Types of Psychiatric Beds and Mental Health Services in 16 Latin American Countries, 1990-2020

OBJECTIVE

Latin America has undergone major changes in psychiatric services over the past three decades. The authors aimed to assess the availability of service data and changes in psychiatric services in this region during the 1990-2020 period.

METHODS

The authors formed a research network to collect data on psychiatric service indicators gathered between 1990 and 2020 from national registries in Argentina, Bolivia, Brazil, Chile, Colombia, Costa Rica, Dominican Republic, Ecuador, El Salvador, Guatemala, Honduras, Mexico, Panama, Paraguay, Peru, and Uruguay. Indicators included psychiatric beds in psychiatric and general hospitals overall, for children and adolescents, and for forensic populations; residential beds for substance use treatment; treatment slots in residential facilities and day hospitals; and outpatient facilities.

RESULTS

Data availability varied among countries, service indicators, and time points. The median prevalence of psychiatric beds decreased in psychiatric hospitals from 5.1 to 3.0 per 100,000 people (-42%) and in general hospitals from 1.0 to 0.8 (-24%). The median prevalence estimates of specialized psychiatric beds for children and adolescents (0.18) and for forensic populations (0.04) remained unchanged. Increases in prevalence were observed for residential beds for substance use treatment (from 0.40 to 0.57, 43% increase), available treatment slots in residential facilities (0.67 to 0.79, 17%), treatment slots in day hospitals (0.41 to 0.54, 32%), and outpatient facilities (0.39 to 0.93, 138%).

CONCLUSIONS

The findings indicate that treatment capacity shifted from inpatient to outpatient and community care. Most countries had a bed shortage for acute psychiatric care, especially for children and adolescents and forensic patients. More comprehensive and standardized mental health service registries are needed.

Hospitalization of patients with schizophrenic and affective disorders in Israel in the aftermath of the structural and rehabilitation reforms

Background

In the last decade (2001–2010) the Ministry of Health implemented two major inter-related reforms: a ’structural reform’ to reduce the number of psychiatric beds and the ’Rehabilitation of the Mentally Disabled in the Community Law’, which allocated funds for a variety of residential and vocational programs in the community for these patients. The objective of the present paper was to examine the impact of the two reforms on the hospitalization of schizophrenic and affective disorder patients by tracking the patterns of their inpatient care during the last decade.

Methods

Data on all psychiatric admissions during the period 1990–2011 were extracted from the Israel Psychiatric Case Register to examine changes in the rate of admissions, length of hospitalizations, total inpatient days and tenure in the community. The analysis was done separately for first-in-life vs. all admissions and for patients with schizophrenia vs. patients with affective disorders.

Results

From 2006 onward, with no decrease in the number the beds, the number of inpatient days for first-in-life patients with schizophrenia decreased by 29%, their admission rates dropped by 22%, the proportion of short [< 30 days] first in life episodes went up, while the percentage of those whose first in life episode lasted more than one year went down from 2.5% to 0.5%. The parallel results for patients with affective disorders were much less significant.

Conclusions

An increasing percentage of patients with schizophrenia are not admitted to psychiatric wards at all and an increasing percentage of those who are admitted are treated during a shorter episode. The change is probably due to the rehabilitation reform which enabled the structural reform (the reduction in beds) to be implemented effectively.