Indicators of psychiatric institutionalization in Southeast Asia between 1990 and 2024.

Background: This study aimed to assess indicators of psychiatric institutionalization and their changes over time across the Southeast Asia Region (SEAR). Methods: We collected numbers of psychiatric beds, specialized forensic psychiatric beds, beds in residential facilities for people living with chronic mental illness and prison populations in the 11 SEAR member states between 1990 and 2024 using primary and secondary data sources. We calculated median rates per 100,000 population, as well as percent changes of the median rates between the first and last available data points. We also compared findings in SEAR with OECD countries. Findings: Psychiatric bed numbers and prison population were available from 10 countries. Bed prevalence increased in seven countries, but decreased in three. The median psychiatric bed prevalence was 1.5 at the first and 2.9 per 100,000 population at the last data point (+94%). The prison population increased in nine countries, with the median rate changing from 60 to 123 (+106%). Data on specialized forensic psychiatric beds were available from seven countries, with a range of 0.0-0.5 beds at the last data point. Based on data from five countries, the median prevalence of beds in residential facilities increased from 1.3 to 2.3. Psychiatric bed prevalence was on average about 5% of that in the OECD, while prison population rates were similar to those in OECD countries. Interpretation: Psychiatric bed provision in the SEAR is among the lowest worldwide. In contrast, incarceration rates are similar to those in high-income regions. Most countries have increased the prevalence of psychiatric beds over the past three decades, but they remain scarce, and further investments need consideration. Funding: Agencia Nacional de Investigación y Desarrollo (ANID), Chile.