Penrose’s Law revisited: The relationship

between mental institution beds, prison

population and crime rate
PÅL HARTVIG, ELLEN KJELSBERG

Hartvig P, Kjelsberg E. Penrose’s Law revisited: The relationship between mental institution
beds, prison population and crime rate. Nord J Psychiatry 2009;63:51
56. Oslo. ISSN 0803-
9488.

In 1939, Lionel Penrose published a cross-sectional study from 18 European countries, including
the Nordic, in which he demonstrated an inverse relationship between the number of mental
hospital beds and the number of prisoners. He also found strong negative correlations between
the number of mental hospital beds and the number of deaths attributed to murder. He argued
that by increasing the number of mental institution beds, a society could reduce serious crimes
and imprisonment rates. The aim of the study was to test Penrose’s theories longitudinally by
monitoring the capacity of all psychiatric institutions and prisons in a society over time. From
official statistics, we collected and systematized all relevant information regarding the number of
mental institution beds and prisoners in Norway during the years 1930
2004, along with major
crime statistics for the same period. During the years 1930
59, there was a 2% population-
adjusted increase in mental institution beds and a 30% decrease in the prison population. During
1960
2004, there was a 74% population-adjusted decrease in mental institution beds and a 52%
increase in the prison population. The same period saw a 500% increase in overall crime and a
900% increase in violent crimes, with a concurrent 94% increase in the size of the country’s police
force. Penrose’s law proved remarkably robust in the longitudinal perspective. As opposed to
Penrose, however, we argue that the rise in crime rates only to a very limited extent can be
attributed to mental health de-institutionalization.
’ Correctional facilities, Crime rates, De-institutionalization, Mental health institutions, Prison
inmates.

Pål Hartvig, Kompetansesenteret, Bygg 7 Gaustad, N-0320 Oslo, Norway, E-mail:

paal.hartvig@kompetanse-senteret.no; Accepted 24 June 2008.

Penrose’s Law components of Penrose’s Law in different societies, at

The British psychiatrist Lionel Penrose published in
1939 (1) a study in which he compared the number of
mental hospital beds, the prison population and the level
of serious crimes in 18 European countries. He demon-
strated a strong negative correlation, 0.62, between
the proportion of the population being incarcerated and
the proportion residing in mental institutions in any one
society. None of the countries investigated diverted
markedly from this pattern. This inverse relationship
has been coined Penrose’s Law. Penrose himself con-
cluded that the provision of facilities for mentally ill
people diminished the crime incidence and consequently
the prison population. He also offered a subsidiary
interpretation of his findings: that psychiatric and
correctional disposals are two alternative ways for
society to handle aberrant behaviour.
More recent papers (2, 3), have used more modern and
sophisticated analyses in their testing of the main
different times. Even so, they have all found the same
inverse relationship between the prison population and
the number of mental institution beds. In addition, the
Australian study (2) demonstrated that the crime level
correlated with the size of the police force. While
Penrose’s original report (1) and the Australian study
(2) both were cross-sectional, the most recent study (3)
included a longitudinal aspect as it covered the years
1982
97 in England and Wales. The inverse relationship
between the number of mental hospital beds and the
prison population was upheld also in this longitudinal
perspective.
Why revisit Penrose’s Law today?
In most societies, there is a continuous debate regarding
changes in the crime scene, crime prevention and the
role of the correctional services. Simultaneously, the

