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ABSTRACT FROM: Mundt AP, Chow WS, Arduino M, et al . Psychiatric hospital beds and prison populations in South America since 1990: does the Penrose hypothesis apply? JAMA Psychiatry 2015;72:112-18.
Background
About 80 years ago, Penrose proposed an inverse relationship between the relative number of psychiatric beds available to a population and its total number of prisoners, based on calculations from cross-sectional study of 18 countries. 1 The subsequent drive for deinstitutionalisation that has dominated policy decisions in many countries for over half a century has provided a convenient natural experiment to test Penrose's hypothesis. In a large multinational cross-sectional study in 2004 2 no association was demonstrated, supporting other work from the USA 3 and Scandinavia. 4 Recently macroeconomic factors have been suggested as more potent drivers of the relative sizes of psychiatric hospitals and prisons. However, none of the published studies have thus far sufficiently disproved Penrose's direct inverse association theory.
Methods of the study
This paper investigated psychiatric bed levels and prisoner numbers in South America since the Caracas Declaration in 1990, where South American countries committed to following a Western model of deinstitutionalisation and investment in community services. At least two separate researchers in 10 South American countries were asked by email to supply retrospective longitudinal data on the numbers of psychiatric beds and the size of prison populations between 1991 and 2011. Primary national data sources were used preferentially and if not available, secondary sources such...