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.