# 2009 Informa UK Ltd. (Informa Healthcare, Taylor & Francis As) DOI: 10.1080/08039480802298697
P HARTVIG, E KJELSBERG
significance of mental disorders in the prevalence of
criminal conduct is hotly debated. How large a propor-
tion of all crimes, particularly violent crimes, are
committed by mentally ill persons (4
6)? How can these
crimes be avoided? Penrose’s almost 70-year-old con-
tribution seems to offer an excellent historical perspec-
tive and a useful point of departure for the discussion of
these matters even today.
Using official statistics from Norway we wanted to
conduct a longitudinal study, from 1930 to present, in
order to test the validity of Penrose’s Law over time.
While the last half of the 19th century and the beginning
of the 20th saw a marked increase in the number of beds
in mental institutions (7, p. 28
31), there was virtually no
increase during the years 1930
60, when corrected for
the population increase (8
10). Since then, there has
been a large reduction in the number of mental institu-
tion beds in Norway, as indeed in most Western
countries (7, p. 28
31). These changes have come about
as a result of fundamental socio-economical and poli-
tical processes in the Norwegian society. Public spending
on mental health services has increased strongly during
both periods. However, during the last period of de-
institutionalization, there has been a compensatory
increase in the psychiatric outpatient services.
We wanted to use this ‘‘experiment of nature’’ to
explore the following issues:
. Is there an inverse relationship between the popula-
tion in the mental institutions and in the prisons also
in a longitudinal perspective (75 years)?
. Does this inverse relationship manifest itself in
periods characterized by an increase in, as well as in
periods characterized by a reduction in the number of
mental institution beds?
. How do changes in crime rates and the size of the
police force correlate with the capacity of the mental
institutions over the same time span?
. Penrose in his study found particularly strong corre-
lations between homicide rates and psychiatric in-
stitution capacity. Are his results upheld in a
longitudinal perspective?
As our study covered a 75-year period that saw a marked
increase in the size of the Norwegian population, we
decided to use population-adjusted figures throughout.
Methods
Information about an institution’s working capacity can
be recorded either as ‘‘beds’’, i.e. the number of indivi-
duals it can accommodate, or as ‘‘heads’’, i.e. the average
number of individuals residing in that institution over a
given period. In Norway, mental health institutions are
recorded according to the average number of beds during
the year, whereas the correctional facilities record the
52
average number of persons imprisoned in the correctional
facilities in the country during the year. As a rule,
Norwegian prisons operate at close to full capacity, 96

100%, while overcrowding is infrequent (11). As we
primarily are interested in changes over time in the
relative capacity of these two types of institutions, this
systematic difference in mode of registration would hardly
influence the results of our study.
Information regarding the total capacity of the
country’s mental health institutions was collected from
reliable sources (8
10, 12). In our estimates, we have
included all beds in mental hospitals and public and
private psychiatric nursing homes, thus defining all these
as mental institutions. For the first period in question,
1930
59, mental institution statistics were available for
some of the years only, including the first and the last
year (8
10). For the second period, 1960
2004, we were
able to obtain exact numbers for every year (9, 12).
The Norwegian Correctional Services have detailed
records regarding the prison capacity over the study
period (13, 14). Data on crime rates and serious and
violent crimes, including homicides, were collected from
Statistics Norway (15, 16). We were able to obtain exact
data from the National Police Directorate regarding the
size of the Norwegian police force during the period in
question (senior advisor PO Kvam, personal communica-
tion).
The Norwegian population increased markedly over
the period investigated, from 2.8 million in 1930 to 3.1
million in 1945, 3.6 million in 1960 and 4.6 million in
2004 (17). In our results, we have calculated population-
adjusted rates for all of the above registrations for the
various points in time.
The relationship between changes in psychiatric
institution beds and prison capacity, registered crime
and the size of the police force during the years 1960

2004, was investigated using Pearson product-moment
correlation coefficient. Preliminary analyses were per-
formed to ensure no violation of the assumptions of
normality, linearity and homoscedasticity.
Results


1930 59
In 1930, there were 11,800 beds in mental institutions in
Norway, corresponding to 42 beds per 10,000 inhabi-
tants. At the end of World War II, in 1945, the number
of beds had risen to 13,500 and in 1959 it had reached
15,500. Even so, the increase was just enough to
compensate for the increase in the country’s population:
43 beds per 10,000 inhabitants in 1959.
In 1930, the prison population was 1800, correspond-
ing to 64 incarcerated individuals per 100,000 inhabi-
tants. Fifteen years later, in 1945, the prison population
had decreased to 1700, in spite of the population
increase over the same period, resulting in a decrease
NORD J PSYCHIATRY×VOL 63 ×NO 1 ×2009
 PENROSE’S LAW

in the incarceration rate to 55 per 100,000. In 1959, the Homicide rates and the percentage of insane
prison population had decreased even further, to 1600,
corresponding to an incarceration rate of 45 prisoners
homicide perpetrators 1960 2004

