In Otago we have closed our psychiatric hospitals: one is now a cheese factory, and the other a backpackers: the remainder of the buildings are becoming ruins.
But we have built more prisons. Some may say this is because the population is greater. But Penrose had a hypothesis prior to deinstutitionalisation, and it may still be true.
About 80 years ago, Penrose proposed an inverse relationship between the relative number of psychiatric beds available to a population and its total number of prisoners, based on calculations from cross-sectional study of 18 countries. The subsequent drive for deinstitutionalisation that has dominated policy decisions in many countries for over half a century has provided a convenient natural experiment to test Penrose’s hypothesis. In a large multinational cross-sectional study in 2004 no association was demonstrated, supporting other work from the USA3 and Scandinavia. Recently macroeconomic factors have been suggested as more potent drivers of the relative sizes of psychiatric hospitals and prisons. However, none of the published studies have thus far sufficiently disproved Penrose’s direct inverse association theory.
This paper investigated psychiatric bed levels and prisoner numbers in South America since the Caracas Declaration in 1990, where South American countries committed to following a Western model of deinstitutionalisation and investment in community services. At least two separate researchers in 10 South American countries were asked by email to supply retrospective longitudinal data on the numbers of psychiatric beds and the size of prison populations between 1991 and 2011. Primary national data sources were used preferentially and if not available, secondary sources such as publications were used. Two multivariate regression analyses were conducted, with GNI (gross national income) and the Gini index (data from the World Bank) as covariates.
Mundt and colleagues demonstrated, based on multinational longitudinal data controlling for economic growth, an association between a reduction in psychiatric beds and an increase in prison population. All six countries where data were available showed a decrease in the number of psychiatric beds per head of population. Relative prison populations rose in all six countries over the same time period. This relative reduction in psychiatric beds was greatest where and when the prison populations increased. A positive association between economic growth and increased prison population was also demonstrated.
Whe we closed the asylums we lost a secular place of shelter. It was not perfect, but for some it saved life. When we closed the monastories (due to the Cardinals of the Roman Church losing their faith) we lost another shelter. When we removed the social bounds that kept families intact we lost yet another shelter.
And the current acute wards are no substitute for the most disabled. In Dunedin, we kept a few long-term beds. In other places, my fear is those people: the most disabled, the most vulnerable, are now incarcerated inside the prison or penitentary.
The two largest psychiatric hospitals in the world are the USA’s two largest prisons. (LA County & Cook County [Chicago]) We do “deal” with these people’s problems, but not until they’ve attacked someone. Or, very sadly, they die on the street. It’s pretty horrible, but it made the bleeding hearts feel better. (And it saved some money, for a decade)
Pretty much what LG said. I mind a few years back when a man ran up to a lady in the Toys R Us parking lot, stabbed her (killed her) and then flung himself to the ground, awaiting the arrival of police. Didn’t know her, she wasn’t even a local.
Even families here in the US can’t make their mentally ill family members accept treatment past age 18. The laws are beyond insane.
The same people who de-institutionalised the mentally unwell, releasing them into ‘community care’ would have a fit if someone suggested the same logic should apply to opening the gates at the zoo. Kine and predator alike, let out to find their own level in surrounding nature, would be much better than having them cooped up in cages. No?
And they forget the Victorians took the idea of humane treatment from the York Retreat. Run by Quakers.
You forgot they blame Mental Health for “letting them go”. Most people are not dangerous: but some truly are. And those people stay in limited acute beds, denying succor to those who need them.
They shut the asylums as I begam ny Psychiatry Training. I hope we reopen them (the ideal size is known: 200 beds) before I retire.