scholarly journals 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

2021 ◽  
pp. 1-7
Author(s):  
Georgina Wild ◽  
Ross Alder ◽  
Scott Weich ◽  
Iain McKinnon ◽  
Patrick Keown
Keyword(s):  
Mental Illness ◽  
Intellectual Disability ◽  
Prison Population ◽  
Significant Negative Correlation ◽  
Time Lags ◽  
Female Prisoners ◽  
Annual Reduction ◽  
Prison Populations ◽  
Psychiatric Beds ◽  
Bed Numbers

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.

scholarly journals Offenders with mental disorders in prison and the courts: links to rates of civil detentions and the number of psychiatric beds in England – longitudinal data from 1984 to 2016

BJPsych Open ◽  
2019 ◽  
Vol 5 (6) ◽  
Author(s):  
Patrick Keown ◽  
Dannielle McKenna ◽  
Hannah Murphy ◽  
Iain McKinnon
Keyword(s):  
Mental Health ◽  
Time Series ◽  
Mental Illness ◽  
Prison Population ◽  
Time Lag ◽  
Secondary Analysis ◽  
Routinely Collected Data ◽  
Court Orders ◽  
Psychiatric Beds ◽  
Bed Numbers

Background The Mental Health Act in England and Wales allows for two types of detention in hospital: civil and forensic detentions. An association between the closure of mental illness beds and a rise in civil detentions has been reported. Aims To examine changes in the rate of court orders and transfer from prison to hospital for treatment, and explore associations with civil involuntary detentions, psychiatric bed numbers and the prison population. Method Secondary analysis of routinely collected data with lagged time series analysis. We focused on two main types of forensic detentions in National Health Service (NHS) hospitals and private units: prison transfers and court treatment orders in England from 1984 to 2016. NHS bed numbers only were available. Results There was an association between the number of psychiatric beds and the number of prison transfers. This was strongest at a time lag of 2 years with the change in psychiatric beds occurring first. There was an association between the rate of civil detentions and the rate of court orders. This was strongest at a time lag of 3 years. Linear regression indicated that 135 fewer psychiatric beds were associated with one additional transfer from prison to hospital; and as the rate of civil detentions increased by 72, the rate of court treatment orders fell by one. Conclusions The closure of psychiatric beds was associated with an increase in transfers from prison to hospital for treatment. The increase in civil detentions was associated with a reduction in the rate of courts detaining to hospital individuals who had offended. Declaration of interest None.

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

2020 ◽  
pp. 1-10
Author(s):  
Mathias Siebenförcher ◽  
Francesco D. Fritz ◽  
Matías Irarrázaval ◽  
Andrés Benavides Salcedo ◽  
Corinne Dedik ◽  
...  
Keyword(s):  
Latin America ◽  
Panel Data ◽  
Latin American ◽  
Fixed Effects ◽  
Inverse Relationship ◽  
Prison Population ◽  
Prison Populations ◽  
Psychiatric Beds ◽  
Latin American Countries ◽  
Bed Numbers

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.

scholarly journals A novel care pathway for prisoners with intellectual disability designed through a Delphi process

2018 ◽  
Vol 14 (4) ◽  
pp. 276-286 ◽  
Author(s):  
Gautam Gulati ◽  
Stephen Quigley ◽  
Valerie Elizabeth Murphy ◽  
Evan Yacoub ◽  
John Bogue ◽  
...  
Keyword(s):  
Intellectual Disability ◽  
Care Pathway ◽  
Prison Population ◽  
Expert Elicitation ◽  
Convenience Sample ◽  
Content Type ◽  
Specialist Services ◽  
Delphi Exercise ◽  
Prison Populations ◽  
Provision Of Care

