Skip to main content Accessibility help
×
Home
Hostname: page-component-7bb4899584-6pg97 Total loading time: 0.512 Render date: 2023-01-27T06:10:49.646Z Has data issue: true Feature Flags: { "useRatesEcommerce": false } hasContentIssue true

Deinstitutionalisation, imprisonment and homelessness

Published online by Cambridge University Press:  02 January 2018

Adrian P. Mundt*
Affiliation:
Medical Faculties Universidad Diego Portales, Universidad San Sebastián and Universidad de Chile. Email: adrian.mundt@mail.udp.cl
Rights & Permissions[Opens in a new window]

Abstract

Type
Columns
Copyright
Copyright © Royal College of Psychiatrists, 2016 

In May 2016, Winkler et al published a systematic review on cohort studies following up patients after discharge from long-term psychiatric hospital care. Reference Winkler, Barrett, McCrone, Csémy, Janousková and Höschl1 The study did not show relevant numbers for imprisonment or homelessness after discharge. The authors concluded that the study contradicted ecological studies reporting a relationship between prison population rates and psychiatric bed numbers. They propose ecological fallacies as a possible explanation. In the related editorial, the ecological studies are referred to as arguing against deinstitutionalisation. Reference Salisbury and Thornicroft2

As an author of one of those ecological studies, I would like to comment. Rather than arguing against deinstitutionalisation of mentally ill people, the studies express concern that deinstitutionalisation does not occur in societies with massively increasing prison populations Reference Mundt, Chow, Arduino, Barrionuevo, Fritsch and Girala3 and very high rates of severe mental illness among prisoners. Reference Mundt, Kastner, Larrain, Fritsch and Priebe4 Although the relationship between psychiatric bed numbers and prison population rates in South America was rather strong, findings from Europe were less robust. Reference Chow and Priebe5 In quantitative terms, prisons have become the most important facilities institutionalising mentally ill people in the Americas. Mentally ill people in prisons cause much more concern with respect to human rights than those in psychiatric hospitals. A way forward could be to improve care for people in prison, as well as improving community care for mentally ill people at risk of criminal justice involvement to prevent imprisonment. There is a broad consensus that short-term hospital admission is more efficient than longer stays, and that psychiatric hospital admission should be linked with community services in care systems. In the ecological studies, all types of psychiatric hospital beds were acknowledged. Reference Mundt, Chow, Arduino, Barrionuevo, Fritsch and Girala3 The majority of beds nowadays are used to provide short-term care, including in low- and middle-income settings. Long-term hospital admission is no longer a common type of service provision in general psychiatry in the countries in which the studies that Winkler et al included in the review were conducted. Reference Winkler, Barrett, McCrone, Csémy, Janousková and Höschl1 Therefore, the study seems rather of historical value.

It is not surprising that elderly people, after decades spent in hospital, have low criminogenic energy. Young people with severe mental illness and comorbid substance use disorders are of much more concern. For understanding the interdependence of penal justice systems and psychiatric in-patient care systems, recently published large linkage studies of registries are more relevant. These show very high rates of psychiatric hospital admission prior to imprisonment and in the year after release from imprisonment. They also show markedly elevated risks for people with mental disorders to commit violent crimes and to be victims of violence compared with the general population. What contribution short-term hospital care can make to postponing or preventing criminal justice involvement and protecting people with mental disorders is still unresolved. However, to reject findings from ecological studies, as in Winkler et al's review, may be a fallacy of categories.

References

1 Winkler, P, Barrett, B, McCrone, P, Csémy, L, Janousková, M, Höschl, C. Deinstitutionalised patients, homelessness and imprisonment: systematic review. Br J Psychiatry 2016; 208: 421–8.CrossRefGoogle ScholarPubMed
2 Salisbury, TT, Thornicroft, G. Deinstitutionalisation does not increase imprisonment or homelessness. Br J Psychiatry 2016; 208: 412–3.CrossRefGoogle ScholarPubMed
3 Mundt, AP, Chow, WS, Arduino, M, Barrionuevo, H, Fritsch, R, Girala, N, et al. Psychiatric hospital beds and prison populations in South America since 1990: does the Penrose hypothesis apply? JAMA Psychiatry 2015; 72: 112–8.CrossRefGoogle ScholarPubMed
4 Mundt, AP, Kastner, S, Larrain, S, Fritsch, R, Priebe, S. Prevalence of mental disorders at admission to the penal justice system in emerging countries: a study from Chile. Epidemiol Psychiatr Sci 2015; doi: 10.1192/S2045796015000554.CrossRefGoogle Scholar
5 Chow, WS, Priebe, S. How has the extent of institutional mental healthcare changed in Western Europe? Analysis of data since 1990. BMJ Open 2016; 6: e010188.CrossRefGoogle ScholarPubMed
Submit a response

eLetters

No eLetters have been published for this article.
You have Access
2
Cited by

Save article to Kindle

To save this article to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Deinstitutionalisation, imprisonment and homelessness
Available formats
×

Save article to Dropbox

To save this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you used this feature, you will be asked to authorise Cambridge Core to connect with your Dropbox account. Find out more about saving content to Dropbox.

Deinstitutionalisation, imprisonment and homelessness
Available formats
×

Save article to Google Drive

To save this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you used this feature, you will be asked to authorise Cambridge Core to connect with your Google Drive account. Find out more about saving content to Google Drive.

Deinstitutionalisation, imprisonment and homelessness
Available formats
×
×

Reply to: Submit a response

Please enter your response.

Your details

Please enter a valid email address.

Conflicting interests

Do you have any conflicting interests? *