Supply or Demand? The Expansion of Mental Asylums in Norrland 1900-1960

Glenn Sandström, Centre for Demographic and Ageing Research (CEDAR), Umeå University
Liselotte Eriksson, Umeå University
Johan Junkka, Centre for Demographic and Ageing Research (CEDAR), Umeå University
Lotta Vikström, Centre for Demographic and Ageing Research (CEDAR), Umeå University

Mental disorders account for one of the largest and fastest growing categories of the burden of disease worldwide. However, already in the late nineteenth century, mental illness became recognized as a problem of national importance on both sides of the Atlantic. Before the introduction of psychiatric medicine in the 1950’s, the major treatment of mental illness available was institutionalization in a mental care institution. During the period 1900-1959 in all western countries, the establishment of asylums for those with mental illness and physical and intellectual disabilities were unprecedented along with admissions. Despite this, the underlying factors to the selection of some mentally ill individuals into institutions are unclear, since previous studies mainly have relied on data of already confined individuals. By employing longitudinal micro data from Northern Sweden during the period 1900-1959, the aim of this study is to investigate factors contributing to the selection of the mentally ill into institutions. Our research design helps examining whether supply-side factors such as population growth and distance to institutions, along with demand-side factors such as family networks, created the conditions in which asylum admissions increased and varied over time. The results based on event history analysis indicate that both supply and demand factors played a role in explaining the institutionalization of the mentally ill. We find a significant association between confinement and the supply of beds over the period and as similar to previous research, the proximity or ‘knowledge’ of asylums increased the probability for mentally ill to become institutionalized. Before the expansion of the mental care system, the institutionalization was a driven by the demand of the family. When the supply of institutional care excessed the family-driven demand, the relative increase in institutionalization of individuals without families became greater.

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 Presented in Session 86. Health, Medicine and Body