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Mundt AP, Rozas-Serri E, Fritz FD, Delhey S, Siebenförcher M, Priebe S. Need estimates of psychiatric beds: a systematic review and meta-analysis. Psychol Med 2024:1-14. [PMID: 39324387 DOI: 10.1017/s0033291724002307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/27/2024]
Abstract
This study aimed to review and synthesize the need estimates for psychiatric beds, explore how they changed over time and compare them against the prevalence of actually existing beds. We searched PubMed, Embase classic and Embase, PsycINFO and PsycIndex, Open Grey, Google Scholar, Global Health EBSCO and Proquest Dissertations, from inception to September 13, 2022. Publications providing estimates for the required number of psychiatric inpatient beds were included. Need estimates, length of stay, and year of the estimate were extracted. Need estimates were synthesized using medians and interquartile ranges (IQRs). We also computed prevalence ratios of the need estimates and the existing bed capacities at the same time and place. Sixty-five publications with 98 estimates were identified. Estimates for bed needs were trending lower until 2000, after which they stabilized. The twenty-six most recent estimates after 2000 were submitted to data synthesis (n = 15 for beds with unspecified length of stay, n = 7 for short-stay, and n = 4 for long-stay beds). Median estimates per 100 000 population were 47 (IQR: 39 to 50) beds with unspecified length of stay, 28 (IQR: 23 to 31) beds for short-stay, and 10 (IQR: 8 to 11) for long-stay beds. The median prevalence ratio of need estimates and the actual bed prevalence was 1.8 (IQR: 1.3 to 2.3) from 2000 onwards. Historically, the need estimates for psychiatric beds have decreased until about 2000. In the past two decades, they were stable over time and consistently higher than the actual bed numbers provided.
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Affiliation(s)
- Adrian P Mundt
- Medical Faculty, Universidad Diego Portales, Santiago, Chile
- Departamento de Neurología y Psiquiatría, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Enzo Rozas-Serri
- Department of Mental Health, Hospital Clínico Universidad de Chile, Santiago, Chile
- Departamento de Neurología y Psiquiatría, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Francesco D Fritz
- Department of Psychiatry and Psychotherapy Campus Mitte, Charité Universitätsmedizin Berlin, Germany
| | - Sabine Delhey
- Medical Faculty, Universidad Diego Portales, Santiago, Chile
| | - Mathias Siebenförcher
- Department of Psychiatry and Psychotherapy Campus Mitte, Charité Universitätsmedizin, Berlin, Germany
| | - Stefan Priebe
- Centre for Mental Health Research, City, University of London, London, UK
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Upfold C, Jentz C, Heilmann P, Nathanielsen N, Chaimowitz G, Sørensen LU. Forensic psychiatry patients, services, and legislation in Nunavut and Greenland. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2023; 91:101921. [PMID: 37690360 DOI: 10.1016/j.ijlp.2023.101921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 07/27/2023] [Accepted: 08/26/2023] [Indexed: 09/12/2023]
Abstract
Circumpolar regions face unique challenges in establishing and maintaining mental health care systems, including forensic psychiatry services. The scarcity of data and lack of evidence concerning the forensic psychiatry patient (FPP) populations of Nunavut and Greenland exacerbates the challenges of informing best practices and healthcare planning. By comparing the prevalence of forensic psychiatry patients, the mental health care services, and the legislation in these two relatively similar but unique regions, insight may be gained that can help inform healthcare planning. This cross-sectional study includes all forensic psychiatry in- and outpatients in one year from Nunavut (2018) and on February 29, 2020, in Greenland. The Greenland sample (n = 93) was nearly four times larger than the Nunavut sample (n = 15) at the population level. Despite considerable differences in forensic legislation and service supply, the forensic psychiatry patients in the two areas share several similarities. A total of 87% (n = 13) in the Nunavut sample were diagnosed with a DSM-5 schizophrenia spectrum disorder or other psychotic disorder. In Greenland, 82% (n = 76) were diagnosed with an ICD-10 F2 diagnosis (schizophrenia, schizotypal and delusional disorders). Approximately 2/3 of the patients in both populations were diagnosed with substance use disorder, and 60% of the Nunavut FPP received long-acting antipsychotic injections versus 62% in Greenland. Nearly half of the FPPs in both populations had never been convicted prior to entering the forensic psychiatry system; Nunavut 45% versus Greenland 47%. A substantial proportion of Greenlandic FPPs were outpatients compared to Nunavut (83% versus 47%). This study is an essential first step toward describing a Model of Care for forensic psychiatry patients in circumpolar regions; furthermore, the clinical similarities between the two populations provide support for future joint Arctic research and the inclusion of artic forensic patients in international studies.
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Affiliation(s)
- Casey Upfold
- Forensic Psychiatry Program, St. Joseph's Healthcare Hamilton, Canada
| | - Christian Jentz
- Department of Forensic Psychiatry, Aarhus University Hospital Psychiatry, Denmark; Institute of Clinical Medicine, Health, Aarhus University, Denmark
| | | | | | - Gary Chaimowitz
- Forensic Psychiatry Program, St. Joseph's Healthcare Hamilton, Canada; McMaster University, Department of Psychiatry and Behavioural Neurosciences, Canada.
| | - Lisbeth Uhrskov Sørensen
- Department of Forensic Psychiatry, Aarhus University Hospital Psychiatry, Denmark; Institute of Clinical Medicine, Health, Aarhus University, Denmark.
