About 80 years ago, Penrose proposed an inverse relationship between the relative number of psychiatric beds available to a population and its total number of prisoners, based on calculations from cross-sectional study of 18 countries.1 The subsequent drive for deinstitutionalisation that has dominated policy decisions in many countries for over half a century has provided a convenient natural experiment to test Penrose's hypothesis. In a large multinational cross-sectional study in 20042 no association was demonstrated, supporting other work from the USA3 and Scandinavia.4 Recently macroeconomic factors have been suggested as more potent drivers of the relative sizes of psychiatric hospitals and prisons. However, none of the published studies have thus far sufficiently disproved Penrose's direct inverse association theory.
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