Jan Mir

Changes in the Provision of Institutionalized Mental Health Care in Post-Communist Countries

Background General psychiatric and forensic psychiatric beds, supported housing and the prison population have been suggested as indicators of institutionalized mental health care. According to the Penrose hypothesis, decreasing psychiatric bed numbers may lead to increasing prison populations. The study aimed to assess indicators of institutionalized mental health care in post-communist countries during the two decades following the political change, and to explore whether the data are consistent with the Penrose hypothesis in that historical context. Methodology/Principal Findings General psychiatric and forensic psychiatric bed numbers, supported housing capacities and the prison population rates were collected in Azerbaijan, Belarus, Croatia, Czech Republic, East Germany, Hungary, Kazakhstan, Latvia, Poland, Romania, Russia and Slovenia. Percentage change of indicators over the decades 1989–1999, 1999–2009 and the whole period of 1989–2009 and correlations between changes of different indicators were calculated. Between 1989 and 2009, the number of general psychiatric beds was reduced in all countries. The decrease ranged from −11% in Croatia to −51% in East Germany. In 2009, the bed numbers per 100,000 population ranged from 44.7 in Azerbaijan to 134.4 in Latvia. Forensic psychiatric bed numbers and supported housing capacities increased in most countries. From 1989–2009, trends in the prison population ranged from a decrease of −58% in East Germany to an increase of 43% in Belarus and Poland. Trends in different indicators of institutionalised care did not show statistically significant associations. Conclusions/Significance After the political changes in 1989, post-communist countries experienced a substantial reduction in general psychiatric hospital beds, which in some countries may have partly been compensated by an increase in supported housing capacities and more forensic psychiatric beds. Changes in the prison population are inconsistent. The findings do not support the Penrose hypothesis in that historical context as a general rule for most of the countries.

Treating substance abuse is not enough: comorbidities in consecutively admitted female prisoners.

INTRODUCTION Several studies have pointed to high rates of substance use disorders among female prisoners. The present study aimed to assess comorbidities of substance use disorders with other mental disorders in female prisoners at admission to a penal justice system. METHODS A sample of 150 female prisoners, consecutively admitted to the penal justice system of Berlin, Germany, was interviewed using the Mini-International Neuropsychiatric Interview (MINI). The presence of borderline personality disorder was assessed using the Structured Clinical Interview II for DSM-IV. Prevalence rates and comorbidities were calculated as percentage values and 95% confidence intervals (CIs). RESULTS Ninety-three prisoners (62%; 95% CI: 54-70) had substance use disorders; n=49 (33%; 95% CI: 24-42) had alcohol abuse/dependence; n=76 (51%; 95% CI: 43-59) had illicit drug abuse/dependence; and n=53 (35%; 95% CI: 28-44) had opiate use disorders. In the group of inmates with substance use disorders, 84 (90%) had at least one other mental disorder; n=63 (68%) had comorbid affective disorders; n=45 (49%) had borderline or antisocial personality disorders; and n=41 (44%) had comorbid anxiety disorders. CONCLUSIONS Female prisoners with addiction have high rates of comorbid mental disorders at admission to the penal justice system, ranging from affective to personality and anxiety disorders. Generic and robust interventions that can address different comorbid mental health problems in a flexible manner may be required to tackle widespread addiction and improve mental health of female prisoners.

Did female prisoners with mental disorders receive psychiatric treatment before imprisonment

BackgroundThroughout the world, high prevalence rates of mental disorders have been found in prison populations, especially in females. It has been suggested that these populations do not access psychiatric treatment. The aim of this study was to establish rates of psychiatric in- and outpatient treatments prior to imprisonment in female prisoners and to explore reasons for discontinuation of such treatments.Methods150 consecutively admitted female prisoners were interviewed in Berlin, Germany. Socio-demographic characteristics, mental disorders, and previous psychiatric in- and outpatient treatments were assessed by trained researchers. Open questions were used to explore reasons for ending previous psychiatric treatment.ResultsA vast majority of 99 prisoners (66%; 95% CI: 58–73) of the total sample reported that they had previously been in psychiatric treatment, 80 (53%; 95 CI: 45–61) in inpatient treatment, 62 (41%; 95 CI: 34–49) in outpatient treatment and 42 (29%; 21–39) in both in- and outpatient treatments. All prisoners with psychosis and 72% of the ones with any lifetime mental health disorder had been in previous treatment. The number of inpatient treatments and imprisonments were positively correlated (rho = 0.27; p < 0.01). Inpatient treatment was described as successfully completed by 56% (N = 41) of those having given reasons for ending such treatment, whilst various reasons were reported for prematurely ending outpatient treatments.ConclusionThe data do not support the notion of a general ‘mental health treatment gap’ in female prisoners. Although inpatient care is often successfully completed, repeated inpatient treatments are not linked with fewer imprisonments. Improved transition from inpatient to outpatient treatment and services that engage female prisoners to sustained outpatient treatments are needed.