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3
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Eber GB. I Refuse for the Devil to Take My Soul: Inside Cook County JailLiliKobielski by powerHouse Book, 2018. 152 pages, ISBN13: 9781576878880. WORLD MEDICAL & HEALTH POLICY 2022. [DOI: 10.1002/wmh3.555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Gabriel B. Eber
- Senior Associate, Department of Epidemiologym, Affiliate Faculty, Center for Public Health and Human Rights Johns Hopkins Bloomberg School of Public Health Baltimore United States
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À Campo JMLG, van Impelen A, Hamakers N, Nijman HLI. Transforensic psychiatry: Addressing inpatient aggression in the "gray zone" between general and forensic psychiatric care. BEHAVIORAL SCIENCES & THE LAW 2022. [PMID: 36349387 DOI: 10.1002/bsl.2602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 10/03/2022] [Accepted: 10/27/2022] [Indexed: 06/16/2023]
Abstract
A minority of psychiatric patients are unfit for general psychiatric care due to offensive behavior that renders them at risk of coming into contact with the criminal justice system. In the absence of criminal proceedings, these patients find themselves in the "gray zone" between general and forensic psychiatric care. To accommodate these patients, we established a "transforensic" ward. Instead of applying forensic treatment elements reactively (as part of a criminal sentence, after an offense has been committed), we applied it preventively (so as to avert offending behavior and resultant criminal sentences). Psychometric psychopathology and violence risk assessment scores were substantially lower at discharge than at admission (Cohen's ds = -0.3 to -0.6). These results offer ground for cautious optimism about the efficacy of transforensic care in serving as a safety net for psychiatric patients who are found to be unfit for general psychiatric care on account of their aggressive behavior.
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Affiliation(s)
- Joost M L G À Campo
- Mondriaan Mental Health Care Institute, Heerlen, The Netherlands
- Maastricht University, Faculty of Law, Maastricht, The Netherlands
| | | | - Nicole Hamakers
- Mondriaan Mental Health Care Institute, Heerlen, The Netherlands
| | - Henk L I Nijman
- Mondriaan Mental Health Care Institute, Heerlen, The Netherlands
- Radboud University, Faculty of Social Sciences, Nijmegen, The Netherlands
- Fivoor Forensic Mental Health Care Institute, Rotterdam, The Netherlands
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Wild G, Alder R, Weich S, McKinnon I, Keown P. The Penrose hypothesis in the second half of the 20th century: investigating the relationship between psychiatric bed numbers and the prison population in England between 1960 and 2018-2019. Br J Psychiatry 2021; 220:1-7. [PMID: 35049470 DOI: 10.1192/bjp.2021.138] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND NHS Psychiatric beds comprise mental illness and intellectual disability beds. Penrose hypothesised that the number of psychiatric in-patients was inversely related to prison population size. AIMS To ascertain whether the Penrose hypothesis held true in England between 1960 and 2018-2019. METHOD A time-series analysis explored the association between total prison population and NHS psychiatric beds; this was also tested for the male and female prison populations, using non-psychiatric beds as a comparator. Associations were explored with time lags of up to 20 years. Linear regression was conducted to estimate the size of the effect of bed closures. RESULTS NHS psychiatric beds decreased 93% and the prison population increased 208%. A strong (r =-0.96) and highly significant negative correlation between these changes was found. Annual reduction in psychiatric bed numbers was associated with an increase in prison population, strongest at a lag of 10 years. The closure of mental illness and intellectual disability beds was associated with increases in female prisoners 10 years later. The only significant explanatory variable for the increase in male prison population was intellectual disability bed reduction. CONCLUSIONS The Penrose hypothesis held true between 1960 and 2018-2019 in England: psychiatric bed closures were associated with increases in prison population up to 10 years later. For every 100 psychiatric beds closed, there were 36 more prisoners 10 years later: 3 more female prisoners and 33 more male prisoners. Our results suggest that the dramatic increase in the female prison population may relate to the closure of NHS beds.
