Mental Illness and Crime

Mental health in America frequently comes up in discussions of violent crimes. The increasing phenomena of mass shooting events have renewed public interest in the connection between crimes and mental illness.  

Fifty percent of people incarcerated in jails and prisons have mental illnesses. There are more mentally ill Americans incarcerated in jails or prisons than there are in psychiatric institutions. Government-sanctioned mandated mental health treatment is only initiated by the courts after an individual has committed a crime, been caught, and been convicted. According to the Center for Behavioral Health Statistics and Quality, over 50% of persons with mental illness do not receive treatment. A common barrier to care is a lack of local on-site access. 

A paper published in the Journal of Urban Economics, “Local Access to Mental Healthcare and Crime” by Monica Deza, Johanna Maclean, and Keisha Solomon explores the relationship between local on-site access to mental health resources and crime. They use data from the FBI’s Uniform Crime Reporting and the U.S. Census Bureau’s County Business Patterns, observing 1999-2014. In addition to improving patient outcomes, the researchers hypothesize that mental health care can produce broader social benefits and a greater number of offices providing mental health care in a county will reduce the amount of crime within that county. However, the researchers also suggest that the ability of mental health care to reduce crime is underutilized.

Is there a correlation between mental illness and criminal behaviors?

Nearly 20% of Americans are affected by mental illness. While the symptoms and severity of mental illnesses vary, there are many mechanisms by which mental illness can influence criminogenic factors. Psychotic disorders can produce hallucinations and disordered thinking; mood disorders can produce volatile swings in energy and disposition. Episodes of acute mental illness can increase aggression, risk-taking behaviors, and poor decision-making. 

In addition to behavioral influences that may increase the likelihood of criminal behaviors, mental illnesses produce challenges to maintaining employment or pursuing employment opportunities, increasing the incentive to commit financially motivated crimes. Persons contending with mental illnesses also face elevated risk of developing a substance use problem, as many people use alcohol or other substances to self-medicate. Substance abuse affects cognitive distortion, increases exposure to criminality, and creates additional financial strain.

Finally, mental illness increases the likelihood of crime victimization. Persons with mental illness experience higher rates of victimization and are more likely to experience homelessness than the general population, exposing them to a myriad of enhanced risks. 

How do you measure access to mental health care?

To test whether access to mental health resources can reduce crime, Deza et al. use the count of mental health care offices as their measurement for mental health access. Mental illnesses are often classified as chronic conditions to be managed. While there are many different courses of treatment for varying mental illnesses, local offices providing services are a good signal indicating local access to care.

Office-based care has become a more significant avenue of mental health treatment in recent years. According to the Substance Abuse and Mental Health Services Administration, in 1986 office-based care made up only 24% of total mental health care expenditures and by 2014 had risen to 44%. In addition to being a less severe life change than a stay in a psychiatric hospital, office-based care has a relatively low variable cost.

In their national view of American counties during the study period, the researchers found the total crime rate per county to be 360 per 10,000 residents, with 44.1 nonviolent crimes and 315.9 violent crimes per 10,000 residents. On average researchers found there to be 122 mental health care provider officers per county.

They confirmed their hypothesis, finding that 10 additional offices in a county reduce crime by 1.7 crimes per 10,000 residents, or 0.4%. Ten additional mental health care offices in a county resulted in 0.9 fewer violent crimes per 10,000 residents, a change of 2%, and 0.8 fewer nonviolent crimes per 10,000 residents, a change of 0.2%. Figure 1 shows the change in crime rate per 1,000 residents with the presence of 10 additional mental health care offices.

How do you measure the cost of crime and the cost of crime prevention?

When assigning a dollar value to the burden placed on society by each committed crime, the impact of violent crime becomes more significant. For example, the value of one averted murder is estimated to be $10.9 million. This incorporates the statistical value of life and the burden on police and legal systems. (Chalfin and McCrary 2018).

The ability of mental health care access to mitigate and/or prevent violent crime can produce meaningful changes in communities. Deza et al. refer to their study as another contribution to academic, empirical literature suggesting that “supportive, rather than punitive, policies are effective in reducing crime related to behavioral health conditions.”