Psychometric Properties of a Russian Version of the General Health Questionnaire-28

Background: The 28-item General Health Questionnaire (GHQ-28) is a scaled version of the General Health Questionnaire that has been used internationally to screen for mental disorders in nonpsychiatric populations. There is great need to validate international screening instruments in the Russian language for their use in post-Soviet countries. Methods: 200 persons were surveyed in a deprived area of Almaty, Kazakhstan using the Russian version of the GHQ-28 and socioeconomic measures (income level, employment situation and education). We calculated the median and the mean GHQ-28 scores for different socioeconomic subgroups. The internal reliability was tested using Cronbach’s α coefficient and intersubscale correlations. We conducted an exploratory factor analysis using varimax rotation. Results: The median score of the GHQ-28 was 2 (mean = 3.56; SD = 5.09) for the total sample. Higher age, unemployment and female gender were significantly associated with high mean GHQ-28 scores. Cronbach’s α coefficient was 0.92 for the total scale. Exploratory factor analysis revealed four factors explaining 50.07% of the variance. The factor Anxiety/Insomnia accounted for 14.87%, Severe Depression for 13.74%, Social Dysfunction for 13.47% and Somatic Symptoms for 8.81% of the variance. Conclusions: The test showed good internal consistency. The median GHQ-28 score was relatively low compared to other countries. The subscale Severe Depression including items on suicidal ideation may have a lower acceptance than the other subscales Somatic Symptoms, Anxiety/Insomnia and Social Dysfunction.

[People with mental disorders in East and West Germany: indicators of institutionalized care since reunification].

OBJECTIVES The aim of this study is to compare the historic development of indicators of institutionalized care for the mentally ill in East and West Germany since the political change of 1989. METHODS Data on numbers of psychiatric beds, prison populations, the occupancy in forensic psychiatric institutions, in rehabilitation services, in supported housing units and involuntary admission rates are presented in historic time lines. Changes were calculated as a percentage. RESULTS After 1989 general psychiatric bed numbers decreased by 61% and the prison population by 77% in East Germany both from initially higher to then lower rates than in West Germany. Since 1993 there has been an approximation of the numbers in East and West Germany. In both parts of Germany the forensic psychiatric bed numbers, supported housing and rehabilitation capacities have increased. Involuntary admission rates into general psychiatry are on the increase in both parts of Germany. They continue to be 3.3 times higher in West Germany than in East Germany. CONCLUSION The harmonization of capacities in mental health care institutions between both parts of Germany was realized within a few years after reunification. Continuous differences remain regarding the involuntary admission rates.ZusammenfassungHintergrundDie Arbeit beschreibt die Entwicklung von Indikatoren der Institutionalisierung psychisch Kranker vergleichend zwischen den alten und neuen Bundesländern seit der politischen Wende.Material und MethodenPsychiatrische Bettenzahlen, Gefangenenraten, die Belegung im Maßregelvollzug, in der stationären Rehabilitation, im stationär betreuten Wohnen und die Raten von Zwangsunterbringungen werden in historischen Zeitreihen dargestellt. Veränderungen wurden in Prozent berechnet.ErgebnisseIn Ostdeutschland kam es nach 1989 zu einem Abbau der allgemeinpsychiatrischen Betten um 61% sowie der Gefangenenrate um 77% von einem zunächst höheren auf ein deutlich niedrigeres Niveau als in Westdeutschland, bevor es zu einer Angleichung der Kapazitäten kam. In beiden Teilen Deutschlands wurden Kapazitäten im Maßregelvollzug, im betreuten Wohnen und in Rehabilitationseinrichtungen aufgebaut. Die Unterbringungsraten in Allgemeinpsychiatrien lagen bei beidseits steigender Tendenz in alten Bundesländern um den Faktor 3,3 höher als in den neuen Bundesländern.SchlussfolgerungEine Angleichung bezüglich der Art und Häufigkeit von Institutionalisierung vollzog sich zwischen Ost- und Westdeutschland innerhalb weniger Jahre. Deutliche Unterschiede bestehen weiter in der Rate von Zwangsunterbringungen.SummaryObjectivesThe aim of this study is to compare the historic development of indicators of institutionalized care for the mentally ill in East and West Germany since the political change of 1989.MethodsData on numbers of psychiatric beds, prison populations, the occupancy in forensic psychiatric institutions, in rehabilitation services, in supported housing units and involuntary admission rates are presented in historic time lines. Changes were calculated as a percentage.ResultsAfter 1989 general psychiatric bed numbers decreased by 61% and the prison population by 77% in East Germany both from initially higher to then lower rates than in West Germany. Since 1993 there has been an approximation of the numbers in East and West Germany. In both parts of Germany the forensic psychiatric bed numbers, supported housing and rehabilitation capacities have increased. Involuntary admission rates into general psychiatry are on the increase in both parts of Germany. They continue to be 3.3 times higher in West Germany than in East Germany.ConclusionThe harmonization of capacities in mental health care institutions between both parts of Germany was realized within a few years after reunification. Continuous differences remain regarding the involuntary admission rates.

