Browsing by Author "Mundt, Adrián"
Now showing 1 - 5 of 5
Results Per Page
Sort Options
Item Changes in rates of psychiatric beds and prison populations in sub-Saharan Africa from 1990 to 2020(2022) Delhey, Sabine; Mundt, Adrián; Jabulanis, Maphisa; Sourabié, Oumar; Nguendo, Blaise; Rozas, Enzo; Bukasa, Jean; H Te, Jeronimo; Bitta, Mary; Mathe, Lipalesa; Liwimbi, Olive; Fortunato, Palmira; Atilola, Olayinka; Jansen, Stefan; Diegane, Jean; Akran, Clementina; Jalloh, Abdul; Kagee, Ashraf; Van Wyk, Elizabeth; Forry, Jimmy; Liamunga, Mwiya; Chigiji, Handrick; Priebe, StefanBackground: Psychiatric bed numbers (general, forensic, and residential) and prison populations have been considered indicators of institutionalization. The present study aimed to assess changes of those indicators across sub-Saharan Africa (SSA) from 1990 to 2020. Methods: We retrospectively obtained data on psychiatric bed numbers and prison populations from 46 countries in SSA between 1990 and 2020. Mean and median rates, as well as percentage changes between first and last data points were calculated for all of SSA and for groups of countries based on income levels. Results: Primary data were retrieved from 17 out of 48 countries. Data from secondary sources were used for 29 countries. From two countries, data were unavailable. The median rate of psychiatric beds decreased from 3.0 to 2.2 per 100 000 population (median percentage change = -16.1%) between 1990 and 2020. Beds in forensic and residential facilities were nonexistent in most countries of SSA in 2020, and no trend for building those capacities was detected. The median prison population rate also decreased from 77.8 to 71.0 per 100 000 population (-7.8%). There were lower rates of psychiatric beds and prison populations in low-income and lower-middle income countries compared with upper-middle income countries. Conclusions: SSA countries showed, on average, a reduction of psychiatric bed rates from already very low levels, which may correspond to a crisis in acute psychiatric care. Psychiatric bed rates were, on average, about one twenty-fifth of countries in the Organization for Economic Co-operation and Development (OECD), while prison population rates were similar. The heterogeneity of trends among SSA countries over the last three decades indicates that developments in the region may not have been based on coordinated policies and reflects unique circumstances faced by the individual countries.Item Expert Arguments for Trends of Psychiatric Bed Numbers: A Systematic Review of Qualitative Data(2021) Mundt, Adrián; Delhey Langerfeldt, Sabine; Rozas Serri, Enzo; Siebenförcher, Mathias; Priebe, StefanIntroduction: Mental health policies have encouraged removals of psychiatric beds in many countries. It is under debate whether to continue those trends. We conducted a systematic review of expert arguments for trends of psychiatric bed numbers. Methods: We searched seven electronic databases and screened 15,479 papers to identify expert opinions, arguments and recommendations for trends of psychiatric bed numbers, published until December 2020. Data were synthesized using thematic analysis and classified into arguments to maintain or increase numbers and to reduce numbers. Results: One hundred six publications from 25 countries were included. The most common themes arguing for reductions of psychiatric bed numbers were inadequate use of inpatient care, better integration of care and better use of community care. Arguments to maintain or increase bed numbers included high demand of psychiatric beds, high occupancy rates, increasing admission rates, criminalization of mentally ill, lack of community care and inadequately short length of stay. Cost effectiveness and quality of care were used as arguments for increase or decrease. Conclusions: The expert arguments presented here may guide and focus future debate on the required psychiatric bed numbers. The recommendations may help policymakers to define targets for psychiatric bed numbers. Arguments need careful local evaluation, especially when supporting opposite directions of trends in different contexts.Item Minimum and optimal numbers of psychiatric beds: expert consensus using a Delphi process(2022) Mundt, Adrián; Rozas, Enzo; rarrázaval, Matías; O'Reilly, Richard; Allison, Stephen; Bastiampillai, Tarun; Musisi, Seggane; Kagee, Ashraf; Golenkov, Andrei; El-Khoury, Joseph; Park, Seon-Cheol; Chwastiak, Lydia; Priebe, StefanThe required minimum number of psychiatric inpatient beds is highly debated and has substantial resource implications. The present study used the Delphi method to try to reach a global consensus on the minimum and optimal psychiatric bed numbers. An international board of scientific advisors nominated the Delphi panel members. In the first round, the expert panel provided responses exploring estimate ranges for a minimum to optimal numbers of psychiatric beds and three levels of shortage. In a second round, the panel reconsidered their responses using the input from the total group to achieve consensus. The Delphi panel comprised 65 experts (42% women, 54% based in low- and middle-income countries) from 40 countries in the six regions of the World Health Organization. Sixty psychiatric beds per 100 000 population were considered optimal and 30 the minimum, whilst 25-30 was regarded as mild, 15-25 as moderate, and less than 15 as severe shortage. This is the first expert consensus on minimum and optimal bed numbers involving experts from HICs and LMICs. Many high-income countries have psychiatric bed numbers that fall within the recommended range. In contrast, the number of beds in many LMIC is below the minimum recommended rate.Item The prevalence of comorbid serious mental illnesses and substance use disorders in prison populations: a systematic review and meta-analysis(2022) Mundt, Adrián; Baranyi, Gergő; Fazel, Seena; Delhey, SabineSummary Background Comorbid mental illnesses and substance use disorders are associated with adverse criminal, social, and health outcomes. Yet, their burden is not reliably known among prison populations. We therefore aimed to estimate the prevalence of comorbid serious mental illnesses and substance use disorders (dual disorders) among people in prison worldwide. Methods In this systematic review and meta-analysis, we searched 15 electronic databases (ASSIA, CAB Abstracts, Criminal Justice Database, Embase, Global Health, Global Index Medicus, IBSS, MEDLINE, NCJRS, PAIS Index, PsycINFO, Russian Science Citation Index, Scielo, Social Services Abstracts, and Web of Science) and the grey literature (Open Grey and ProQuest Dissertations & Theses Global) for studies reporting the prevalence of serious mental illnesses and substance use disorders in prison populations published between Jan 1, 1980, and Sept 25, 2021, and contacted the authors of relevant studies. Empirical studies among unselected adult prison populations that applied representative sampling strategies and validated diagnostic instruments, and either reported the prevalence of dual disorders or had authors who could provide prevalence data in correspondence, were included. Two reviewers(GB and SDL) independently extracted data from the eligible studies; both current (up to 1 year) and lifetimeprevalence were extracted, if available. We sought summary estimates. Our primary outcomes were comorbid nonaffective psychosis with substance use disorders and comorbid major depression with substance use disorders. Weconducted a random-effects meta-analysis, explored between-sample heterogeneity with meta-regression, andcalculated odds ratios (ORs) to assess bidirectional relationships between mental and substance use disorders. Risk ofbias was assessed by use of a standard tool. The study protocol was registered with PROSPERO, CRD42020207301Item The story behind Chile’s rapid rollout of COVID-19 vaccination(2021) Aguilera, Ximena; Mundt, Adrián; Araos, Rafael; Thomas, Weitzel; PublicadoSurprisingly, Chile was among the most successful nations worldwide in terms of both, vaccine availability and implementation and rollout of the vaccine program. Since vaccines currently are the most promising tool to control the pandemic, it seems appropriate to explore the reasons behind the vaccination success in Chile.