PurposeIndividuals with an intellectual disability (ID) form a significant minority in the Irish prison population and worldwide prison populations. There is growing recognition that specialist services for such individuals are in need of development. The purpose of this paper is to propose a care pathway for the management of individuals with an ID who present in prison, based on expert elicitation and consensus.Design/methodology/approachA convenience sample of professionals with a special interest in forensic intellectual disabilities was invited to participate in a Delphi exercise. In total, 12 agreed to participation and 10 subsequently completed the study (83.3 per cent). Expert views were elicited using a semi-structured questionnaire. Content analysis was completed using NVivo 11 software. A care pathway was subsequently proposed, based on the outcomes of the analysis, and circulated to participants for debate and consensus. A consensus was reached on management considerations.FindingsTen experts across a range of disciplines with a combined experience of 187 years participated in the study. Current provision of care was seen as limited and geographically variable. The vulnerability of prisoners with ID was highlighted. The need for equivalence of care with the community through multidisciplinary input and development of specialist secure and residential placements to facilitate diversion was identified. Consensus was achieved on a proposed care pathway.Originality/valueThis study proposes a care pathway for the assessment and management of prisoners with an ID and is, therefore, potentially relevant to those interested in this topic internationally who may similarly struggle with the current lack of decision-making tools for this setting. Although written from an Irish perspective, it outlines key considerations for psychiatrists in keeping with international guidance and, therefore, may be generalisable to other jurisdictions.

The downside of downsizing: Persistence of racial disparities following state prison reform

2021 ◽  
pp. 146247452110060
Author(s):  
Amy E Lerman ◽  
Alyssa C Mooney
Keyword(s):  
Racial Disparities ◽  
Prison Population ◽  
Mass Incarceration ◽  
Prison Reform ◽  
State Prison ◽  
Probation And Parole ◽  
Substantial Progress ◽  
Prison Populations ◽  
Racial Ethnic ◽  
Double Digit

Nationwide, prison populations have declined nearly 5% from their peak, and 16 states have seen double-digit declines. It is unclear, though, how decarceration has affected racial disparities. Using national data, we find substantial variation in state prison populations from 2005–2018, with increases in some states and declines in others. However, although declines in the overall state prison population were associated with declines for all groups, states with rising prison populations experienced slight upticks in prison rates among the white population, while rates among Black and Latinx populations declined. As a result, greater progress in overall decarceration within states did not translate to larger reductions in racial disparities. At the same time, we do not find evidence that a decline in prison populations is associated with a rise in jail incarceration for any racial/ethnic group. In additional exploratory analyses, we suggest that recent incarceration trends may be driven by changes in returns to prison for probation and parole violations, rather than commitments for new crimes. Our results make clear that while efforts to reverse mass incarceration have reduced the size of prison populations in some states, they have not yet made substantial progress in resolving the crisis of race in American criminal justice.

scholarly journals Expert Arguments for Trends of Psychiatric Bed Numbers: A Systematic Review of Qualitative Data

2021 ◽  
Vol 12 ◽  
Author(s):  
Adrian P. Mundt ◽  
Sabine Delhey Langerfeldt ◽  
Enzo Rozas Serri ◽  
Mathias Siebenförcher ◽  
Stefan Priebe
Keyword(s):  
Systematic Review ◽  
Community Care ◽  
Integration Of Care ◽  
Admission Rates ◽  
Expert Opinions ◽  
Psychiatric Beds ◽  
Occupancy Rates ◽  
Mental Health Policies ◽  
Bed Numbers

Introduction: Mental health policies have encouraged removals of psychiatric beds in many countries. It is under debate whether to continue those trends. We conducted a systematic review of expert arguments for trends of psychiatric bed numbers.Methods: We searched seven electronic databases and screened 15,479 papers to identify expert opinions, arguments and recommendations for trends of psychiatric bed numbers, published until December 2020. Data were synthesized using thematic analysis and classified into arguments to maintain or increase numbers and to reduce numbers.Results: One hundred six publications from 25 countries were included. The most common themes arguing for reductions of psychiatric bed numbers were inadequate use of inpatient care, better integration of care and better use of community care. Arguments to maintain or increase bed numbers included high demand of psychiatric beds, high occupancy rates, increasing admission rates, criminalization of mentally ill, lack of community care and inadequately short length of stay. Cost effectiveness and quality of care were used as arguments for increase or decrease.Conclusions: The expert arguments presented here may guide and focus future debate on the required psychiatric bed numbers. The recommendations may help policymakers to define targets for psychiatric bed numbers. Arguments need careful local evaluation, especially when supporting opposite directions of trends in different contexts.

scholarly journals Racial representation of psychological services in a London male remand prison

