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Psychiatric beds and prison populations in 17 Latin American countries between 1991 and 2017: rates, trends and an inverse relationship between the two indicators

Published online by Cambridge University Press:  10 August 2020

Mathias Siebenförcher ,
Francesco D. Fritz ,
Matías Irarrázaval ,
Andrés Benavides Salcedo Open the ORCID record for Andrés Benavides Salcedo [Opens in a new window] ,
Corinne Dedik ,
Ana Fresán Orellana ,
Alejandro Herrera Ramos ,
J. Nicolás Ivan Martínez-López ,
Carla Molina  and
Fany Alejandra Rivas Gomez
...Show all authors
Mathias Siebenförcher
Affiliation:
Department of Psychiatry, Medical Faculty Charité – Universitätsmedizin, Berlin, Germany Department of Psychiatry and Mental Health, Medical Faculty, Universidad de Chile, Santiago, Chile
Francesco D. Fritz
Affiliation:
Department of Psychiatry, Medical Faculty Charité – Universitätsmedizin, Berlin, Germany Department of Psychiatry and Mental Health, Medical Faculty, Universidad de Chile, Santiago, Chile
Matías Irarrázaval
Affiliation:
Department of Psychiatry and Mental Health, Medical Faculty, Universidad de Chile, Santiago, Chile Millennium Institute for Research in Depression and Personality, Santiago, Chile
Andrés Benavides Salcedo
Affiliation:
Ministry of Public Health, Quito, Ecuador
Corinne Dedik
Affiliation:
Centro de Investigaciones Económicas Nacionales, City of Guatemala, Guatemala
Ana Fresán Orellana
Affiliation:
Instituto Nacional de Psiquiatría Ramón de la Fuente Muñíz, Mexico City, Mexico
Alejandro Herrera Ramos
Affiliation:
Universidad Nacional Autónoma de Honduras, Tegucigalpa, Honduras
J. Nicolás Ivan Martínez-López
Affiliation:
Instituto Nacional de Psiquiatría Ramón de la Fuente Muñíz, Mexico City, Mexico
Carla Molina
Affiliation:
Department of Psychiatry, Hospital Universitario de Los Andes, Mérida, Venezuela
Fany Alejandra Rivas Gomez
Affiliation:
Universidad Nacional Autónoma de Honduras, Tegucigalpa, Honduras
Guillermo Rivera
Affiliation:
Department of Psychology, Universidad Privada de Santa Cruz de la Sierra, Santa Cruz de la Sierra, Bolivia
Ignacio Sandia Saldivia
Affiliation:
Department of Psychiatry, Universidad de Los Andes, Mérida, Venezuela
Julio Torales
Affiliation:
Department of Psychiatry, Universidad Nacional de Asunción, San Lorenzo, Paraguay
Natalia Trujillo Orrego
Affiliation:
Mental Health Group, National Faculty of Public Health, Universidad de Antioquia, Medellín, Colombia
Andreas Heinz
Affiliation:
Department of Psychiatry, Medical Faculty Charité – Universitätsmedizin, Berlin, Germany
Adrian P. Mundt*
Affiliation:
Medical Faculty, Universidad Diego Portales, Santiago, Chile Medical Faculty, Universidad San Sebastián, Puerto Montt, Chile
*
Author for correspondence: Adrian P. Mundt, E-mail: [email protected]
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Abstract

Background

In 1990, Latin American countries committed to psychiatric reforms including psychiatric bed removals. Aim of the study was to quantify changes in psychiatric bed numbers and prison population rates after the initiation of psychiatric reforms in Latin America.

Methods

We searched primary sources to collect numbers of psychiatric beds and prison population rates across Latin America between the years 1991 and 2017. Changes of psychiatric bed numbers were compared against trends of incarceration rates and tested for associations using fixed-effects regression of panel data. Economic variables were used as covariates. Reliable data were obtained from 17 Latin American countries: Argentina, Bolivia, Brazil, Chile, Colombia, Costa Rica, Ecuador, Honduras, Guatemala, Mexico, Nicaragua, Panama, Paraguay, Peru, El Salvador, Uruguay and Venezuela.

Results

The number of psychiatric beds decreased in 15 out of 17 Latin American countries (median −35%) since 1991. Our findings indicate the total removal of 69 415 psychiatric beds. The prison population increased in all countries (median +181%). Panel data regression analyses showed a significant inverse relationship −2.70 (95% CI −4.28 to −1.11; p = 0.002) indicating that prison populations increased more when and where more psychiatric beds were removed. This relationship held up when introducing per capita income and income inequality as covariates −2.37 (95% CI −3.95 to −0.8; p = 0.006).

Conclusions

Important numbers of psychiatric beds have been removed in Latin America. Removals of psychiatric beds were related to increasing incarceration rates. Minimum numbers of psychiatric beds need to be defined and addressed in national policies.

Keywords

Deinstitutionalizationglobal healthhealth care reformmental health servicesprisoners
Type
Original Article
Information
Psychological Medicine , Volume 52 , Issue 5 , April 2022 , pp. 936 - 945
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Copyright
Copyright © The Author(s), 2020. Published by Cambridge University Press

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