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Affiliation(s)
| | - Ross Alder
- School of Psychology, Newcastle University, UK
| | - Scott Weich
- School of Health and Related Research, Sheffield University, UK
| | - Iain McKinnon
- Academic Psychiatry Wolfson Research Centre, Newcastle University, UK; and Cumbria Northumberland Tyne and Wear NHS Foundation Trust, UK
| | - Patrick Keown
- Academic Psychiatry Wolfson Research Centre, Newcastle University, UK; and Cumbria Northumberland Tyne and Wear NHS Foundation Trust, UK
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Smeekens MV, Sappelli F, de Vries MG, Bulten BH. Dutch Forensic Flexible Assertive Community Treatment: Operating on the Interface Between General Mental Health Care and Forensic Psychiatric Care. Front Psychol 2021; 12:708722. [PMID: 34630215 PMCID: PMC8492920 DOI: 10.3389/fpsyg.2021.708722] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 08/24/2021] [Indexed: 11/13/2022] Open
Abstract
In the Netherlands, Forensic Flexible Assertive Community Treatment (ForFACT) is used as a specialized form of outpatient intensive treatment. This outreaching type of treatment is aimed at patients with severe and long lasting psychiatric problems that are at risk of engaging in criminal behavior. In addition, these patients often suffer from addiction and experience problems in different areas of their life (e.g., financial debt, unemployment, or lack of daytime activities). The aim of this exploratory study was to gain more insight into the characteristics of the ForFACT patient population. More knowledge about these patients may enhance the effectiveness of ForFACT and therefore (further) reduce the risk of recidivism. Data on 132 ForFACT patients were gathered by studying electronic patient records, criminal records, and by conducting semi-structured interviews with practitioners and patients. Additionally, as part of a cognitive screening, two screening instruments were conducted to gain insight into intelligence and possible mild cognitive impairments. This article gives a broad description of the ForFACT patient population, including demographic data and context variables, diagnostics, recidivism risk and offense history, and aspects related to care. Furthermore, several recommendations are given to further improve ForFACT. Based on the results it can be concluded that the ForFACT patient population shows a high degree of diversity in complex care needs and responsivity issues. Therefore, this article highlights the necessity for ForFACT to collaborate with other mental health institutions, as well as probation officers, and forensic or criminal justice institutions. Moreover, it is important to continually check the inclusion and exclusion criteria when admitting patients to ForFACT, and to examine whether ForFACT is still the most adequate care for patients or if they need to be referred. In addition, the results emphasize the importance of cognitive screening for forensic outpatients. Finally, this study zooms in on the interface between forensic psychiatric care and general mental health care.
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Affiliation(s)
- Marjam V Smeekens
- Department Assessment, Research and Professional Development, Pompefoundation, Nijmegen, Netherlands
| | - Fedde Sappelli
- Department Assessment, Research and Professional Development, Pompefoundation, Nijmegen, Netherlands
| | - Meike G de Vries
- Department Assessment, Research and Professional Development, Pompefoundation, Nijmegen, Netherlands
| | - Berend H Bulten
- Department Assessment, Research and Professional Development, Pompefoundation, Nijmegen, Netherlands.,Faculty of Social Sciences, Radboud University, Nijmegen, Netherlands
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Mundt AP, Rozas Serri E, Siebenförcher M, Alikaj V, Ismayilov F, Razvodovsky YE, Hasanovic M, Marinov P, Frančišković T, Cermakova P, Harro J, Sulaberidze L, Kalapos MP, Assimov M, Nurmagambetova S, Ibishi NF, Molchanova E, Taube M, Chihai J, Dedovic J, Gosek P, Tataru N, Golenkov A, Lecic-Tosevski D, Randjelovic D, Izakova L, Švab V, Vohidova M, Kerimi N, Sukhovii O, Priebe S. Changes in national rates of psychiatric beds and incarceration in Central Eastern Europe and Central Asia from 1990-2019: A retrospective database analysis. LANCET REGIONAL HEALTH-EUROPE 2021; 7:100137. [PMID: 34557842 PMCID: PMC8454862 DOI: 10.1016/j.lanepe.2021.100137] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background Numbers of psychiatric beds (general, forensic, and residential) and prison populations have been considered to be indicators of institutionalisation of people with mental illnesses. The present study aimed to assess changes of those indicators across Central Eastern Europe and Central Asia (CEECA) over the last three decades to capture how care has developed during that historical period. Methods We retrospectively obtained data on numbers of psychiatric beds and prison populations from 30 countries in CEECA between 1990 and 2019. We calculated the median of the percent changes between the first and last available data points for all CEECA and for groups of countries based on former political alliances and income levels. Findings Primary national data were retrieved from 25 out of 30 countries. Data from international registries were used for the remaining five countries. For all of CEECA, the median decrease of the general psychiatric bed rates was 33•8% between 1990 and 2019. Median increases were observed for forensic psychiatric beds (24•7%), residential facility beds (12•0%), and for prison populations (36•0%). Greater reductions of rates of psychiatric beds were observed in countries with lower per capita income as well as in countries that were formerly part of the Soviet Union. Seventeen out of 30 countries showed inverse trends for general psychiatric beds and prison populations over time, indicating a possible shift of institutionalisation towards correctional settings. Interpretation Most countries had decreased rates of general psychiatric beds, while there was an increase of forensic capacities. There was an increase in incarceration rates in a majority of countries. The large variation of changes underlines the need for policies that are informed by data and by comparisons across countries. Funding Agencia Nacional de Investigación y Desarrollo in Chile, grant scheme FONDECYT Regular, grant number 1190613.
