The Crime and Safety Blind Spot: Are mental health disorders fueling criminal activity?

This is part of the “Crime and Safety Blind Spot” series, which presents an opportunity to understand various perspectives, entertain new ones, and consider different conclusions. Read the introduction and view other posts here.

INTRODUCTION

Some argue that mental health disorders drive criminal behavior, triggering violent crimes like mass shootings due to impaired judgment and delusional thinking. This causality, some believe, means that mental health disorders should be punished accordingly. Others question any such link or contend that, if any exist, they are not causal, but rather stem from root causes, such as trauma or socio-economic conditions. This perspective promotes a focus on rehabilitation outside the justice system. In this post, we will explore various views, studies, and solutions related to the intersection of crime and mental health disorders.

EXPLORING KEY PERSPECTIVES AND BLIND SPOTS

What is the relationship between crime and mental health disorder trends?

The following charts provide a high-level view of mental health disorders and crime trends from 2008-2022.

Potential Blind Spot: Inpatient beds for individuals with severe mental health disorders have decreased by 97 percent since the 1950s. Consequently, many individuals in mental health crises requiring intensive psychiatric treatment may end up in emergency departments or jails while awaiting inpatient care. These cases often go uncounted in inpatient treatment statistics, potentially indicating a much higher demand than reflected. Although a causal inference cannot be drawn between general mental health disorders and crime, it does not rule out a possible correlation between certain serious mental health disorders and propensity for specific criminogenic behavior.

What is the prevalence of mental illness in the criminal justice system?

• Federal statistics and other studies have consistently found that mental disorders and severe mental health disorders are highly prevalent within the jail, prison, and probation population, with depression, anxiety, and psychotic disorders being the most common. Further, more than 70 percent of people in jails and prisons have at least one diagnosed mental health disorder, substance use disorder, or both.
• A 2022 Oregon study revealed a surge in the number of individuals court-ordered to an evaluation for competency to stand trial. Notably, the study found a correlating decrease in civil commitments—a process outside the criminal system where individuals with severe mental health disorders are involuntarily admitted to a mental health facility.
• In 2023, psychiatric hospital beds were at an all-time low, with most states facing a moderate to severe shortage. This has resulted in jail inmates often waiting months for a bed.

Potential Blind Spot: Most data on mental health disorders in jails and prisons is outdated and limited, complicating our understanding of incarceration trends for individuals with serious mental health disorders and the adequacy of responses. Ensuring consistent diagnostic criteria across facilities would also make for more meaningful analysis. Statistics on the rise in competency hearings and psychiatric bed shortages for inmates indicate possible shortcomings in preventive mental health measures and suggest jails as the default care provider. This trend prompts an examination of whether external front-end systems are failing individuals or if communities accept the justice system as the primary solution for support and rehabilitation.

How does untreated mental illness contribute to criminal behavior?

• Studies broadly indicate that people with serious mental health disorders, including major depressive disorder, bipolar disorder, schizophrenia, and schizoaffective disorder, have a slightly higher likelihood of committing acts of violence compared to the general population.
• Experts generally agree that the risk of criminal acts significantly increases when severe mental health disorders are combined with substance abuse.
• Research shows that most individuals with severe mental health disorders are not violent and are largely not responsible for mass or community violence. Some experts believe that co-occurring factors, such as adverse childhood experiences, environmental influences, and substance use, often drive violent behavior, rather than mental illness itself.

Potential Blind Spot: Societal perceptions and media portrayals directly linking severe mental health disorders with crime can fuel negative stereotypes and obscure more nuanced solutions. While it appears that individuals with mental health disorders are accused of more crimes, it is unclear whether the disorder itself drives criminal behavior or if underlying factors contribute to both. Approximately one in 20 American adults live with a serious mental health disorder, yet most are productive, law-abiding citizens. This suggests the disorder alone does not promote crime but may contribute to criminogenic behavior in combination with other factors.

What are the common approaches to address mental illness in the context of public safety?

• Involuntary mental health hold laws allow for involuntary admission of someone with an acute mental health disorder under certain conditions. While all states have these laws, they differ in duration, authority, and oversight. Typically, a hold is justified when a person poses a danger to self or others, although parameters and oversight vary.
• Alternative police responses provide specialized on-scene mental health care and ongoing case management through co-responder models with an officer and mental health professional team or community responder models with non-police personnel handling low-risk mental health calls.
• Alternatives to prosecution divert defendants with mental health issues from the traditional prosecution process through tailored mental health approaches like problem-solving mental health courts or specialized diversion programs.
• Services in incarceration can include evaluations, psychotropic medicine, or individual or group therapy.

Potential Blind Spot: Some question whether dismantling state hospitals created a care gap, leaving those in need of structured residential support reliant on the criminal justice system as a substitute. Despite the implementation of different voluntary and involuntary treatment solutions to fill this gap, the rise in mental health disorders and the severe shortage of behavioral health providers likely exacerbate the difficulty of obtaining successful outcomes, regardless of the approach instituted. Communities facing overcrowded jails only worsens the situation.

R Street’s Perspective

The closure of state psychiatric hospitals starting in the late 1950s, driven by poor conditions and a push for community-based care, forced many psychiatric patients onto the streets and increased their contact with law enforcement. Inadequate training among police, prosecutors, and judges worsened the situation, leading to a growing number of mentally ill individuals incarcerated. A steady increase in mental health disorders and shortage of behavioral health providers has compounded the issue by limiting the availability of comprehensive mental health services. As a result, jails became the single largest provider of mental health services.

The majority of individuals with mental health issues, even serious mental health disorders, do not commit crimes. However, mental health and substance use often intersect, with individuals lacking the support systems to manage both conditions. Poverty exacerbates the struggle for adequate care, leaving many with serious mental health disorders without necessary support, perpetuating cycles of homelessness and incarceration.

Fortunately, many communities are adopting alternative solutions, and many programs show promising outcomes. Initiatives like mental health courts, co-responder models, and mobile crisis teams offer more effective approaches. However, these efforts are insufficient to meet the overwhelming demand for mental health services and often face staffing challenges of their own. Consequently, individuals frequently wait for services and must fend for themselves in the interim. Additionally, the rise in competency hearings remains concerning and further strains the system.

Communities need to focus on and expand proactive solutions to address the intertwined issues of mental health disorders and criminal behavior. Investing in preventative measures like early intervention programs, community-based mental health services, and comprehensive support systems, can mitigate the factors that contribute to the minority who do engage in criminal behavior. By prioritizing these efforts, we can create a more just and supportive system for all individuals impacted by mental health challenges.

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