[Bernard Harcourt, guest-blogging, April 30, 2007 at 9:15pm] Trackbacks
Mental Hospitalization and Prison Rates in Western Europe:

In response to my first blog entry here, some readers asked how the rates of institutionalization in the United States compare to Western Europe. There is no doubt that the graph of institutionalization over the twentieth century immediately raises the question whether Western or industrialized countries with currently low prison populations use their mental health systems as an alternative form of social control.

One reader, for instance, notes: "Our high rate of penal imprisonment is widely-cited, but your study makes me wonder whether that's a fair picture. How do US rates of total institutionalization compare to the world? I suspect (given how we've dismantled mental health infrastructure), that we're somewhat closer to the rest of the industrialized world."

I was curious about that too and did a bit of research -- and plan on doing a lot more. I discuss it in the conclusion of the study here.

My preliminary findings are interesting and suggest that these suspicions are not entirely off the mark, though not exactly right either.

Among countries in the European Union, the highest rate regarding the number of beds in psychiatric hospitals per 100,000 inhabitants in 2000 was in the Netherlands, which had a rate of 188.5. Other highs were posted in Belgium (161.6), Switzerland (119.9), France (113), and Finland (102.9). The average for the 25 European Union countries in 2000 was 90.1, down from 115.5 in 1993.

These figures are, indeed, higher than the corresponding prison rates for the same countries, which stood in 2006 at 128 per 100,000 persons in the Netherlands, 91 in Belgium, 83 in Switzerland, 85 in France, and 75 in Finland. But they certainly do not come close to the rates of aggregated institutionalization in the United States.

These are preliminary findings, and I obviously need to conduct more research on these comparative figures. There is one country, though, that may offer some competition to the United States -- strangely reminiscent of the Cold War era. The Russian Federation has a prison rate of 611 per 100,000, which, when combined with mental health institutionalization, may begin to get close to our institutionalization rates.

On a related issue, there is evidence that in the past some European countries used institutions other than the prison more than they do now to control those deemed deviant—in other words, that the trends identified in the United States may bear some resemblance to trends in Europe.

The Republic of Ireland, for example, had much higher rates of institutionalization in a wide range of facilities, including psychiatric institutions and homes for unmarried mothers, at mid-century—in fact, eight times higher—than at the turn of the twentieth century. Eoin O'Sullivan and Ian O'Donnell have an interesting new paper on that in Punishment & Society. It's called "Coercive confinement in the Republic of Ireland: The waning of a culture of control," and it's in Volume 9(1) at 27-48 (2006).

In Belgium, the number of psychiatric hospital beds per 100,000 inhabitants fell from 275 in 1970 to 162 in 2000; in France, it fell from 242 in 1980 to 111 in 2000; in the UK, from 250 in 1985 to 100 in 1998; and in Switzerland, from 300 in 1970 to 120 in 2000. Again, this requires more research, but there may be a parallel here in terms of the rise and fall of mental health rates.

So overall, important differences, but some parallels. Apart from Russia, though, the numbers should not be much comfort for the United States.

great unknown (mail):
Have you compensated for the number of people incarcerated for minor drug "crimes"? In most European countries, that would be about 0 per 100,000. In the US, it is a significant percentage of the prison population.
4.30.2007 10:32pm
Stephen C. Carlson (www):
What are the US numbers for relevant time periods? If they're found somewhere maybe they can be added to the post?
4.30.2007 11:00pm
Freddy Hill:
As Great Unknown says, "consumer side" drug offenses do not result in incarceration in most of Western Europe, if they are offenses at all. I believe that DWI DUI-type offenses are another major difference. While drunk-driving laws have become very strict in Western Europe in terms of thresholds, I don't think people go to jail for driving under the influence, not even repeat offenders, not even for the night.

But I wonder if the differences in rates of internment have more to do with the way jail time is accounted for in Europe vs. America. Could it be that preventive, county jail-type of internment is counted in US statistics but not in Europe? One data point I remember reading -- that about 30% of young males aged 18-34 in the UK have seen the inside of a jail (I don't remember the exact numbers, I'm just quoting from my faulty memory)-- does not seem to support the much lower levels of internment in the UK.
4.30.2007 11:39pm
A. Zarkov (mail):
Did you include race in your analysis of institutionalization? For example how does the white rate (non-Hispanic) of institutionalization in the US compare to the white rates in Europe? It seems to me that until you do this, you have left out an important confounding variable?
5.1.2007 12:06am
gattsuru (mail) (www):
I'd be more interested in seeing data relating crime rates to rates of imprisonment and recidivism, particularly in countries where imprisonment tends to be in jail rather than criminal charges.

