Addressing Mental Health and the Criminal Justice System
- As of July 2021, approximately 1 million people were incarcerated in the U.S.
- By comparison, China is estimated to have had a prison population of 1.7 million in 2021 despite having a total population more than four times that of the U.S.
- Brazil ranks third with about 760,000 incarcerated individuals.
- The per capita rate of incarceration in the U.S. is 639 per 100,000 as of May 2021; the second-highest rate is in El Salvador at 562 per 100,000.
- About 44% of people in jail and 37% of those in state or federal prison have been diagnosed with a mental illness, according to the Bureau of Justice Statistics (BJS), compared to about 20% of the general population.
- Nearly 25% of police shootings involve an encounter with a person with a mental illness, according to data compiled by The Washington Post.
- Suicide remains the leading cause of death in jails and occurs at rates in jails and prisons that are much higher than in the general population, according to the BJS.
How Mental Health Affects the Criminal Justice System
- Inmates whom the courts have ordered to be admitted for competency restoration may have to wait weeks or months to be treated.
- The longer that treatment is delayed, the worse their symptoms and long-term prognosis may become.
How Mental Health Impacts Criminal Defendants
- Twenty-five percent of people arrested and booked two or more times in a 12-month period reported a serious or moderate mental illness. By comparison, 9% of individuals who were not arrested during that period reported a mental illness.
- Fifty-two percent of people arrested and booked two or more times in a 12-month period reported having a substance use disorder. By comparison, 7% of individuals who were not arrested during the period reported a substance use disorder.
- Twenty-seven percent of people arrested and booked two or more times in a 12-month period reported having no health insurance. Meanwhile, 8% of individuals who were not arrested and booked during the period had no health insurance.
How Mental Health Impairs the Fair Administration of Justice
- Among the community services the task force calls for are income maintenance programs, supportive housing, transportation, substance abuse treatment, and healthcare.
- Funding for the services requires that state and local public health agencies and social service partners make the provision of consistent and sustainable mental health programs a priority.
Resources on Mental Health and Criminal Justice
- Council of State Governments Justice Center, Justice and Mental Health Collaboration Program (JMHCP) — Among the free services offered by the JMHCP are training, resources, and other support to communities working to enhance the criminal justice system’s response to people with mental illness.
- S. Department of Justice, “Justice Department Announces $29 Million to Support Justice and Mental Health Programs” — The Office of Justice Programs has allocated funds for grants to community programs designed to reduce recidivism associated with mental illness and co-occurring disorders.
Mental Health and Criminality
- In most cases of violence in acute-care settings, factors such as the ward environment, a lack of clinical leadership, overcrowding, ward restrictions, and lack of activities contributed to the incident.
- Movies and television shows portraying “crazed killers” and news reports of real-life violence contribute to the public’s misperception of a link between violence and mental illness. This causes many people to avoid contact with individuals who have a mental illness, according to World Psychiatry.
- The public’s erroneous presumption of violence in mentally ill people provides justification for bullying and otherwise victimizing people with a mental illness.
The Link Between Mental Health and Criminality
- About 40% of all violent crime is committed while the perpetrator is under the influence of alcohol, according to BJS data.
- Alcohol, cocaine, and other psychoactive substances are known to increase aggression in susceptible individuals.
- Most of the substances being abused cause disinhibition that weakens people’s built-in resistance to antisocial behavior.
Prevalence of Mental Illness in the Incarcerated Population
- Repeat arrestees are often treated in emergency rooms and are disproportionately homeless.
- Almost half of the people arrested for a mental health protection hold are arrested again within 60 days, and close to 25% are rearrested within 14 days of being released from incarceration.
- Nearly 2 in 5 incarcerated people have a history of mental illness, according to NAMI.
- Among incarcerated women, the percentage with mental illness is 66%.
- Compared to the general prison population, mentally ill prisoners are incarcerated for longer periods, cost more to house, are more likely to commit suicide, and are more frequently placed in solitary confinement, according to information from the Treatment Advocacy Center.
Resources on Mental Health and Criminality
- Alcohol Rehab Guide, “Alcohol-Related Crimes” — This article describes how robbery, sexual assault, aggravated assault, intimate partner violence, and child abuse are among the crimes associated with alcohol use.
- Vera Institute of Justice, “The Impacts of Solitary Confinement” — The practice of solitary confinement is shown to cause serious and lasting psychological damage, especially for people with preexisting mental illness, as outlined in this brief.
- Prison Policy Initiative, “Research Roundup: Incarceration Can Cause Lasting Damage to Mental Health” — In addition to exacerbating the mental illnesses of prisoners, incarceration is associated with negative mental health outcomes due to disconnection from family, loss of autonomy, and other causes as found in this research.
Mental Health and Criminal Proceedings
- The mental illness underlying their offense remains untreated despite costly competency assessments and hospitalization prior to standing trial.
- While confined in the prison system, their mental condition is likely to become worse due to the harsh environment.