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Affiliation(s)
- Adrian P Mundt
- Medical Faculty, Universidad Diego Portales, Santiago, Chile; Departamento de Neurología y Psiquiatría, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Enzo Rozas Serri
- Department of Psychiatry and Mental Health, Hospital Clínico Universidad de Chile, Santiago, Chile; Medical Faculty, Universidad Diego Portales, Santiago, Chile
| | - Mathias Siebenförcher
- Department of Psychiatry and Psychotherapy Campus Mitte, Charité Universitätsmedizin Berlin, Germany
| | - Valbona Alikaj
- Department of Neuroscience, Faculty of Medicine, Medical University, Tirana, Albania
| | | | | | - Mevludin Hasanovic
- Department of Psychiatry, University Clinical Centre Tuzla, Medical Faculty, University of Tuzla, Bosnia and Herzegovina
| | - Petar Marinov
- Association of Experts in Mental Health, Sofia, Bulgaria; Standing Committee for Professional Standards and By-Laws of the Bulgarian Psychiatric Association, Sofia, Bulgaria; Sofia University "St. Kliment Ohridski", Thrakian University St. Zagora, Bulgaria
| | | | - Pavla Cermakova
- National Institute of Mental Health, Klecany, Czech Republic; Third Faculty of Medicine, Charles University Prague, Czech Republic; Second Faculty of Medicine, Charles University Prague, Czech Republic
| | - Jaanus Harro
- North Estonia Medical Centre, Psychiatry Clinic, Tallinn, and Chair of Neuropsychopharmacology, Institute of Chemistry, University of Tartu, Tartu, Estonia
| | | | | | - Marat Assimov
- Department of Communication Skills of the Kazakh National Medical University, Almaty, Kazakhstan
| | | | - Nazmie F Ibishi
- Clinic of Psychiatry, University Clinical Centre of Kosovo, Pristina, Kosovo
| | | | - Māris Taube
- Department of Psychiatry, Riga Stradin's University, Riga, Latvia
| | - Jana Chihai
- Psychiatry, Narcology and Medical Psychology Department, State Medical and Pharmaceutical University Nicolae Testemitanu, Chisinau, Moldova
| | - Jovo Dedovic
- Forensic Psychiatry Unit - Special Psychiatric Hospital Kotor, Kotor, Montenegro
| | - Paweł Gosek
- Institute of Psychiatry and Neurology • Department of Forensic Psychiatry, Warsaw, Poland
| | - Nicoleta Tataru
- Senior consultant psychiatrist, Psychiatry Ambulatory Clinic, Oradea, România
| | - Andrei Golenkov
- Psychiatry and Medical Psychology, Chuvash State University, Cheboksary, Russia
| | | | | | - Lubomira Izakova
- Department of Psychiatry, Comenius University in Bratislava, Faculty of Medicine, Bratislava, Slovak Republic
| | - Vesna Švab
- Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | | | - Nina Kerimi
- Consultant, United Nations Office on Drugs and Crime (UNODC), Programme Office in Turkmenistan, Ashgabat, Turkmenistan
| | - Oleksii Sukhovii
- Center for Mental Health and Monitoring of Drugs and Alcohol MoH of Ukraine
| | - Stefan Priebe
- Unit of Social and Community Psychiatry, Queen Mary University of London, UK
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Bülow P, Topor A, Andersson G, Denhov A, Stefansson CG. The Stockholm Follow-up Study of Users Diagnosed with Psychosis (SUPP): A 10-year Follow-up 2004-2013. Community Ment Health J 2021; 57:1121-1129. [PMID: 33191458 PMCID: PMC8217026 DOI: 10.1007/s10597-020-00740-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 10/31/2020] [Indexed: 11/25/2022]
Abstract
Since the 1970s, psychiatric care in the western world has undergone fundamental changes known as de-institutionalisation. This has changed the living conditions for people with severe mental illness. The purpose of this study was to investigate the living conditions and utilisation of care and social services for a group of people in Sweden with diagnosis of psychosis over a 10-year period, 2004-2013. During this period, psychiatric care decreased at the same time as interventions from the social services increased. Half of the persons in the studied group did not have any institutional care, that is, neither been hospitalised nor dwelling in supported housing, during the last 5 years, and just over 20% had no contact with either psychiatry or the municipality's social services during the last 2 years of the investigated period.
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Affiliation(s)
- Per Bülow
- Department of Social Work, School of Health and Welfare, Jönköping University, Jönköping, Sweden. .,Regional Forensic Psychiatric Hospital, Vadstena, Sweden.
| | - Alain Topor
- Department of Psychosocial Health, University of Agder, Kristiansand, Norway.,Department of Social Work, Stockholm University, Stockholm, Sweden
| | - Gunnel Andersson
- Department of Social Work, Stockholm University, Stockholm, Sweden
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Lantta T, Anttila M, Varpula J, Välimäki M. Facilitators for improvement of psychiatric services and barriers in implementing changes: From the perspective of Finnish patients and family members. Int J Ment Health Nurs 2021; 30:506-523. [PMID: 33216435 DOI: 10.1111/inm.12815] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 10/18/2020] [Accepted: 10/21/2020] [Indexed: 11/30/2022]
Abstract
The need for psychiatric patients and their family members to have access to quality user-friendly services has been studied for decades, yet few improvements have been made in treatment services. This study aims to explain how patients and family members have experienced facilitators of improvements, and their thoughts about barriers in the implementation of changes. An explanatory qualitative design was adopted. Data were collected using semi-structured interviews with eight focus groups made up of a total of 35 participants from mental health associations in Finland. The Theoretical Domains Framework guided the deductive data analysis. The Consolidated Criteria for Reporting Qualitative Studies (COREQ) was followed in the study. Participants in patient and family member associations had similar experiences and thoughts about facilitators of improvements in psychiatric services and barriers in the implementation of changes. For example, both participant groups experienced that promoting more positive roles of professionals could facilitate improvements in psychiatric care. On the other hand, a lack of theoretical competence and interpersonal skills of professionals could hinder change. We conclude that many of the facilitators that patients and families suggested could be addressed by enhancing collaboration and communication, having a more person-centred approach, focusing on recovery throughout the course of care, and acknowledging staff's well-being at work. Second, the barriers to implementing changes centre around the limited knowledge and skills of staff, and a paternalistic system that focuses on managing risk and administering treatment.
