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Research ArticleRegular Articles

Treatment of Mentally Ill Offenders in Nine Developing Latin American Countries

Santiago Almanzar, Craig L. Katz and Bruce Harry
Journal of the American Academy of Psychiatry and the Law Online September 2015, 43 (3) 340-349;
Santiago Almanzar
Dr. Almanzar is affiliated with the Clarion Psychiatric Center, Universal Health Services, Clarion, PA. Dr. Harry is Director of the Forensic Psychiatry Fellowship Program and Associate Professor of Clinical Psychiatry, University of Missouri School of Medicine, Columbia, MO. Dr. Katz is Associate Clinical Professor of Psychiatry and Medical Education and Director of the Program in Global Mental Health, Icahn School of Medicine, Mount Sinai Medical Center, New York, NY. Dr. Almanzar completed this work while a Fellow in Forensic Psychiatry, University of Missouri School of Medicine, Columbia, MO.
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Craig L. Katz
Dr. Almanzar is affiliated with the Clarion Psychiatric Center, Universal Health Services, Clarion, PA. Dr. Harry is Director of the Forensic Psychiatry Fellowship Program and Associate Professor of Clinical Psychiatry, University of Missouri School of Medicine, Columbia, MO. Dr. Katz is Associate Clinical Professor of Psychiatry and Medical Education and Director of the Program in Global Mental Health, Icahn School of Medicine, Mount Sinai Medical Center, New York, NY. Dr. Almanzar completed this work while a Fellow in Forensic Psychiatry, University of Missouri School of Medicine, Columbia, MO.
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Bruce Harry
Dr. Almanzar is affiliated with the Clarion Psychiatric Center, Universal Health Services, Clarion, PA. Dr. Harry is Director of the Forensic Psychiatry Fellowship Program and Associate Professor of Clinical Psychiatry, University of Missouri School of Medicine, Columbia, MO. Dr. Katz is Associate Clinical Professor of Psychiatry and Medical Education and Director of the Program in Global Mental Health, Icahn School of Medicine, Mount Sinai Medical Center, New York, NY. Dr. Almanzar completed this work while a Fellow in Forensic Psychiatry, University of Missouri School of Medicine, Columbia, MO.
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    Table 1

    Demographic Information of the Latin American Countries

    El SalvadorPanamaCosta RicaUruguayBrazilThe Dominican RepublicPeruMexicoArgentina
    Population3,336,134,0003,571,1854,726,5753,368,595199,800,00010,056,18129,399,817120,286,65542,192,500
    Legal system33Common/civilCivilCivilCivilCivilCivil/commonCivilCommon/civilCivil
    Total prisoner population726,79614,17014,9639,829548,00324,98667,597246,33462,263
    Incarceration rate per 100,0007424383314289274247220212149
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    Table 2

    Incarceration Rate and Estimated Number of Psychiatrists and Forensic Beds per 100,000 People in Latin American and Other countries

    Region or countryIncarceration rate per 100,000 peopleForensic beds per 100,000 peoplePsychiatrists per 100,000 people
    Central America and Mexico281 (7)0.5 (8)1.5 (8)
    South American countries202 (7)1.6 (8)2.9 (8)
    The United States707 (7)14.1 (34)14.1 (35)
    Canada118 (7)6.1 (36)15.8 (35)
    Spain144 (7)1.5 (37)10.5 (35)
    England149 (7)1.8 (37)19.5 (35)
    Germany78 (7)7.8 (37)20.9 (35)
    The Netherlands75 (7)11.4 (37)20.5 (35)
    Sweden60 (7)14.3 (37)22 (35)
    • The numbers in parentheses in the data columns are reference citations.

