Changes in the provision of psychiatric beds and incarceration in the Eastern Mediterranean Region from 1990 to 2022

Adrian P Mundt^1,2*Mohammad Akbar Paiman³Heyam Dalky⁴Joseph El-Khoury⁵Suhaila Ghuloum⁶Sabine Delhey Langerfeldt¹Feten Fekih-Romdhane^7,8Medhat Elsabbahy⁹Mohammad Marie¹⁰Maan Saleh¹¹Stefan Priebe¹²Enzo Rozas-Serri^13,2

• ¹Faculty of Medicine, Diego Portales University, Santiago, Chile
• ²Clínica Alemana, Universidad del Desarrollo, Santiago, Santiago Metropolitan Region (RM), Chile
• ³Ministry of Public Health, Kabul, Afghanistan
• ⁴Faculty of Nursing/WHO Collaborating Center, Jordan University of Science and Technology, Irbid, Jordan
• ⁵Department of Psychiatry, American University of Beirut Medical Center, Beirut, Lebanon
• ⁶Mental Health Services, Hamad Medical Corportation, Doha, Qatar
• ⁷Faculty of Medicine, Tunis El Manar University, Tunis, Tunis, Tunisia
• ⁸Hôpital Razi, Manouba, Tunisia
• ⁹Gulf Medical University, Ajman, Ajman, United Arab Emirates
• ¹⁰Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
• ¹¹Department of Psychiatry, College of Medicine, Imam Abdulrahman Bin Faisal University, Damam, Saudi Arabia
• ¹²Centre for Mental Health Research, City St. George’s, University of London, London, United Kingdom
• ¹³Department of Psychiatry and Mental Health, Clinical Hospital of the University of Chile, Santiago, Santiago Metropolitan Region (RM), Chile

Background: Psychiatric bed numbers (general, forensic, and residential) and prison populations are considered indicators of institutionalization. The present study aimed to assess trends in institutional mental health care and incarceration, measured through psychiatric bed availability and prison population rates, across the Eastern Mediterranean Region (EMR) from 1990 to 2022.Methods: We obtained retrospective data on psychiatric bed numbers and prison populations from 22 countries between 1990 and 2022. Prevalence per 100,000 population, the median prevalence and percentage changes between the first and last data points were calculated.Findings: Primary data were retrieved from 10 out of 22 countries. Data from secondary sources were used for the remaining 12 countries. In Libya and Somalia, primary data were only available for the prison populations. The median prevalence of psychiatric beds decreased from 8.8 to 5.8 per 100,000 population (-35%) between 1990 and 2022. An increase from 0.2 to 0.4 in forensic psychiatric beds was observed. The prevalence of beds in residential facilities was available from seven countries, two of which did not have beds between 1990 and 2022. The median rates increased from 0.1 to 0.2 between 1990 and 2022. The median prison population also increased from 86.9 to 108.0 per 100,000 people (+24%).Interpretation: EMR countries showed, on average, a reduction in the prevalence of psychiatric beds from low numbers, while more people were imprisoned over the past three decades. The availability of forensic psychiatric beds and residential facilities has remained limited. These findings suggest a gradual shift in the EMR from institutional psychiatric care toward increased reliance on incarceration, paralleling trends observed in other global regions like Latin America and Central Eastern Europe and Central Asia.