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Affiliation(s)
- Tella Lantta
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Minna Anttila
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Jaakko Varpula
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Maritta Välimäki
- Department of Nursing Science, University of Turku, Turku, Finland.,Xiangya School of Nursing, Central South University, Changsha, China
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Meinert P, Behr J, Gauger U, Krebs J, Konrad N, Opitz-Welke A. Psychosis in German prisoners: Comparison of the clinical appearance of psychotic disorder of an imprisoned population with a not detained community group. BEHAVIORAL SCIENCES & THE LAW 2020; 38:482-492. [PMID: 32833256 DOI: 10.1002/bsl.2480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 07/23/2020] [Accepted: 07/30/2020] [Indexed: 06/11/2023]
Abstract
Surveys confirm risk factors for the incarceration of patients with psychosis including homelessness and comorbidity. There is also agreement that severe psychosis can lead to violence. Data describing prisoners with psychosis in Germany are scarce. We aimed to compare patients with psychosis in a prison hospital and patients with psychosis in a community hospital. Demographic data were collected, as well as comorbidity in the form of substance dependence and a psychiatric assessment using the German version of the 18-item Brief Psychiatric Rating Scale (BPRS) and the Positive and Negative Syndrome Scale (PANSS). In the prison hospital group more patients were homeless (17 versus 2%) and non-German (36 versus 4%). There were also more patients with substance dependence or abuse in the prison hospital group. The total scores of BPRS and PANSS were lower in the prison hospital group (BPRS, 43.8 versus 51.2; PANSS, 71.5 versus 83.7). We assume that social disintegration for mentally disturbed offenders prior to incarceration hindered effective treatment. To avoid further social disintegration and possible further deterioration of mental health status of released offenders, which may lead to reoffending after imprisonment, discharge management after release from prison should be improved.
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Affiliation(s)
- Philipp Meinert
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Brandenburg Medical School, Neuruppin, Germany
- Institute of Forensic Psychiatry, Charité University Hospital Berlin, Germany
| | - Joachim Behr
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Brandenburg Medical School, Neuruppin, Germany
- Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin Berlin, Germany
| | - Ulrich Gauger
- Institute of Forensic Psychiatry, Charité University Hospital Berlin, Germany
| | - Julia Krebs
- Institute of Forensic Psychiatry, Charité University Hospital Berlin, Germany
| | - Norbert Konrad
- Institute of Forensic Psychiatry, Charité University Hospital Berlin, Germany
| | - Annette Opitz-Welke
- Institute of Forensic Psychiatry, Charité University Hospital Berlin, Germany
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Kalapos MP. Does Penrose's Law apply to Hungary? Data of an extended survey and reappraisal. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2020; 72:101608. [PMID: 32889421 DOI: 10.1016/j.ijlp.2020.101608] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 06/21/2020] [Accepted: 06/25/2020] [Indexed: 06/11/2023]
Abstract
Penrose described an observation in 1939, according to which an inverse relationship between the size of prison populations and the number of psychiatric beds existed. The purpose of this article was to investigate the validity of this statement for Hungary. The national data between 1989 and 2017 for 25 variables were extracted from the official reports of the Hungarian Central Statistical Office. The number of psychiatric beds decreased by 33%, while the number of prisoners increased by about 50%. At the same time, the number of mentally ill patients under compulsive treatment was low, but showed a slight, statistically significant increase. Variables measuring similar feature, for example, the psychiatric characteristics (alcoholics registered, suicide rate, number of hospital beds, welfare home inmates) are variables consistently moving in one direction or the other that may allow finding appropriate indicators of and explanations for the phenomena. An example is the number of psychiatric beds showing a parallel decrease to the numbers of total hospital beds, registered alcoholics, out-patient clinics for children, and suicide rate, and just the opposite direction with forensic settling, involuntary admissions, and welfare home inmates. Similarly, crimes, criminals, homicides, and prisoners can also be grouped. Correlation does not mean a cause and effect relationship, therefore, at the current state of knowledge the connection among variables is not clear in all the cases. To sum up, Hungarian statistical data for three decades support Penrose's original observation on psychiatric beds and prison population, while the Penrose's statement on the inverse relationship between the number of crimes and of psychiatric beds is not supported. However, until deeper relationships are explored, aggregation of variables into few factors seems impossible.