- When mentally ill people are released from incarceration, they reenter the community with no discharge plan for their care.
Four Legal Standards of Criminal Insanity
- The M’Naghten Rule: A “disease of the mind” causes the person to be unable to distinguish right from wrong, or to fail to understand the consequences of their actions.
- The Irresistible Impulse Test: A mental disorder causes the person to be unable to control their impulses, which results in them committing a crime.
- The Model Penal Code Test: A mental defect results in the person being unable to act within legal constraints or failing to understand that the acts are criminal.
- The Durham Rule: A mental defect caused the person to commit a crime, with or without a clinical diagnosis of a mental illness or disorder.
How Mental Illness Is Addressed in Court Proceedings
- The legal standard for showing competence to stand trial is the ability of the defendant to consult with their lawyer “with a reasonable degree of rational understanding.”
- Procedural competency requires that trial courts hold a competency hearing, while substantive competency requires that defendants not be tried and convicted when they are incompetent.
- They are often held in confinement for longer periods than they would have been held had they been found guilty of the offense they were charged with. This occurs despite the U.S. Supreme Court’s ruling that such confinement is unconstitutional.
- They may receive less effective treatment for their serious mental illness in a long-term care facility than they would have received in prison.
- Defendants are not always informed of all the consequences of pleading not guilty by reason of insanity.
Resources on Mental Health and Criminal Justice Court Proceedings
- American Bar Association, “The ABA Criminal Justice Standards on Mental Health: The Greatest Practice Resource You’ve Never Heard Of” — The ABA’s standards for lawyers in criminal proceedings involving parties who have a mental illness are described as “aspirational” rather than being enforceable under codes of professional responsibility.
- National Center for State Courts, National Judicial Task Force to Examine State Courts’ Response to Mental Illness — The goal of this judicial task force is to help state courts establish practices that are more effective, fair, and timely in cases that involve people with a serious mental illness.
Crimes Linked to Mental Illness
Nuisance Crimes vs. Violent Crimes
- SAMHSA has created a best practice toolkit that provides guidelines for behavioral health crisis care via regional crisis call centers, mobile crisis response teams, and crisis receiving and stabilization facilities.
- It has implemented the 988 telephone number for reporting behavioral health crises to avoid the calls being directed to the 911 emergency service line. This number will also replace the current nine-digit National Suicide Prevention Hotline number of 800-273-TALK.
- The program promotes the creation of crisis service systems designed to divert mentally ill people from jail, reduce reliance on emergency rooms, and minimize the involvement of law enforcement officials in responding to behavioral health crises
No Connection Between Mental Illness and Violence
- Likelihood of committing a violent act correlates with being young, male, or of lower socioeconomic status, according to World Psychiatry.
- Substance abuse is a major determinant of violence, according to World Psychiatry. Substance abuse often is concurrent with mental illness.
- According to a study cited by the APA, a history of prior violence or childhood physical abuse, having a father who was a criminal or substance abuser, displaying antisocial behavior, and lack of anger control were just as likely to predict violent behavior as having a mental illness.
Resources on Crimes Linked to Mental Illness
- Mental Health America, “Mental Health and Criminal Justice Issues” — This article describes programs designed to divert people with serious mental illness from juvenile and criminal courts and to prevent unfair treatment of mentally ill people in the criminal justice system.
- National Alliance on Mental Illness, “Criminal Justice Reform Means Reforming the Mental Health System” — This article explores how reducing law enforcement’s role in responding to mental health crises requires a crisis-response system that is available 24/7 and readily accessible by community agencies and the public.
Mental Health Treatment as a Crime Deterrent
- Even when police attempt to secure treatment for the person in crisis, when psychiatric hospital beds aren’t available, the only alternative in most cases is putting the person in jail.
- The largest mental health institution in the country is the Cook County Jail in Chicago, which houses more than 2,000 inmates with mental illness.
Alternatives to Criminal Proceedings for Mentally Ill Defendants
- The Sequential Intercept Model attempts to prevent the criminalization of people with mental illness by creating a mental health treatment system that is accessible, comprehensive, and effective.
- Once criminal charges have been filed, the person will be assigned to a mental health court, which tends to criminalize homelessness, loitering, and other social issues that neighborhoods and communities are attempting to address.
- Mental health courts are often effective at reducing recidivism, improving mental health outcomes, and reducing inmates’ length of incarceration, but they are inherently coercive because defendants agree to participate as an alternative to criminal prosecution.
Resources on Alternatives to Criminal Proceedings for Mentally Ill Defendants
- Mental Health America, “Position Statement 53: Mental Health Courts” — This article challenges the expansion of mental health courts as an alternative to creating comprehensive community-based services to support people with behavioral health conditions.
- Prison Legal News, “Mental Health and Prison Systems in Major Need of Reform” — The ethical concerns that arise from policies that jail people who are mentally ill rather than provide them with treatment are discussed here.