The yearly average registered homicide rates per million
per 100,000 inhabitants. in Norway were as follows:
All in all, the population-adjusted number of mental
institution beds had seen a 2% increase during the . 1960
69: 3.0 (range 5
24)
period, while the corresponding incarceration rate had . 1970
79: 5.5 (range 6
32)
decreased by 30%. . 1980
89: 9.8 (range 27
62)
. 1990
99: 8.6 (range 26
50)
. 2000
04: 9.1 (range 38
48)


1960 2004
The main results are presented in Fig. 1. It depicts the This constitutes a definite increase in the homicide rate
changes over the period in population-adjusted rates of from the 1960s, parallel to the increase in violent crimes
mental institution beds (per 10,000), imprisonment rates in general. The proportion of homicides perpetrated by
(per 100,000), registered overall crime (per 1000), persons declared insane by the court has been estimated
registered violent crimes (per 10,000) and police force to be approximately 25% during the years 1960
80 (7, p.
(per 10,000). The changes seen constitute substantial 526
7) and 18% during the years 1980
96 (18, 19).
changes in the population-adjusted figures: a 74%
decline in the number of mental institution beds, a
52% increase in the prison population, a sixfold increase
in registered overall crime, a 10-fold increase in violent Discussion
crimes, and a 94% increase in the police force during the
Main findings
Penrose, in his cross-sectional study from 1939 (1),
period. In addition, there had been a 115% population-
demonstrated an inverse relationship between the num-
adjusted increase in the number of individuals sentenced
ber of mental institution beds and the number of prison
to prison during the 1960
2004 period (not shown in the
inmates in any given society. We have been able to
figure), indicating an increased turnover of prisoners.
confirm his findings also in a longitudinal perspective,
Correlation analyses identified strong, negative corre-
using official statistics from Norway covering the period
lations between the number of mental institution beds
1930
2004. This inverse relationship worked in opposite
and 1) the size of the prison population (r .82), 2)
directions in the first and the second part of the period.
the overall crime rate (r.98), 3) the violent crime
We also found strong negative correlations between the
rate (r.92) and 4) the size of the police force (r
number of mental institution beds and the number of
.94), with low number of mental institution beds
registered crimes, violent crimes, and the size of the
associated with higher numbers of prison inmates,
police force during the second period, 1960
2004.
overall and violent crime rates and police force.

Fig. 1. Line chart describing population-adjusted changes in Norway over the years 1960
2004 in the number of mental
institution beds, imprisonment rate, overall crime rate per year, violent crime rate per year and the size of the police force.

NORD J PSYCHIATRY ×VOL 63×NO 1×2009 53

P HARTVIG, E KJELSBERG
Changes in mental institution capacity; de- and
re-institutionalization
In Norway, a marked de-institutionalization of the
psychiatric health services started in the late 1960s.
This trend accelerated during the years 1980
95 with a
subsequent levelling off in more recent years. This
levelling-off parallels the findings of Priebe et al. (20),
who studied signs of re-institutionalization in six Eur-
opean countries from 1992 to 2002. They found either a
small or no increase in the total number of psychiatric
hospital beds, while there was an increase in the number
of forensic beds in all countries studied. Norway does
not have specific forensic beds. There has, however, been
a moderate increase in the number of high security beds
in general psychiatry during the period.
The USA has experienced a dramatic de-institutiona-
lization of the mental health services. In 1955, there were
559,000 patients in mental state hospitals in the country;
today there are less than 60,000, in spite of a 70%
increase of the population (21). The results of this
massive de-institutionalization have been described by
Torrey (22), who refers to jails and prisons as ‘‘America’s
new mental hospitals’’.
In spite of marked de-institutionalization in Norway
during the last several decades, there has been a strong
growth in public spending on mental health services the
last 70 years. The number of persons receiving some kind
of psychiatric treatment has increased many times over
(9, 23). Still, the issues pertaining to de- and re-
institutionalization are widely debated, also in connec-
tion with crime prevention. Inpatient treatment offers
better possibilities for control of aberrant and poten-
tially dangerous behaviour than ambulant treatment
does. Only residential treatment was included in Pen-
rose’s study. In our study, we have limited our analyses
similarly, although the effect of ambulant psychiatric
treatment in crime prevention is an important issue in
need of research.
Are crime rates rising?
The crime rates depicted in Fig. 1 represent officially
registered crime. Admittedly, registered crime represents
only a fraction of all crimes committed in any given
society (24). Hence, criminologists have questioned the
representativity of such official statistics (24). Maybe
routines for registration have changed from one period
to another? Maybe the threshold for being apprehended
and sentenced has changed? Maybe the development of
new electronic registration systems has made it easier to
register crimes? And has the increase in the size of the
police force itself lead to more crimes being investigated
and brought to court (2, 24)? All the above proposed
mechanisms may add to an inflated estimate of increas-
ing crime rates in society.
54
Still, we have not found any generally accepted
criminological research contradicting the fact that Nor-
way has experienced a marked quantitative increase in
most types of crime during the last several decades, with
a particular acceleration in the last 30 years. Particularly
homicide rates have increased markedly from the 1960s
but have levelled out in recent years. The area with the
most striking increase in crime rates is drug offences,
with a 20-fold increase since 1980 in the number of
investigated cases (25).
The impact of de-institutionalization on overall and
violent crime rates
Implicit in Penrose’s theory was the notion that dein-
stitutionalization would lead to a rise in the number of
serious crimes. This has also been a popular belief (3).
An Australian study (26) has demonstrated that the
number of crimes committed by persons with schizo-
phrenia increased distinctly during the period 1975