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12
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Casiano H, Hensel JM, Chartier MJ, Ekuma O, MacWilliam L, Mota N, McDougall C, Bolton JM. The Intersection between Criminal Accusations, Victimization, and Mental Disorders: A Canadian Population-Based Study. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2020; 65:492-501. [PMID: 32363932 PMCID: PMC7298584 DOI: 10.1177/0706743720919660] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Understand the relationship between criminal accusations, victimization, and mental disorders at a population level using administrative data from Manitoba, Canada. METHOD Residents aged 18 to 64 between April 1, 2007, and March 31, 2012 (N = 793,024) with hospital- and physician-diagnosed mental disorders were compared to those without. Overall and per-person rates of criminal accusations and reported victimization in the 2011/2012 fiscal year were examined. Relative risks were calculated, adjusting for age, sex, income, and presence of a substance use disorder. The overlap between diagnosed mental disorders, accusations, and victimization with a χ2 test of independence was studied. RESULTS Twenty-four percent (n = 188,693) of the population had a mental disorder over the 5-year time frame. Four to fifteen percent of those with a mental disorder had a criminal accusation, compared to 2.4% of the referent group. Individuals with mental disorders, especially psychotic or personality disorders, were often living in low-income, urban neighborhoods. The adjusted relative risk of accusations and victimization remained 2 to 5 times higher in those with mental disorders compared to the referent group. Criminal accusations and victimization were most prevalent among individuals with a history of attempted suicide (15.2% had an accusation and 8.1% were victims). The risk of victimization in the same year as a criminal accusation was significantly increased among those with mental disorders compared to those without (χ2 = 211.8, P < 0.001). CONCLUSIONS Individuals with mental disorders are at elevated risk of both criminal involvement and victimization. The identification of these multiply-stigmatized individuals may lead to better intervention and support.
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Affiliation(s)
- Hygiea Casiano
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jennifer M Hensel
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Mariette J Chartier
- Manitoba Centre for Health Policy, Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Okechukwu Ekuma
- Manitoba Centre for Health Policy, Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Leonard MacWilliam
- Manitoba Centre for Health Policy, Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Natalie Mota
- Department of Clinical Health Psychology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Chelsey McDougall
- Manitoba Centre for Health Policy, Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - James M Bolton
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada.,Manitoba Centre for Health Policy, Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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Observed Outcomes: An Approach to Calculate the Optimum Number of Psychiatric Beds. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2020; 46:507-517. [PMID: 30778781 DOI: 10.1007/s10488-018-00917-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The number of psychiatric beds, in most developed countries, has decreased progressively since the late 1950s. Many clinicians believe that this reduction has gone too far. But how can we determine the number of psychiatric beds a mental health system needs? While the population health approach has advantages over the normative approach, it makes assumptions about optimal and minimum duration of hospitalization required for various psychiatric disorders. In this paper, we describe a naturalistic approach that estimates the required number of psychiatric beds by comparing the bed levels at which negative outcomes develop in different jurisdictions. We hypothesize that there will be a threshold below which negative outcomes will be seen across jurisdictions. We predict that hospital key performance indices will be more sensitive to bed reductions than the clinical and social outcomes of patients. The observed outcome approach can complement other approaches to determining bed numbers at the national and local levels, and should be a priority for future health services research.
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14
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Grecco GG, Andrew Chambers R. The Penrose Effect and its acceleration by the war on drugs: a crisis of untranslated neuroscience and untreated addiction and mental illness. Transl Psychiatry 2019; 9:320. [PMID: 31780638 PMCID: PMC6882902 DOI: 10.1038/s41398-019-0661-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 11/05/2019] [Accepted: 11/07/2019] [Indexed: 12/15/2022] Open
Abstract
In 1939, British psychiatrist Lionel Penrose described an inverse relationship between mental health treatment infrastructure and criminal incarcerations. This relationship, later termed the 'Penrose Effect', has proven remarkably predictive of modern trends which have manifested as reciprocal components, referred to as 'deinstitutionalization' and 'mass incarceration'. In this review, we consider how a third dynamic-the criminalization of addiction via the 'War on Drugs', although unanticipated by Penrose, has likely amplified the Penrose Effect over the last 30 years, with devastating social, economic, and healthcare consequences. We discuss how synergy been the Penrose Effect and the War on Drugs has been mediated by, and reflects, a fundamental neurobiological connection between the brain diseases of mental illness and addiction. This neuroscience of dual diagnosis, also not anticipated by Penrose, is still not being adequately translated into improving clinical training, practice, or research, to treat patients across the mental illness-addictions comorbidity spectrum. This failure in translation, and the ongoing fragmentation and collapse of behavioral healthcare, has worsened the epidemic of untreated mental illness and addictions, while driving unsustainable government investment into mass incarceration and high-cost medical care that profits too exclusively on injuries and multi-organ diseases resulting from untreated addictions. Reversing the fragmentation and decline of behavioral healthcare with decisive action to co-integrate mental health and addiction training, care, and research-may be key to ending criminalization of mental illness and addiction, and refocusing the healthcare system on keeping the population healthy at the lowest possible cost.
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Affiliation(s)
- Gregory G Grecco
- Medical Scientist Training Program, Indiana University of School of Medicine, Indianapolis, IN, USA
- Stark Neurosciences Research Institute, Indiana University School of Medicine, Indianapolis, IN, USA
| | - R Andrew Chambers
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA.
- Laboratory for Translational Neuroscience of Dual Diagnosis & Development, IU Neuroscience Research Center, Indianapolis, IN, USA.
