INCAS

Institutionalised care for people with mental disorders in South America: indicators and trends

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 Obiettivo del progetto (Objective)

'In the Caracas declaration of 1990, South American countries committed themselves to improve the human rights situation and social inclusion of people with mental disorders, de-institutionalise their care and develop community mental health services. There is however little evidence on the extent to which this has happened and what the current trends are. Indicators of institutionalised care include the provision of psychiatric hospital beds, forensic psychiatric beds, involuntary admission rates, supported housing, and residential homes. A particular question is how many people with mental disorders have been imprisoned, since the prison population increased substantially over the past decade (e.g. in Chile by more than 100%). The study has two aims 1) to assess indicators of institutionalised care for people with mental disorders across South America since 1990 and identify trends of de-, trans- or re-institutionalisation; 2) to establish the rate of people with mental disorders in a prison population in Chile. Primary data sources from ministries and social welfare, national prison administrations, hospital administrations and non-governmental organisations will be used to obtain indicators of institutionalised care. The prevalence of mental disorders in a prison population in Chile will be assessed in interviews of a representative sample of 800 prisoners. It is hypothesized that there is a trend towards trans-institutionalisation with a decrease of conventional hospital beds, but with high rates of people with mental disorders in prison and an increased provision of supported housing, whilst community services are still lacking. The findings will be explained against the background of societal, economic and professional developments in South America. The study will be based at the Universidad de Chile and the Queen Mary University of London, two centres of excellence in social psychiatry, and it will reinforce Europe’s leading position in Global Mental Health.'

Introduzione (Teaser)

A close look at institutionalised care for people with mental disorders in South America highlights indicators and trends, including the relationship of psychiatric bed numbers and prison population rates.

Descrizione progetto (Article)

Since the Caracas Declaration of 1990, South American countries have committed to the improvement of human rights and social inclusion of people suffering from mental disorders. Reforms meant to de-institutionalise their care and create community mental health services. However, what remains unclear since this was initiated is to what extent this has actually taken place, where institutionalisation of mentally ill occurs and what the current trends are.

Thus, the 'Institutionalised care for people with mental disorders in South America: Indicators and trends' (INCAS) project has begun investigating these questions. It is also looking into the number of people with mental disorders that are admitted to prisons in Chile. The project is striving to assess indicators as well as trends at which people with mental disorders are institutionalised in South America. Indicators of institutionalisation include hospital and forensic beds, rates of involuntary admission, supported housing and prison population rates.

Data were collected from Argentina, Bolivia, Brazil, Chile, Paraguay and Uruguay, and an association between the number of psychiatric beds and prison population has been tested. For the first time, an inverse relationship of psychiatric beds and prison population rates was found in a longitudinal data set covering the past two decades. The relationship can in part be explained and mediated by the increase of per capita gross national income as a socioeconomic indicator. High rates of mental illness such as psychoses, depression, personality disorders and substance abuse, were found among those assessed when entering prison.

Based at the Universidad de Chile and the Queen Mary University of London, the study is helping to reinforce Europe's position in global mental health.