2000, but not more so than for the rest of the
population. Similar trends have been reported regarding
homicide committed by persons with severe mental
illness (3, 27). Homicide rates have increased markedly
in Norway since 1960. However, the percentage of
psychotic homicide perpetrators in Norway has not
increased over the period (7, p. 526
7; 18,19). This
speaks against de-institutionalization as a major cause
of the rise in homicide cases.
However, less serious crimes, particularly simple
larceny and crimes against public order and peace, and
committed by persons deemed not responsible for their
criminal acts because of major mental disorder, may
have increased, as these individuals who earlier would
have been institutionalized and kept under close surveil-
lance today most often are offered outpatient treatment
only. If the felony is of a serious and dangerous kind, a
perpetrator suffering from a major mental disorder will
most often be sentenced to compulsory psychiatric
inpatient treatment. These crimes will be found in
official registers. Even so, it is difficult to substantiate
that de-institutionalization as such has had anything but
a marginal contribution to the overall increase seen in
overall and violent crime rates.
The total number of investigated crimes in Norway
rose from 39,000 in 1960 to 290,000 in 2004 (15). The
successfully investigated crimes in 2001 were committed
by 100,000 different individuals (16). With a reduction in
the number of mental institution beds from 15,000 to
5,000 over the same time span, it is obvious that this
reduction alone cannot explain the rise in the number of
perpetrators in society. Furthermore, we know that only
about 100 persons with major mental illness reside in
Norwegian prisons (28, 29). Hence, the current increase
in the number of perpetrators in society at large can not
NORD J PSYCHIATRY×VOL 63 ×NO 1 ×2009

