In 1939, British psychiatrist Lionel Penrose described an inverse relationship between mental health treatment infrastructure and criminal incarcerations. This relationship, later termed the 'Penrose Effect', has proven remarkably predictive of modern trends which have manifested as reciprocal components, referred to as 'deinstitutionalization' and 'mass incarceration'. In this review, we consider how a third dynamic-the criminalization of addiction via the 'War on Drugs', although unanticipated by Penrose, has likely amplified the Penrose Effect over the last 30 years, with devastating social, economic, and healthcare consequences. We discuss how synergy been the Penrose Effect and the War on Drugs has been mediated by, and reflects, a fundamental neurobiological connection between the brain diseases of mental illness and addiction. This neuroscience of dual diagnosis, also not anticipated by Penrose, is still not being adequately translated into improving clinical training, practice, or research, to treat patients across the mental illness-addictions comorbidity spectrum. This failure in translation, and the ongoing fragmentation and collapse of behavioral healthcare, has worsened the epidemic of untreated mental illness and addictions, while driving unsustainable government investment into mass incarceration and high-cost medical care that profits too exclusively on injuries and multi-organ diseases resulting from untreated addictions. Reversing the fragmentation and decline of behavioral healthcare with decisive action to co-integrate mental health and addiction training, care, and research-may be key to ending criminalization of mental illness and addiction, and refocusing the healthcare system on keeping the population healthy at the lowest possible cost.

中文翻译：

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彭罗斯效应及其因毒品战争而​​加速：未翻译的神经科学以及未经治疗的成瘾和精神疾病的危机。

1939 年，英国精神病学家莱昂内尔·彭罗斯 (Lionel Penrose) 描述了心理健康治疗基础设施与刑事监禁之间的负相关关系。这种关系后来被称为“彭罗斯效应”，已被证明对现代趋势具有显着的预测作用，这些趋势表现为相互的组成部分，称为“去机构化”和“大规模监禁”。在这篇综述中，我们考虑了第三种动态——尽管彭罗斯没有预料到，通过“毒品战争”将成瘾定为犯罪，但它可能在过去 30 年中放大了彭罗斯效应，造成了毁灭性的社会、经济和医疗后果。我们讨论彭罗斯效应和毒品战争的协同作用如何通过精神疾病和成瘾等脑部疾病之间的基本神经生物学联系来介导和反映。这种双重诊断的神经科学也没有被彭罗斯预见到，它仍然没有被充分转化为改善临床培训、实践或研究，以治疗患有精神疾病-成瘾共病的患者。这种翻译上的失败，以及行为医疗保健的持续碎片化和崩溃，加剧了未经治疗的精神疾病和成瘾的流行，同时推动了不可持续的政府对大规模监禁和高成本医疗保健的投资，而这些投资只从伤害和多器官移植中获利。因未治疗的成瘾而导致的疾病。通过采取果断行动，将心理健康和成瘾培训、护理和研究结合起来，扭转行为医疗保健的支离破碎和衰落现象，这可能是结束对精神疾病和成瘾的刑事定罪，并重新将医疗保健系统的重点放在保持人口健康上的关键。尽可能最低的成本。