For example, the United Kingdom appears to imprison only a sixth of the percentage of the populace that the United States do, if I'm reading this data correctly. However, this seems contradictory with the United Kingdom's vastly higher rates of crime. Even giving fairly heavy time commitments for murder and very light punishments for forms of crime more common in the United Kingdom, and assuming half of US prisoners are in for non-violent crime and zero percent of the United Kingdom's are, this doesn't close the discrepancy.
That suggests that either individuals in the United Kingdom are more likely to commit enough severe crimes in one sitting to severely mess with the imprisonment values (not supported by data), that those who commit crimes are not likely to be punished, or that violent offenders are back on the streets much faster.
5.1.2007 12:39am
George Weiss:
1. the other day on dr helen's blog ( was a review of the incarceration of the mentally ill hypothesis...the idea that our prisons are teeming with those who are mentally ill.

the review analyzes 8 studies that are published and two unpublished studies...all with wildly disparate findings about the rate of mental illness in our prison systems.

the conclusion of the study is that the hypothesis that we are just filling our prisons with the people from de-institutionalization...has little support.

she links to this review of the literature..with a link to a full text of the review:

2. even if your right that more people are now loose on the street and violent and dangerous (and shooting people) because of de-institutionalization....and if your going to use this as a major factor contibuting to the tradagy at must also realize that what happened at VT at a university...and a policy problem for that university and universitys nationwide...perhapps more so than the question of de-instituionalization is for the rest of america.

what i mean is as i have said to many others:
there really are no concrete rules a university has to or can follow... there are just..lawsuits...lawsuits when the university kicks people out..and lawsuits when they don't and something happens.

contrast the incident at VT with the one at GW not too long ago where a kid was thrown out of school...just for getting a voluntary hospitalization.

so my position all along has been that there should be legislative guidance. If you go to a doctor and he butchers can win a suit if he hasn't acted reasonably according to loose if he has..even if he make you a vegetable.

why shouldn't it be the same for mental health at university? why shouldn't there be concrete guidance by which the universities act. they act one way if the facts are such (maybe hes just depressed) they act another if the facts are another way (he is suicidal)..they act a third way if hes obsessed with guns...if hes stable or on medication that might be a consideration etc..)

unfortunately...thats kinda similar to asking why doesn't congress adress the coke/crack discrepancy in sentencing..

the issue is a loose politically..nobody wants to touch it...nobody wants to LOWER drug penalties..even if its to make them fair with other drug penalties...and nobody wants to be responsible for the law that caused a massacre..or a unfortunate premature university dismissal.

its much easier for the state or federal legislatures to debate gay marriage..and let the lawyers and courts litigate the issue to death using laws that only tangentially discuss the issue

i understand there cant be a rulebook to tell you how to move in every situation.

but there can be rules that tell you not to throw the GW guy out simply for just seeking treatment and nothing else.
and there can be rules requiring either counseling or expulsion (if counseling refused) for someone who had a court document saying he was a danger to self or others (like the VT shooter had)

in many cases..even rules that are controversial...and even arbitrary compromises are better than no rules at all.

of course..i realize some people might feel differently...but let me tell you what i do know..anyone who says that the Americans with disability act permits this regarding students with mental problems or prohibits stretching the truth..federal and state courts are very far from deciding whats what...partly because these cases are settled before trial..or just end at trial..never getting to the appeal stage where case president is set.

3. even if you get past my first and second point you then have the issue of how much you want to risk going back to the problems of institutionalization (cost..due process/one flew over the coo coos nest-husbands committing wives they dont like etc..)

of understand number 3...but in order to even get to those issues you also have to get past 1 and 2...which im not sure youve even thought about
5.1.2007 12:40am
Eli Rabett (www):
One would expect a large decrease in hospitalizations from the 1970s with the development of drugs that can be used to treat psychiatric disorders. You need to control for that.
5.1.2007 1:10am
Clayton E. Cramer (mail) (www):

One would expect a large decrease in hospitalizations from the 1970s with the development of drugs that can be used to treat psychiatric disorders. You need to control for that.
Actually, the big surge would have been in the late 1950s, when chlorpromazine starts to be used. But even then, the various medications for treating psychosis aren't cures. A psychotic who talks taking his or her medicine will, in a few months, be delusionary again. They may end up back in the hospital, or they may be running amok at your local shopping mall.
5.1.2007 8:18pm
Clayton E. Cramer (mail) (www):

even if you get past my first and second point you then have the issue of how much you want to risk going back to the problems of institutionalization (cost..due process/one flew over the coo coos nest-husbands committing wives they dont like etc..)
There was a real problem with this, but One Flew Over the Cuckoo's Nest is an example of how fiction becomes more important than reality to judges and legislators.
5.1.2007 8:20pm