    • View popup
    Table 3

    Mental Health and Forensic Mental Health Services Available in the Latin American Countries and Their Expenditures on Mental Health

    Services and Budget8El SalvadorPanamaCosta RicaUruguayBrazilThe Dominican RepublicPeruMexicoArgentina
    Percentage of health budget devoted to mental health1%2.9%2.9%7%2.35%0.4%3%2%2%
    Number of psychiatric hospitals2122228134629
    Number of forensic hospitals0010*31†002‡2§
    Number of forensic beds40001913,6770421,096150
    Forensic service within prisonNoNoNoNoNoNoNoYesNo
    Police officers who received mental health education in the last 5 years (%)1–2051–8021–501–20001–201–201–20
    Judges and lawyers who received mental health education in the last 5 years (%)1–201–2021–501–201–201–201–201–201–50
    • ↵* Direct communication with Dr. Fernanda Porteiro, 2014.

    • ↵† Direct communication with Dr. J. G. V. Taborda, 2014.

    • ↵‡ Direct communication with Dr. Carlos Isaac, 2014.

    • ↵§ Direct communication with Dr. J. O. Folino, 2014.

    • View popup
    Table 4

    Estimated Occupancy and Conditions of Prisons in the Latin American and Developed Countries

    Region or countryOccupancy rate, based on official capacity (%)6,7Prison Conditions7,32
    El Salvador320.3Overcrowding is a serious threat to prisoners' health and lives. In many facilities, provisions for sanitation, potable water, ventilation, temperature, medical care, and lighting are inadequate.
    Panama172.5Prison conditions remain harsh and, in some cases, life threatening. Problems include overcrowding and inadequate health care.
    Costa Rica117.0Prison conditions are harsh. Overcrowding, inadequate sanitation, difficulties obtaining medical care, and violence among prisoners remain serious problems in some prison facilities.
    Uruguay119.9Prison and detention center conditions continue to be harsh and life threatening in some facilities. Increased crime and high recidivism (60%) rates contribute, as well as excessive use of force and solitary confinement as disciplinary measures and inadequate medical attention.
    Brazil171.9Conditions in many prisons are poor and sometimes life threatening, though many states have made efforts to improve conditions. Abuse by prison guards continues to occur at many facilities.
    The Dominican Republic174.0Prison conditions range from fair to extremely harsh. Threats to life and health include communicable diseases, poor sanitation, poor access to health services, a lack of well-trained prison guards, and prisoner-on-prisoner brutality.
    Peru218.9Prison conditions remain harsh for most of the country's inmates. Overcrowding, poor sanitation, inadequate nutrition and health care, and corruption among guards are serious problems. Basic medical care is available at most prisons, but there is a shortage of doctors.
    Mexico126.3Treatment and physical conditions in prisons and detention centers are often harsh and life threatening, most notably in state-level prisons. Overcrowding, prisoner abuse, and alcohol and drug addiction are prevalent in most facilities.
    Argentina101.6Inmates in many facilities suffer from extreme overcrowding, poor nutrition, inadequate medical and psychological treatment, inadequate sanitation, limited visits from family, and frequent degrading treatment, according to various reports by human rights organizations and research centers.
    The United States99.0Prison and detention center conditions mostly meet international standards.
    Canada6,796.4Prison and detention center conditions mostly meet international standards.
    Spain6,788.0Prison and detention center conditions mostly meet international standards.
    England6,7111.6Prison and detention center conditions mostly meet international standards.
    Germany6,781.8Prison and detention center conditions mostly meet international standards.
    The Netherlands6,777.0Prison and detention center conditions mostly meet international standards.
    Sweden6,786.3Prison and detention center conditions mostly meet international standards.
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Journal of the American Academy of Psychiatry and the Law Online: 43 (3)
Journal of the American Academy of Psychiatry and the Law Online
Vol. 43, Issue 3
1 Sep 2015
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Treatment of Mentally Ill Offenders in Nine Developing Latin American Countries
Santiago Almanzar, Craig L. Katz, Bruce Harry
Journal of the American Academy of Psychiatry and the Law Online Sep 2015, 43 (3) 340-349;

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Santiago Almanzar, Craig L. Katz, Bruce Harry
Journal of the American Academy of Psychiatry and the Law Online Sep 2015, 43 (3) 340-349;
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