Institutions: Prisons and Asylums and the Deinstitutionalization

Reference work entry
Part of the Mental Health and Illness Worldwide book series (MHIW)


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.


Deinstitutionalization Transintitutionalization Homelessness Serious mental illness Community care Rehabilitation Prisons 


  1. Birmingham L, Mason D, Grubin DH (1996) Prevalence of mental disorder in remand prisoners: consecutive case study. Br Med J 313:1521–1524CrossRefGoogle Scholar
  2. Carlier VE, Lamberts RD, Fouwels AJ et al (1996) PTSD in relation to dissociation in traumatized police officers. Am J Psychiatr 153:1325–1328CrossRefPubMedGoogle Scholar
  3. Chaimowitz G (2012) The criminalization of people with mental illness. Can J Psychiatr 57:1–7Google Scholar
  4. Cohen L, Freeman H (1945) How dangerous to the community are State hospital patients? Conn State Med J 9:265–276Google Scholar
  5. Coid J, Kahtan N, Cook A et al (2001) Predicting admission rates to secure forensic psychiatry services. Psychol Med 31:531–539CrossRefPubMedGoogle Scholar
  6. Dartnall E, Modiba P, Porteus K et al (1999) Is deinstitutionalization appropriate? Discharge potential and service needs of psychiatric inpatients in KwaZulu-Natal and the Eastern Cape. Centre for Health Policy, University of Witwatersrand, South AfricaGoogle Scholar
  7. Eaton J, Mccay L, Semrau M et al (2011) Scale up of services for emtnal health in low-income and middle-income countries. Lancet 378:1592–1603CrossRefPubMedGoogle Scholar
  8. Fakhoury W, Priebe S (2002) The process of deinstitutionalization: an international overview. Curr Opin Psychiatry 15:187–192CrossRefGoogle Scholar
  9. Fakhoury W, Priebe S (2007) Deinstitutionalization and reinstitutionalization: major changes in the provision of mental healthcare. Psychiatry 6:313–316CrossRefGoogle Scholar
  10. Fazel S, Grann M (2006) The population impact of menal illness on violent crime. Am J Psychiatry 163:1397–1403CrossRefPubMedGoogle Scholar
  11. Fazel S, Seewald K (2012) Severe mental illness in 33 588 prisoners worlwide: systematic review and meta-regression analysis. Br J Psychiatry 200:364–373CrossRefPubMedGoogle Scholar
  12. Fazel S, Gulati G, Linsell L et al (2009) Schizophrenia and violence: systematic review and meta-analysis. PLoS Med 6:e1000120CrossRefPubMedPubMedCentralGoogle Scholar
  13. Fazel S, Lichtenstein P, Grann M et al (2010) Bipolar disorder and violent crime. Arch Gen Psychiatry 67:931–938CrossRefPubMedGoogle Scholar
  14. Grann M, Fazel S (2004) Substance misuse and violent crime: Swedish population study. BMJ 328:1233–1234CrossRefPubMedPubMedCentralGoogle Scholar
  15. Gunn J (1977) Criminal behaviour and mental disorder. Br J Psychiatry 130:317–329CrossRefPubMedGoogle Scholar
  16. Gunn J (2000) Future directions for treatment in forensic psychiatry. Br J Psychiatry 174:332–338CrossRefGoogle Scholar
  17. Hodgins S, Muller-Isberner R, Allaire J (2006) Attempting to understand the increase in the numbers of forensic beds in Europe: a multi-site study of patients in forensic and general psychiatric services. Int J Forensic Men Health 5:173–184CrossRefGoogle Scholar
  18. Irmiter C, Mccarthy JF, Barry KL et al (2007) Reinstitutionalization following psychiatric discharge among VA patients with serious mental illness: a national longitudinal study. Psychiatry Q 78:279–286CrossRefGoogle Scholar
  19. Kaliski S (2013) Reinstitutionalization by stealth: the forensic mental health service is the new chronic system. Afr J Psychiatry 16:13–17Google Scholar
  20. Kramp P, Gabrielsen G (2009) The organization of the psychiatric srvice and criminality committed by the mentally ill. Eur Psychiatry 24:401–411CrossRefPubMedGoogle Scholar
  21. Lamb HR, Bachrach LL (2001) Some perspectives on deinstitutionalization. Psychiatr Serv 52:1039–1046CrossRefPubMedGoogle Scholar
  22. Leff J (2001) Why is care in the community perceived as a failure? Br J Psychiatry 179:381–383CrossRefPubMedGoogle Scholar
  23. Lund C, Kleintjes S, Kakuma R et al (2010a) Public sector mental health systems in South Africa: inter-provincial comparisons and policy implications. Soc Psychiatry Psychiatr Epidemiol 45:393–404CrossRefPubMedGoogle Scholar
