BACKGROUND: Numbers of psychiatric beds (general, forensic, and residential) and prison populations have been considered to be indicators of institutionalisation of people with mental illnesses. The present study aimed to assess changes of those indicators across Central Eastern Europe and Central Asia (CEECA) over the last three decades to capture how care has developed during that historical period. METHODS: We retrospectively obtained data on numbers of psychiatric beds and prison populations from 30 countries in CEECA between 1990 and 2019. We calculated the median of the percent changes between the first and last available data points for all CEECA and for groups of countries based on former political alliances and income levels. FINDINGS: Primary national data were retrieved from 25 out of 30 countries. Data from international registries were used for the remaining five countries. For all of CEECA, the median decrease of the general psychiatric bed rates was 33•8% between 1990 and 2019. Median increases were observed for forensic psychiatric beds (24•7%), residential facility beds (12•0%), and for prison populations (36•0%). Greater reductions of rates of psychiatric beds were observed in countries with lower per capita income as well as in countries that were formerly part of the Soviet Union. Seventeen out of 30 countries showed inverse trends for general psychiatric beds and prison populations over time, indicating a possible shift of institutionalisation towards correctional settings. INTERPRETATION: Most countries had decreased rates of general psychiatric beds, while there was an increase of forensic capacities. There was an increase in incarceration rates in a majority of countries. The large variation of changes underlines the need for policies that are informed by data and by comparisons across countries. FUNDING: Agencia Nacional de Investigación y Desarrollo in Chile, grant scheme FONDECYT Regular, grant number 1190613.

American University in Central Asia Bishkek Kyrgyzstan

Association of Experts in Mental Health Sofia Bulgaria; Standing Committee for Professional Standards and By Laws of the Bulgarian Psychiatric Association Sofia Bulgaria; Sofia University St Kliment Ohridski Thrakian University St Zagora Bulgaria

Azerbaijan Medical University Baku Azerbaijan

Center for Mental Health and Monitoring of Drugs and Alcohol MoH of Ukraine

Clinic of Psychiatry University Clinical Centre of Kosovo Pristina Kosovo

Consultant United Nations Office on Drugs and Crime Programme Office in Turkmenistan Ashgabat Turkmenistan

Curatio International Foundation Tbilisi Georgia

Department of Communication Skills of the Kazakh National Medical University Almaty Kazakhstan

Department of Neuroscience Faculty of Medicine Medical University Tirana Albania

Department of Psychiatry and Mental Health Hospital Clínico Universidad de Chile Santiago Chile; Medical Faculty Universidad Diego Portales Santiago Chile

Department of Psychiatry and Psychotherapy Campus Mitte Charité Universitätsmedizin Berlin Germany

Department of Psychiatry Comenius University in Bratislava Faculty of Medicine Bratislava Slovak Republic

Department of Psychiatry Riga Stradin's University Riga Latvia

Department of Psychiatry University Clinical Centre Tuzla Medical Faculty University of Tuzla Bosnia and Herzegovina

Faculty of Health Studies University of Rijeka Craotia

Forensic Psychiatry Unit Special Psychiatric Hospital Kotor Kotor Montenegro

Grodno State Medical University Grodno Belarus

Institute of Mental Health Belgrade Serbia

Institute of Psychiatry and Neurology • Department of Forensic Psychiatry Warsaw Poland

Kazakhstan Republican Mental Health Center Almaty Kazakhstan

Medical Faculty Universidad Diego Portales Santiago Chile; Departamento de Neurología y Psiquiatría Clínica Alemana de Santiago Facultad de Medicina Clínica Alemana Universidad del Desarrollo Santiago Chile

Medical Faculty University of Ljubljana Ljubljana Slovenia

National Institute of Mental Health Klecany Czech Republic; 3rd Faculty of Medicine Charles University Prague Czech Republic; 2nd Faculty of Medicine Charles University Prague Czech Republic

National Project Officer UNODC Tajikistan

North Estonia Medical Centre Psychiatry Clinic Tallinn and Chair of Neuropsychopharmacology Institute of Chemistry University of Tartu Tartu Estonia

Psychiatry and Medical Psychology Chuvash State University Cheboksary Russia

Psychiatry Narcology and Medical Psychology Department State Medical and Pharmaceutical University Nicolae Testemitanu Chisinau Moldova

Senior consultant psychiatrist Psychiatry Ambulatory Clinic Oradea România

Serbian Academy of Sciences and Arts Belgrade Serbia

Theoretical Biology Research Group Budapest Hungary

Unit of Social and Community Psychiatry Queen Mary University of London UK

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