Changes in the provision of institutionalized mental health care in post-communist countries.

Adrian P Mundt,Matej Potočan,Fouad Ismayilov,Jiří Raboch,Isaac Gurovich,Stefan Priebe,Dzianis Padruchny,Adriana Mihai,Yuriy Ignatyev,Miklós Péter Kalapos,Tanja Frančišković,Andreas Heinz,Māris Taube,Jan Mir,Marta Welbel,Valery Krasnov

doi:10.1371/journal.pone.0038490

Abstract

BackgroundGeneral psychiatric and forensic psychiatric beds, supported housing and the prison population have been suggested as indicators of institutionalized mental health care. According to the Penrose hypothesis, decreasing psychiatric bed numbers may lead to increasing prison populations. The study aimed to assess indicators of institutionalized mental health care in post-communist countries during the two decades following the political change, and to explore whether the data are consistent with the Penrose hypothesis in that historical context.Methodology/Principal FindingsGeneral psychiatric and forensic psychiatric bed numbers, supported housing capacities and the prison population rates were collected in Azerbaijan, Belarus, Croatia, Czech Republic, East Germany, Hungary, Kazakhstan, Latvia, Poland, Romania, Russia and Slovenia. Percentage change of indicators over the decades 1989–1999, 1999–2009 and the whole period of 1989–2009 and correlations between changes of different indicators were calculated. Between 1989 and 2009, the number of general psychiatric beds was reduced in all countries. The decrease ranged from −11% in Croatia to −51% in East Germany. In 2009, the bed numbers per 100,000 population ranged from 44.7 in Azerbaijan to 134.4 in Latvia. Forensic psychiatric bed numbers and supported housing capacities increased in most countries. From 1989–2009, trends in the prison population ranged from a decrease of −58% in East Germany to an increase of 43% in Belarus and Poland. Trends in different indicators of institutionalised care did not show statistically significant associations.Conclusions/SignificanceAfter the political changes in 1989, post-communist countries experienced a substantial reduction in general psychiatric hospital beds, which in some countries may have partly been compensated by an increase in supported housing capacities and more forensic psychiatric beds. Changes in the prison population are inconsistent. The findings do not support the Penrose hypothesis in that historical context as a general rule for most of the countries.

Highlights

In 1939, Lionel Sharples Penrose (1898–1972) described for the first time inverse relationships between psychiatric bed numbers and the size of the prison population analysing data from 18 European countries [1]
We investigated to what degree indicators of institutionalized mental health care such as general psychiatric bed numbers, forensic bed numbers, prison population numbers and capacities in supported housing services for mentally ill were altered after the political change in 1989, and tested whether the findings were consistent with the Penrose hypothesis
General Psychiatric Bed Numbers In the first decade after the political change from 1989–1999, psychiatric bed numbers decreased in all 12 participating countries

Summary

Introduction

In 1939, Lionel Sharples Penrose (1898–1972) described for the first time inverse relationships between psychiatric bed numbers and the size of the prison population analysing data from 18 European countries [1]. The so called Penrose hypothesis or Penrose law suggests that decreasing psychiatric bed numbers are related to an increase in the prison population Even though this hypothesis may be a simplification, the issue continues to be of importance [2,3] and has been replicated and discussed in different settings [4,5,6]. One study questions this relationship for high-income countries and postulates a direct, not inverse, relationship of psychiatric bed numbers and prison populations for low- and middle-income countries (LMICs) [7]. The study aimed to assess indicators of institutionalized mental health care in post-communist countries during the two decades following the political change, and to explore whether the data are consistent with the Penrose hypothesis in that historical context

Methods

Results

Conclusion