Psychisch Kranke in Ost- und Westdeutschland

OBJECTIVES The aim of this study is to compare the historic development of indicators of institutionalized care for the mentally ill in East and West Germany since the political change of 1989. METHODS Data on numbers of psychiatric beds, prison populations, the occupancy in forensic psychiatric institutions, in rehabilitation services, in supported housing units and involuntary admission rates are presented in historic time lines. Changes were calculated as a percentage. RESULTS After 1989 general psychiatric bed numbers decreased by 61% and the prison population by 77% in East Germany both from initially higher to then lower rates than in West Germany. Since 1993 there has been an approximation of the numbers in East and West Germany. In both parts of Germany the forensic psychiatric bed numbers, supported housing and rehabilitation capacities have increased. Involuntary admission rates into general psychiatry are on the increase in both parts of Germany. They continue to be 3.3 times higher in West Germany than in East Germany. CONCLUSION The harmonization of capacities in mental health care institutions between both parts of Germany was realized within a few years after reunification. Continuous differences remain regarding the involuntary admission rates.ZusammenfassungHintergrundDie Arbeit beschreibt die Entwicklung von Indikatoren der Institutionalisierung psychisch Kranker vergleichend zwischen den alten und neuen Bundesländern seit der politischen Wende.Material und MethodenPsychiatrische Bettenzahlen, Gefangenenraten, die Belegung im Maßregelvollzug, in der stationären Rehabilitation, im stationär betreuten Wohnen und die Raten von Zwangsunterbringungen werden in historischen Zeitreihen dargestellt. Veränderungen wurden in Prozent berechnet.ErgebnisseIn Ostdeutschland kam es nach 1989 zu einem Abbau der allgemeinpsychiatrischen Betten um 61% sowie der Gefangenenrate um 77% von einem zunächst höheren auf ein deutlich niedrigeres Niveau als in Westdeutschland, bevor es zu einer Angleichung der Kapazitäten kam. In beiden Teilen Deutschlands wurden Kapazitäten im Maßregelvollzug, im betreuten Wohnen und in Rehabilitationseinrichtungen aufgebaut. Die Unterbringungsraten in Allgemeinpsychiatrien lagen bei beidseits steigender Tendenz in alten Bundesländern um den Faktor 3,3 höher als in den neuen Bundesländern.SchlussfolgerungEine Angleichung bezüglich der Art und Häufigkeit von Institutionalisierung vollzog sich zwischen Ost- und Westdeutschland innerhalb weniger Jahre. Deutliche Unterschiede bestehen weiter in der Rate von Zwangsunterbringungen.SummaryObjectivesThe aim of this study is to compare the historic development of indicators of institutionalized care for the mentally ill in East and West Germany since the political change of 1989.MethodsData on numbers of psychiatric beds, prison populations, the occupancy in forensic psychiatric institutions, in rehabilitation services, in supported housing units and involuntary admission rates are presented in historic time lines. Changes were calculated as a percentage.ResultsAfter 1989 general psychiatric bed numbers decreased by 61% and the prison population by 77% in East Germany both from initially higher to then lower rates than in West Germany. Since 1993 there has been an approximation of the numbers in East and West Germany. In both parts of Germany the forensic psychiatric bed numbers, supported housing and rehabilitation capacities have increased. Involuntary admission rates into general psychiatry are on the increase in both parts of Germany. They continue to be 3.3 times higher in West Germany than in East Germany.ConclusionThe harmonization of capacities in mental health care institutions between both parts of Germany was realized within a few years after reunification. Continuous differences remain regarding the involuntary admission rates.

