How much are we willing to pay, as a society, toward preventing crime and easing the burdens on our prison systems? How much are we willing to pay to provide help to people struggling with serious mental illness, the kind of illness that makes it hard for them to cope with daily life?
The results of a study out last month in Psychiatric Services might give some insight into how to think about the intersection of both of those difficult questions. A research team at North Carolina State University looked at the impact of routine outpatient treatment for adults with serious mental illness on arrest rates over several years.
The researchers considered over 4,000 people who had been hospitalized for mental illness in 2004 and 2005, and kept track of what happened to them from 2005 to 2012. The subjects were all adults living in Florida, all Medicaid patients, and had all been diagnosed with either schizophrenia or bipolar disorder. They looked at which people received government-subsidized medication or therapy and which ones didn’t receive any help at all.
“This study shows that providing mental health care is not only in the best interest of people with mental illness, but in the best interests of society.”
About a third of the people in the group were arrested for some reason, at some point, over that seven-year period. But those who received medication or therapy (or both) were less likely to have had run-ins with the law. In addition, the timing of the treatment seemed to be significant, as there were fewer arrests among people who were given medication for 90 days right after being discharged from their initial hospitalizations.
It might seem cold or crass to reduce the wellbeing of some of society’s most vulnerable members to dollars and cents. But the study also showed quite clearly that providing mental health treatment isn’t merely the right thing for a society to do—it’s the more cost-effective thing to do, too.
“Individuals who were arrested received less treatment and each cost the government approximately $95,000 during the study period,” according to the North Carolina State University summary of the project. “Individuals who were not arrested received more treatment and each cost the government approximately $68,000 during the study period.”
“This study shows that providing mental health care is not only in the best interest of people with mental illness, but in the best interests of society,” said one of the paper’s authors, psychologist Sarah Desmarais.
The study also notes the fact that people with mental illness make up a disproportionate number of this country’s arrests and convictions overall. For instance, there are close to 33,000 inmates in California state prisons who suffer from mental illness—accounting for 30 percent of the prison population. According to The National Center for Mental Health and Juvenile Justice, up to 70 percent of all youth in juvenile detention programs have a diagnosable mental health disorder, and at least 20 percent of them suffer from an illness severe enough “that their ability to function is significantly impaired.”
It’s easy for conversations on these difficult topics to get muddied, so it’s worth pointing out what this very limited study doesn’t show. It doesn’t show that people with mental illness are more likely to commit crimes, or to commit certain types of crimes, than people without mental illness. There was no mentally healthy control group involved here.
Nor does it show that people with mental illness to be more violent than those in the rest of the population. In this study, misdemeanor arrests were included in the calculations with more serious crimes.
In fact, as Dr. Richard A. Friedman pointed out in an excellent piece in The New York Times during the discussion of the Newtown school shooting last year, the “risk factor for violence” for people with mental illness is actually quite small. True, certain conditions, like schizophrenia and bipolar disorder (the same diagnoses that this particular study focused on), do increase the risk for violence—but maybe not as much as the typical news consumer might think.
As Friedman noted, an extensive National Institute of Mental Health study of 18,000 subjects showed that sufferers of these types of serious mental illnesses had about a 16 percent chance of displaying violent behavior at some point in their lives—as opposed to those without mental illness diagnoses, who had about a seven percent chance. If there was one factor that researchers could point to as a consistent contributor to violence, it wasn’t mental illness; it was drug or alcohol abuse.
So in the spirit of keeping the facts clear, and making way for clear-headed policy discussion: the takeaway from the North Carolina State University study is that treatment of mental illness can reduce overall arrests and save taxpayers money. Among people with these types of diagnoses, whatever the risk of criminal behavior is, it can be reduced with timely medication and therapy. It’s perhaps not a shocking conclusion, but a vitally significant one nonetheless.