Institutions: Prisons and Asylums and the Deinstitutionalization

Abstract

As noted by Penrose in the mid-twentieth century the numbers of psychiatric hospital beds and prisoners in most countries seem to be almost consistently inversely related. Superficially this implies that provision of institutional psychiatric care somehow ameliorates the crime rate. Conversely deinstitutionalization, which primarily emptied and reduced beds in psychiatric hospitals, should have led to increased rates of crime and incarceration of mentally ill individuals. The reality is somewhat complicated; many discharged patients are leading more satisfying lives, but significant numbers of people with serious mental illness are homeless, receive inadequate care, misuse substances, and have other risk factors associated with criminal behavior. More than expected numbers of these people are in prisons or are being admitted into ever-expanding forensic mental health facilities, which can be characterized as a process of reinstitutionalization by stealth. A future program should perhaps recognize that a certain number of mentally ill people do require long-term institutional care within the current context of creating adequate community care for most people with psychiatric disorders. (PsycInfo Database Record (c) 2020 APA, all rights reserved) (Source: chapter)