  24. Lund C, Oosthuizen P, Flisher AJ et al (2010b) Pathways to inpatient mental health care among people with schizophrenia spectrum disorders in South Africa. Psychiatr Serv 61:235–240CrossRefPubMedGoogle Scholar
  25. Markowitz FE (2006) Psychiatric hospital capacity, homelessness, adn crime and arrest rates. Criminology 44:45–72CrossRefGoogle Scholar
  26. Moore MA, Walton BA (2013) Improving the mental health functioning of youth in rural communities. Contem Rural Soc Work 5:85–103Google Scholar
  27. Mundt AP, Chow WS, Arduino M et al (2015) Psychiatric hospital beds and prison populations in South America since 1990. Does the Penrose hypothesis apply? JAMA Psychiatry 72:112–118CrossRefPubMedGoogle Scholar
  28. Munk-Jorgensen P (1999) Has deinstitutionalization gone too far? Eur Arch Psychiatry Clin Neurosci 249:136–143CrossRefPubMedGoogle Scholar
  29. Penrose L (1939) Mental illness and crime:outline of comparative study of European statistics. Br J Med Psychol 18:1–15CrossRefGoogle Scholar
  30. Peterson AL, Skeem J, Hart EL et al (2010) Analyzing offence patterns as a function of mental illness to test the criminalization hypothesis. Psychiatr Serv 61:1217–1222CrossRefPubMedGoogle Scholar
  31. Priebe S, Badesconyi A, Fioritti A et al (2005) Reinstitutionalization in mental health care: comparison of data on service provision from six European countries. BMJ 330:123–126CrossRefPubMedPubMedCentralGoogle Scholar
  32. Primeau A, Bowers TG, Harrison MA et al (2013) Deinstiutionalization of the mentally ill: evidence for transinstitutionalization from psychiatric hospitals to penal institutions. Compr Psychol 2:1–10CrossRefGoogle Scholar
  33. Sealy P, Whitehead PC (2004) Forty years of deinstitutionalization of psychiatric services in Canada: an empirical assessment. Can J Psychiatr 49:249–257CrossRefGoogle Scholar
  34. Shorter E (1997) A history of psychiatry: from the era of the asylum to the age of Prozac. Wiley, New YorkGoogle Scholar
  35. Sisti DA, Segal AG, Emanuel IZJ (2015) Improving long-term psychiatric care. Bring back the asylum. JAMA 313:243–244CrossRefPubMedGoogle Scholar
  36. Skeem J, Winter E, Kennealy P et al (2013) Offenders with mental illness have criminogenic needs, too: toward recidivism reduction. Law Hum Behav 38:212–224CrossRefPubMedGoogle Scholar
  37. Stein DJ, Seedat S, Herman A et al (2008) Lifetime prevalence of psychiatric disorders in South Africa. Br J Psychiatry 192:112–117CrossRefPubMedPubMedCentralGoogle Scholar
  38. Swanson JW, Holzer CE, Ganju VK et al (1990) Violence and psychiatric disorder in the community: evidence from the Epidemiologic Catchment Area surveys. Hosp Community Psychiatry 41:761–770PubMedGoogle Scholar
  39. Szasz T (2011) The myth of mental illness: 50 years later. Psychiatrist 35:179–182CrossRefGoogle Scholar
  40. Taylor PJ, Dunn E, Ogloff JRP et al (2009) Offenders with mental disorder on five Continents: a comparison of approaches to treatment and demographic factors relevant to measurement of outcome. Int J Forensic Ment Health 8:81–96CrossRefGoogle Scholar
  41. Turner T (2004) The history of deinstitutionalization and reinstitutionalization. Psychiatry 3:1–4CrossRefGoogle Scholar
  42. Van Dorn R, Volavka J, Johnson N (2012) Mental disorder and violence: is there a relationship beyond substance abuse? Soc Psychiatry Psychiatr Epidemiol 47:487–503CrossRefPubMedGoogle Scholar
  43. Wallace C, Mullen PE, Burgess P (2004) Criminal offending in schizophrenia over a 25-year period marked by deinstitutionalization and increasing prevalence of comorbid substance use disorders. Am J Psychiatr 161:716–727CrossRefPubMedGoogle Scholar
  44. Winkler P, Barrett B, Mccrone P et al (2016) Deinstitutionalised patients and homelessness and imprisonment: systematic review. Br J Psychiatry 208:421–428CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media Singapore 2017

Authors and Affiliations

  1. 1.Department of Psychiatry and Mental HealthUniversity of Cape TownCape TownSouth Africa

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