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Unit for Social and Community Psychiatry

INCAS: institutionalised care in SA


In the Caracas Declaration of the year 1990, South American countries committed themselves to psychiatric reforms. The psychiatric reforms included closures of psychiatric hospitals for long-stay patients, reductions of psychiatric bed numbers and establishing community mental health care. The intention of the reforms was better social inclusion of chronically mentally ill. Yet, there is little research evaluating the effects of the reforms. In recent years, a debate has started in Europe whether there is a trend to re-institutionalisation of mentally ill taking into account other institutions than psychiatric hospitals and whether a trans-institutionalisation of mentally ill into penal justice systems has occurred. At the same time, first prevalence studies of mental disorders in prison populations had pointed to high rates of severe mental health and substance use disorders.

Research questions

  • What are the indicators and trends of institutionalisation of mentally ill in South America?
  • What was the relationship between psychiatric bed numbers and prison population rates over the past two decades in South America?
  • What is the proportion of consecutively admitted prisoners in the metropolitan region of Santiago de Chile with mental health and substance use disorders?

Research activities

  • We assembled a research network of collaborators from six South American countries to collect data on institutionalisation of mentally ill.
  • We assessed what proportion of a sample of consecutively admitted male and female prisoners had mental health and substance use disorders.


  • There is a significant association between removals of psychiatric beds and increasing prison population rates over the past two decades in South America.


  • Prof. Stefan Priebe
  • Dr Adrian Mundt

Associated papers

Mundt AP, Chow W, Priebe S. Penrose Hypothesis in South America consistent with adding year fixed effects. JAMA Psychiatry, in press.


European Commission, FP7 People, Marie Curie International Outgoing Fellowship

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