Changes in the Provision of Institutionalized Mental Health Care in Post-Communist Countries

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.

Understanding psychiatric institutionalization: a conceptual review

“…The results of this review can be related to critiques of Goffman’s notion of the mental institution [20,37,83,84] namely that the earlier conceptualizations of institutionalization are limiting and can no longer be applicable in today’s context. The traditional conceptualization of institutionalization reinforces mainly a restrictive understanding of institutionalization as taking place in institutions, where patients are only the sufferers of the treatment process and have limited autonomy and are completely isolated from the outside world.…”

“…Moreover, provision of bed numbers in institutional settings can provide an indication of the trend of (de)institutionalization from a bricks and mortar perspective. Surprisingly, however, such data is difficult to obtain and clearer definitions and reliable sources are still required to investigate trends over time and even more so to compare internationally [84,85]. Thus more research is needed to fully understand the international development of mental health institutions.…”

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“…They serve to reduce the period of imprisonment of people with severe mental disorders [5]. It is not yet clear whether high rates of people with mental disorders in prisons are linked to reduced capacities of institutionalized mental health care [6,7]. Criminal offenders with mental disorders who do not undergo adequate treatment may enter in a cycle of recidivism regarding both the mental disorders and the criminal offenses [8,9].…”

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“…In absence of alternatives in the community, in some countries, professionals encourage families to admit people with severe and enduring mental health problems to internats (social asylums outside the jurisdiction of the health sector). 13,14 Eventually, they even facilitate the paper work.…”