Psychisch Kranke in Ost- und Westdeutschland@@@People with mental disorders in East and West Germany: Indikatoren der Institutionalisierung seit der politischen Wende@@@Indicators of institutionalized care since reunification

OBJECTIVES The aim of this study is to compare the historic development of indicators of institutionalized care for the mentally ill in East and West Germany since the political change of 1989. METHODS Data on numbers of psychiatric beds, prison populations, the occupancy in forensic psychiatric institutions, in rehabilitation services, in supported housing units and involuntary admission rates are presented in historic time lines. Changes were calculated as a percentage. RESULTS After 1989 general psychiatric bed numbers decreased by 61% and the prison population by 77% in East Germany both from initially higher to then lower rates than in West Germany. Since 1993 there has been an approximation of the numbers in East and West Germany. In both parts of Germany the forensic psychiatric bed numbers, supported housing and rehabilitation capacities have increased. Involuntary admission rates into general psychiatry are on the increase in both parts of Germany. They continue to be 3.3 times higher in West Germany than in East Germany. CONCLUSION The harmonization of capacities in mental health care institutions between both parts of Germany was realized within a few years after reunification. Continuous differences remain regarding the involuntary admission rates.ZusammenfassungHintergrundDie Arbeit beschreibt die Entwicklung von Indikatoren der Institutionalisierung psychisch Kranker vergleichend zwischen den alten und neuen Bundesländern seit der politischen Wende.Material und MethodenPsychiatrische Bettenzahlen, Gefangenenraten, die Belegung im Maßregelvollzug, in der stationären Rehabilitation, im stationär betreuten Wohnen und die Raten von Zwangsunterbringungen werden in historischen Zeitreihen dargestellt. Veränderungen wurden in Prozent berechnet.ErgebnisseIn Ostdeutschland kam es nach 1989 zu einem Abbau der allgemeinpsychiatrischen Betten um 61% sowie der Gefangenenrate um 77% von einem zunächst höheren auf ein deutlich niedrigeres Niveau als in Westdeutschland, bevor es zu einer Angleichung der Kapazitäten kam. In beiden Teilen Deutschlands wurden Kapazitäten im Maßregelvollzug, im betreuten Wohnen und in Rehabilitationseinrichtungen aufgebaut. Die Unterbringungsraten in Allgemeinpsychiatrien lagen bei beidseits steigender Tendenz in alten Bundesländern um den Faktor 3,3 höher als in den neuen Bundesländern.SchlussfolgerungEine Angleichung bezüglich der Art und Häufigkeit von Institutionalisierung vollzog sich zwischen Ost- und Westdeutschland innerhalb weniger Jahre. Deutliche Unterschiede bestehen weiter in der Rate von Zwangsunterbringungen.SummaryObjectivesThe aim of this study is to compare the historic development of indicators of institutionalized care for the mentally ill in East and West Germany since the political change of 1989.MethodsData on numbers of psychiatric beds, prison populations, the occupancy in forensic psychiatric institutions, in rehabilitation services, in supported housing units and involuntary admission rates are presented in historic time lines. Changes were calculated as a percentage.ResultsAfter 1989 general psychiatric bed numbers decreased by 61% and the prison population by 77% in East Germany both from initially higher to then lower rates than in West Germany. Since 1993 there has been an approximation of the numbers in East and West Germany. In both parts of Germany the forensic psychiatric bed numbers, supported housing and rehabilitation capacities have increased. Involuntary admission rates into general psychiatry are on the increase in both parts of Germany. They continue to be 3.3 times higher in West Germany than in East Germany.ConclusionThe harmonization of capacities in mental health care institutions between both parts of Germany was realized within a few years after reunification. Continuous differences remain regarding the involuntary admission rates.