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15
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Välimäki M, Yang M, Vahlberg T, Lantta T, Pekurinen V, Anttila M, Normand SL. Trends in the use of coercive measures in Finnish psychiatric hospitals: a register analysis of the past two decades. BMC Psychiatry 2019; 19:230. [PMID: 31349787 PMCID: PMC6660969 DOI: 10.1186/s12888-019-2200-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 06/30/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Coercive measures is a topic that has long been discussed in the field of psychiatry. Despite global reports of reductions in the use of restraint episodes due to new regulations, it is still questionable if practices have really changed over time. For this study, we examined the rates of coercive measures in the inpatient population of psychiatric care providers across Finland to identify changing trends as well as variations in such trends by region. METHODS In this nationwide registry analysis, we extracted patient data from the national database (The Finnish National Care Register for Health Care) over a 20-year period. We included adult patients admitted to psychiatric units (care providers) and focused on patients who had faced coercive measures (seclusion, limb restraints, forced injection and physical restraints) during their hospital stay. Multilevel logistical models (a polynomial model of quadratic form) were used to examine trends in prevalence of any coercive measures as well as the other four specified coercive measures over time, and to investigate variation in such trends among care providers and regions. RESULTS Between 1995 and 2014, the dataset contained 226,948 inpatients who had been admitted during the 20-year time frame (505,169 treatment periods). The overall prevalence of coercive treatment on inpatients was 9.8%, with a small decrease during 2011-2014. The overall prevalence of seclusion, limb restraints, forced injection and physical restraints on inpatients was 6.9, 3.8, 2.6 and 0.8%, respectively. Only the use of limb restraints showed a downward trend over time. Geographic and care provider variations in specific coercive measures used were also observed. CONCLUSIONS Despite the decreasing national level of coercive measures used in Finnish psychiatric hospitals, the overall reduction has been small during the last two decades. These results have implications on the future development of structured guidelines and interventions for preventing and more effectively managing challenging situations. Clinical guidelines and staff education related to the use of coercive measures should be critically assessed to ensure that the staff members working with vulnerable patient populations in psychiatric hospitals are ethically competent.
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Affiliation(s)
- Maritta Välimäki
- Department of Nursing Science, Faculty of Medicine, 20014 University of Turku, Turku, Finland. .,School of Nursing, Hong Kong Polytechnic University, Hong Kong, Hong Kong, Special Administrative Region, People's Republic of China. .,Turku University Hospital, Turku, Finland.
| | - Min Yang
- 0000 0001 0807 1581grid.13291.38West China Research Center for Rural Health Development, Sichuan University Huaxi Medical Center, Sichuan University of China, Administration Building, No 17, Section 3, Ren Ming Nan Lu, Chengdu, Sichuan China
| | - Tero Vahlberg
- 0000 0001 2097 1371grid.1374.1Department of Biostatistics, University of Turku, 20014 University of Turku, Turku, Finland
| | - Tella Lantta
- 0000 0001 2097 1371grid.1374.1Department of Nursing Science, Faculty of Medicine, 20014 University of Turku, Turku, Finland
| | - Virve Pekurinen
- 0000 0001 2097 1371grid.1374.1Department of Nursing Science, Faculty of Medicine, 20014 University of Turku, Turku, Finland
| | - Minna Anttila
- 0000 0001 2097 1371grid.1374.1Department of Nursing Science, Faculty of Medicine, 20014 University of Turku, Turku, Finland
| | - Sharon-Lise Normand
- 000000041936754Xgrid.38142.3cDepartment of Health Care Policy, Harvard Medical School, Boston, USA ,000000041936754Xgrid.38142.3cDepartment of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, USA
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16
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Seidel P, Konrad N, Negatsch V, Dezsö D, Kogan I, Gauger U, Neumann B, Voulgaris A, Opitz-Welke A. Violent Behavior During Psychiatric Inpatient Treatment in a German Prison Hospital. Front Psychiatry 2019; 10:762. [PMID: 31736795 PMCID: PMC6836873 DOI: 10.3389/fpsyt.2019.00762] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Accepted: 09/23/2019] [Indexed: 12/26/2022] Open
Abstract
Violent behavior in correctional facilities is common and differs substantially in type, target, implication, and trigger. Research on frequency and characteristics of violent behavior in correctional facilities and psychiatric hospitals is limited. Results from recent research suggest that comorbidity of severe mental disorder, personality disorder, and diagnosis of substance abuse is related to a higher risk of violent behavior. In the Berlin prison hospital, a database was created to collect data from all violent incidences (n=210) between 1997 and 2006 and between 2010 and 2016. In a retrospective, case-control study, we analyzed specific socioeconomic data and psychiatric diagnosis and compared the group of prisoners with violent behavior with randomly selected prisoners of the same department without violent behavior (n = 210). Diagnosis of schizophrenia, non-German nationality, no use of an interpreter, no children, and no previous sentence remained significantly associated with the dependent variable violent behavior. There were no significant differences regarding age and legal statuses. Practical implications for clinical work are discussed.
