“Are many prisoners in jail or prison because of their mental illness? And if so, is mental health treatment a cost-effective way to reduce crime and lower criminal justice costs?” Those are the questions asked in a review paper by two of my former Professors at Harvard, Richard Frank and Tom McGuire: Mental Health Treatment and Criminal Justice Outcomes. If we believe mental illness causes crime, and mental health treatment programs reduce mental illness, it may follow that investments in mental health programs could reduce crime (oh, and mental illness too!), potentially even more cost-effectively than other forms of crime deterrence. The logic seems straightforward, but is it true?
When I arrived in the United States from Canada, one of the things that really struck me was the extent to which mental illness was visible in certain American cities while not in others. In Boston, I saw few cases of people with very obvious mental illness on the streets, but if I traveled to cities like Seattle they were hard to miss. I have fond vivid memories of being chased, heckled, and called all kinds of obscenities while walking around the Pike Market in Seattle (yet despite the disturbances, it still one of my favorite places in the US). Perhaps it an East Coast/West Coast thing, but it may also have to due with the priority given to mental health policies within state Medicaid programs. I’ve always taken this visible variation to suggest that mental health policy is not just an important health policy but good social policy.
The association between mental illness and crime has been extensively studied in the social science literature, and despite some obvious identification challenges, it generally finds that there is in fact a causal relationship between mental illness and crime, however, it is not particularly large and tends to only affect a subset of of patients at a certain stage in their illness. Some forms of mental health policy have been shown to have some effect at reducing crime, in particular institutional based care that tends to get people off the streets, but the overall cost-effectiveness of such approaches is not overwhelming. The authors therefore conclude that there is not sufficient evidence to support the view that treating mental illness will lead to reductions in crime. Too bad, the crime externality story would have made a great case for further investments in such programs. I guess we’ll just have to keep treating people with mental illness for the sake of treating illness, or tourism?Share on Facebook