:10.1001/jamapsychiatry.2018.0219.CrossRefGoogle ScholarPubMed
Swanson, J. W., & Belden, C. M. (2018). The link between mental illness and being subjected to crime in Denmark vs the United States: How much do poverty and the safety net matter? JAMA Psychiatry, 75(7), 669–670. doi:10.1001/jamapsychiatry.2018.0528.CrossRefGoogle ScholarPubMed
Tonry, M. (2007). Determinants of penal policies. Crime and Justice, 36(1), 1–48. doi:10.1086/518582.CrossRefGoogle Scholar
Torrey, E. F., Entsminger, K., Geller, J., Stanley, J., & Jaffe, D. J. (2008). The shortage of Public Hospital Beds for Mentally Ill Persons. The Treatment Advocacy Center: Arlington, USA.Google Scholar
Tsai, A. C., & Venkataramani, A. S. (2015). A more robust test of the Penrose hypothesis. JAMA Psychiatry, 72(7), 735–736. doi:10.1001/jamapsychiatry.2015.0212.CrossRefGoogle ScholarPubMed
Tyrer, P. (2011). Has the closure of psychiatric beds gone too far? Yes. BMJ, 343, d7457. doi:10.1136/bmj.d7457.CrossRefGoogle ScholarPubMed
Tyrer, P., Sharfstein, S., O'Reilly, R., Allison, S., & Bastiampillai, T. (2017). Psychiatric hospital beds: An Orwellian crisis. Lancet, 389(10067), 363. doi:10.1016/S0140-6736(17)30149-6.CrossRefGoogle ScholarPubMed
UNDP. (2013). Regional Human Development Report 2013-2014, CITIZEN SECURITY WITH A HUMAN FACE: Evidence and Proposals for Latin America. Retrieved from https://www.undp.org/content/undp/en/home/librarypage/hdr/human-development-report-for-latin-america-2013-2014.html.Google Scholar
Wacquant, L. (2008). The militarization of urban marginality: Lessons from the Brazilian metropolis. International Political Sociology, 2(1), 56–74. doi:10.1111/j.1749-5687.2008.00037.x.CrossRefGoogle Scholar
Walmsley, R. (2016). World Prison Population List – 11th edition. Available at http://www.prisonstudies.org/sites/default/files/resources/downloads/world_prison_population_list_11th_edition_0.pdf.Google Scholar
WHO. (2018). Mental health atlas 2017. Available at http://apps.who.int/iris/bitstream/handle/10665/272735/9789241514019-eng.pdf?ua=1.Google Scholar
World Bank. (2017). World Development Indicators: Unemployment, total (% of total labor force) (modeled ILO estimate) – Latin America & Caribbean [Data file]. Available at https://data.worldbank.org/indicator/SL.UEM.TOTL.ZS?end=2017&locations=ZJ&start=1991.Google Scholar
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