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Affiliation(s)
- P Seidel
- Justizvollzugskrankenhaus, JVA Plötzensee, Berlin, Germany
| | - N Konrad
- Institut für Forensische Psychiatrie, Charité, Berlin, Germany
| | - V Negatsch
- Institut für Forensische Psychiatrie, Charité, Berlin, Germany
| | - D Dezsö
- Institut für Forensische Psychiatrie, Charité, Berlin, Germany
| | - I Kogan
- Institut für Forensische Psychiatrie, Charité, Berlin, Germany
| | - U Gauger
- Institut für Forensische Psychiatrie, Charité, Berlin, Germany
| | - B Neumann
- Institut für Forensische Psychiatrie, Charité, Berlin, Germany
| | - A Voulgaris
- Institut für Sexualforschung und Forensische Psychiatrie, Universitätsklinikum Hamburg Eppendorf, Hamburg, Germany
| | - A Opitz-Welke
- Institut für Forensische Psychiatrie, Charité, Berlin, Germany
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17
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A 25-year dynamic ecological analysis of psychiatric hospital admissions and prison committals: Penrose’s hypothesis updated. Ir J Psychol Med 2018; 38:182-185. [DOI: 10.1017/ipm.2018.40] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AimsThere is renewed interest in the inverse association between psychiatric hospital and prison places, with reciprocal time trends shown in more than one country. We hypothesised that the numbers of admissions to psychiatric hospitals and committals to prisons in Ireland would also correlate inversely over time (i.e. dynamic measures of admission and committal rather than static, cross-sectional numbers of places).MethodPublicly available activity statistics for psychiatric hospitals and prisons in Ireland were collated from 1986 to 2010.ResultsThere was a reciprocal association between psychiatric admissions and prison committals (Pearson r=−0.788, p<0.001), an increase of 91 prison committals for every 100 psychiatric hospital admissions foregone.ConclusionPenrose’s hypothesis applies to admissions to psychiatric hospitals and prisons in Ireland over time (dynamic measures), just as it does to the numbers of places in psychiatric hospitals and prisons in Ireland and elsewhere (static, cross-sectional measures). Although no causal connection can be definitively established yet, mentally disordered prisoners are usually known to community mental health services. Psychiatric services for prisons and the community should be linked to ensure that the needs of those currently accessing care through prisons can also be met in the community.
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Seppänen A, Törmänen I, Shaw C, Kennedy H. Modern forensic psychiatric hospital design: clinical, legal and structural aspects. Int J Ment Health Syst 2018; 12:58. [PMID: 30377440 PMCID: PMC6195744 DOI: 10.1186/s13033-018-0238-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 10/11/2018] [Indexed: 11/10/2022] Open
Abstract
Forensic psychiatric care must be provided within the least restrictive setting possible, whilst simultaneously maintaining appropriate levels of security. This presents particular challenges for the design of forensic psychiatric hospitals, which are required to provide both a therapeutic and a safe material environment, often for extended periods of treatment and rehabilitation. By taking into consideration variable trends in psychiatric service provision and myriad clinical, legal and ethical issues, interdisciplinary forensic facility design teams are at the very forefront in implementing the latest developments in medical architecture. Also, although there are significant differences in how forensic psychiatric services are organized around the world, the underlying clinical challenges and increasingly research-based treatment principles are similar worldwide; it is therefore becoming less acceptable to operate and develop national forensic services without reference to international standards. Accordingly, we here review the literature on what features of forensic psychiatric facilities best serve the needs of those patients who need to rely on them, and we present a systematic and widely applicable approach to the complex and costly challenge of modern forensic psychiatric hospital design.
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Affiliation(s)
- Allan Seppänen
- Department of Psychoses and Forensic Psychiatry, Helsinki University Hospital, Helsinki, Finland
- Vanha Vaasa Hospital, Vaasa, Finland
| | - Iida Törmänen
- Department of Psychoses and Forensic Psychiatry, Helsinki University Hospital, Helsinki, Finland
- Department of ICT Psychiatry and Psychosocial Treatments, Helsinki University Hospital, Helsinki, Finland
| | | | - Harry Kennedy
- Department of Psychiatry, Trinity College, Dublin, Ireland
- National Forensic Mental Health Service, Central Mental Hospital, Dundrum, Dublin, Ireland
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Kalapos MP. Penrose's law: Methodological challenges and call for data. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2016; 49:1-9. [PMID: 27143118 DOI: 10.1016/j.ijlp.2016.04.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Accepted: 04/18/2016] [Indexed: 06/05/2023]
Abstract
The investigation of the relationship between the sizes of the mental health population and the prison population, outlined in Penrose's Law, has received renewed interest in recent decades. The problems that arise in the course of the deinstitutionalization have repeatedly drawn attention to this issue. This article presents methodological challenges to the examination of Penrose's Law and retrospectively reviews historical data from empirical studies. A critical element of surveys is the sampling method; longitudinal studies seem appropriate here. The relationship between the numbers of psychiatric beds and the size of the prison population is inverse in most cases. However, a serious failure is that almost all of the data were collected in countries historically belonging to a Christian or Jewish cultural community. Only very limited conclusions can be drawn from these sparse and non-comprehensive data: a reduction in the number of psychiatric beds seems to be accompanied by increases in the numbers of involuntary admissions and forensic treatments and an accumulation of mentally ill persons in prisons. A kind of transinstitutionalization is currently ongoing. A pragmatic balance between academic epidemiological numbers and cultural narratives should be found in order to confirm or refute the validity of Penrose's Law. Unless comprehensive research is undertaken, it is impossible to draw any real conclusion.
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