be explained by a diversion of people from mental to
penitentiary institutions.
Why then, this strong rise in overall and violent
crimes in recent years?
The main perspective of this study has been on the
inverse relationship between psychiatric inpatient care
and prison capacity, and the concurrent increase in the
crime rates in a well defined society. We maintain the
view that the psychiatric de-institutionalization that has
taken place during the period has played a very modest,
if any, causal role. We find that an exhaustive discussion
about possible causes for the rising crime rates observed
is beyond the scope of this article. We do, however, want
to draw attention to a recent report that discusses the
issue comprehensively, with particular focus on recent
developments in Norway (25). Parallel trends are noted
in most Western countries (30). Among factors discussed
are: increased urbanization, mobility and immigration,
drug abuse, changes in family structure, a more compe-
titive and excluding society, increased marginalization
and stigmatization. Particularly the relevance of the size
of the police force has been pointed out by Biles &
Mulligan (2). They found, as we did, a positive correla-
tion between the size of the police force and the crime
level.
Is healthcare for persons with severe mental illness
effective crime prevention?
A number of empirical studies (6, 31) have demonstrated
a clear association between severe mental illness, pre-
dominantly schizophrenia, and overall criminal offend-
ing. Studies focusing on violent offending have found
even higher risks, compared to the general population
(5). The issue is under debate, however, as most
researchers stress the importance of confounding factors
(32). Even so, the fact remains that 18% of all homicides
in Norway during the period 1980
96 were committed
by persons deemed actively psychotic at the time of the
act in (18, 19). This is close to the Swedish estimate of
20% mentally ill homicide offenders during the years
1988
2001 (4) and testifies to the strong correlation
between severe mental illness and homicide.
Accordingly, preventive efforts have been strongly
advocated, in order to limit violent crime and homicide
by persons with severe mental illness (6, 33). With a
downsized hospital system and strong demands in
society for psychiatric help for all types of mental
problems, the possibility of overlooking the needs of
patients with a high risk of violence may have increased
during the last several decades. Prevention of violent
crimes might be easier to achieve in the group of severely
mentally ill individuals than in society in general, as
these individuals usually are under some sort of super-
vision or control and receive active treatment (19).
NORD J PSYCHIATRY ×VOL 63×NO 1×2009
PENROSE’S LAW
Society’s crime policies have varied over the last
several decades. While the 1970s seemed to be governed
by a therapeutic optimism as to the effect of proper
medical and rehabilitative measures, later decades have
put stronger emphasise on control and retribution (25).
Strengths and limitations of the study
The Norwegian population is small and easy to monitor.
As the country has reliable population statistics, we
believe we have been able to describe the development
over time reliably. Even so, a number of issues need
clarification.
First of all, this study has counted all beds in public
and private psychiatric nursing homes in addition to all
psychiatric hospital beds, in order to arrive at the total
number of mental institution beds available. We believe
that this gives a better picture of the inpatient services
rendered to the population.
However, the number of institution beds does not give
a comprehensive picture of the total amount of psychia-
tric health services delivered. Outpatient services have
become increasingly important. There has been a
marked increase in outpatient facilities for mentally ill
persons, paralleling the process of de-institutionaliza-
tion. However, as Penrose in his 1939 article (1)
concentrated on inpatient services only, we chose to do
the same. A parallel exists in the correctional system, as
in our study we have not included persons sentenced to
community services or individuals on parole.
We have registered institution beds and prison capa-
city only. We have not collected data about duration of
stay. Such data would have provided us with information
about patient and prisoner flow. This has been beyond
the scope of this study.
During the major part of the 20th century, mental
hospitals in many countries cared for not only persons
with psychiatric disorders, but also mentally retarded
persons. In his original article, Penrose discussed this
issue (1). He found that the proportion of mentally
retarded in mental hospitals varied markedly, from 20

36% in countries like Denmark, Sweden and England to
5% in Norway. In the 1930s, the services for the mentally
retarded had already been separated from the mental
health services in Norway, as is the case today. The
Norwegian Mental Health Act safeguards this practice,
as it stipulates that non-psychotic persons cannot be
involuntarily admitted to or kept in psychiatric hospitals.
Conclusions
Penrose’s law has proven its robustness in the Norwegian
society over a 75-year period, with an inverse relationship
between the number of mental institution patients and the
number of imprisoned individuals. The law held up in two
distinctly different time periods, one characterized by a
55
P HARTVIG, E KJELSBERG
marked reduction in the number of mental institution
beds.
The period from 1960 to 2004 has seen a manifold
increase in overall and violent offending. We argue that
the main cause of this rise is not de-institutionalization
of the mental healthcare services; the causes must be
sought in complex sociological changes in society.
We further argue that the mental healthcare services
have a limited, but important responsibility in crime
prevention.
Acknowledgements*We gratefully acknowledge Yngve Hammerlin’s
and Per Kvam’s assistance in obtaining relevant statistical data. The
study has not received any external grants.
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Pål Hartvig, M.D., Centre for Research and Education in Forensic
Psychiatry, Ullevaal University Hospital, Oslo, Norway.
Ellen Kjelsberg, M.D., Centre for Research and Education in
Forensic Psychiatry, Ullevaal University Hospital, Oslo, Norway.
NORD J PSYCHIATRY×VOL 63 ×NO 1 ×2009