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S72-S73
Author(s):  
Josh Covey ◽  
Joanne Williams ◽  
Radha Kothari ◽  
Scott Bartle
Keyword(s):  
Emotional Regulation ◽  
Help Seeking ◽  
Prison Population ◽  
Psychological Needs ◽  
Racial Group ◽  
Psychological Therapy ◽  
Psychological Services ◽  
Racial Groups ◽  
Hearing Voices ◽  
Prison Populations

AimsTo investigate whether racial groups are proportionally represented in referrals for trauma, hearing voices, emotional regulation and psychological therapy.To understand the psychological needs across racial groups in HMP Wormwood Scrubs, the UK's 4th-most diverse prison.To see if the long-established under-representation of Asian males and over-representation of Mixed males in psychological services in the community is also occuring in the prison system.MethodPsychological referrals were recieved via the medical notes system (SystmOne), whereby a prisoner's name, age, location, racial group and reason for referral are trasnferred into the psychology referrals database.773 referrals were made between October 2018 and May 2020. As the prison's population throughout this time period was fluid, the month of December 2019 was used as a reference for the general prison poipulation.Racial groups were specified using the Office of National Statistics' 5-category classification system (White, Black, Asian, Mixed and Other).ResultThere is a consistent under-representation of Asian males in psychological referrals in relation to their general prison population. Whilst this group makes up 17% of the population of the prison, only 10% of prisoners referred to psychological services identified as Asian.Those identifying as Mixed are over-represented in trauma referrals and psychological therapy referrals. The prison's mixed population is 7%, whereas 16% of those being referred for these two reasons were from the same racial category.The proportion of patients who identified as Black, White or Other and were referred for psychology input were found to be representitive of the wider prison population, suggesting no clear over or under-representation.ConclusionTrends seen in the community in regards to Asian males being under-represented in psychological services are also evident in one of the UK's most diverse prison populations.Public health campaigning to reduce stigma and promote help seeking in BAME communities is of vital importance to provide the needed support for those silently dealing with psychological problems.The two largest racial groups in the prison, White and Black individuals, where found to be proportionally represented in their respective referrals to psychological services.One key finding was in regards to Mixed race individuals, who comprise 7% of the total prison population but 16% of psychology referrals. As this racial group is one of the fastest-growing in addition to be over-represented in referrals, it is vital to understand how provisions can be put in place to appropriately address the needs of this group.

Does Ethnicity Affect Need for Mental Health Service Among New Zealand Prisoners?

2003 ◽  
Vol 37 (6) ◽  
pp. 728-734 ◽  
Author(s):  
Alexander I. F. Simpson ◽  
Philip M. Brinded ◽  
Nigel Fairley ◽  
Tannis M. Laidlaw ◽  
Fiona Malcolm
Keyword(s):  
Mental Illness ◽  
New Zealand ◽  
Mental Disorders ◽  
Mental Disorder ◽  
Ethnic Groups ◽  
Diagnostic Interview ◽  
Pacific Island ◽  
Treatment Needs ◽  
Female Prisoners ◽  
Male Prisoners

Objective: The National Study on Psychiatric Morbidity in New Zealand Prisons identified undiagnosed mental illness and unmet treatment needs for mentally disordered offenders. As approximately 50% of prisoners are of Maori and 8.3% Pacific Island ethnicity, we analyzed the data to determine if there were any differences in the rates of major mental disorders between ethnic groups. Method: A census of all female prisoners, all remand male prisoners and an 18% random sample of the sentenced male prisoners were interviewed employing the diagnostic interview for mental illness (CIDI-A), screening diagnostic interview for relevant personality disorders (PDQ) and suicide screening questions. Self-identified ethnicity was recorded. Ethnic groups were compared for sociodemographic variables, morbidity for mental disorder, treatment experience and suicidality. Results: The ethnic groups were largely similar in age and current prevalence for mental disorders, although there was some evidence of differing sociodemographic factors, especially younger age among the Maori prisoners. Maori report fewer suicidal thoughts, but acted suicidally at the same rate as non-Maori. Treatment for mental disorder was less common among Maori and Pacific Island prisoners than others, both in prison and in the community. Conclusion: Criminogenic factors present in the developmental histories of prisoners might also increase the risk of mental disorders. Ethnic groups were not different in the rate at which they manifest mental disorders in the face of such factors. Younger prisoners were disproportionately more likely to be of Maori or Pacific Island ethnicity. Both prior to and after entry to prison, services must improve responsiveness to Maori and Pacific Island people.

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