Mental Health and Crime: Reforming Criminal Justice

Introduction

The issue of mental health in the criminal justice system is important because, as Stringer (2019) notes, the U.S. Department of Justice has acknowledged that nearly 40% of individuals in prison have a history of mental illness. Unfortunately, the criminal justice system does not appear to be focused on addressing the situation in a way that benefits people convicted of crime. The prison industry faces a crossroads with respect to the mental health needs of prisoners: it can either continue on its current trajectory, ignoring the obvious mental health needs of inmates, or it can take steps now to address the mental health problem within the criminal justice system. This paper explains why there is a problem and what can be done to address it. It will ultimately argue that the prison industry needs to do a better job of addressing the mental health needs of prisoners, because otherwise there will be no meaningful rehabilitation or reform.

The Mental Health Problem

There are many theories for why crime occurs. From social bond theory to life course theory, criminologists have sought to examine, explore, and understand the factors that cause people to commit crimes. Researchers are now increasingly exploring the role that mental health plays in criminal behavior. Clearly, this is an issue that must be addressed, since nearly half of all people convicted and incarcerated have a history of poor mental health. It makes a certain grim sense that mental health as a social problem goes ignored, because society is conditioned to think of crime in black-and-white terms — as though there were only law-abiding citizens and criminals, with nothing gray about the situation. Yet when one analyzes the situation in greater context, a more complicated picture emerges. People are not always in full control of their own behavior. In many cases, individuals are dealing with mental health problems that lead them into behaviors society condemns and that the criminal justice system says must be punished with incarceration — while the actual root of the problem goes unaddressed.

Criminal justice cannot be effective unless it aligns with social justice, and social justice demands that the mental health issues at the root of crime be confronted. It can be argued that crime in the U.S. is really a mental health issue rather than a purely criminal justice issue, since nearly half of all crimes committed are linked to some form of mental illness experienced by offenders. The situation is made worse by the fact that, according to Yi, Turney, and Wildeman (2016), "jail and prison inmates have different, perhaps unequal, access to on-site physical and mental health services that may mitigate poor mental health outcomes" (p. 905). There is no real equality in terms of who receives mental health care and who does not. Convicts are being incarcerated instead of treated for their mental health issues, and in those places where mental health services are provided, the provisions are incomplete, hasty, and unequally administered. Without a consistent, holistic, and comprehensive approach, the criminal justice system is simply placing a bandage over a serious wound — and society accepts the situation because it does not have to confront the problem directly: those who are mentally ill are imprisoned, some placed in solitary confinement for days, weeks, months, or even years (Haney, 2018).

The social justice principles at stake here include respect for all human persons and the need to address inequality within the criminal justice system. Persons with mental health issues are subjected to marginalization and oppression as they are kept locked within a system that is punitive rather than rehabilitative. From a social justice perspective, prisons are considered a critical instrument of justice. It is, however, important to note that insofar as the health and wellbeing of prisoners is concerned, prisons fail to promote certain societal aspirations. Instead of addressing the mental health dimensions of crime, the system focuses on punitive justice. This is partly because of a conflict of interest at the heart of the criminal justice system: a private prison industry profits from the imprisonment of convicts. The labor of these convicts is outsourced to competing companies, which pay inmates pennies on the dollar — inmates who have no choice but to work for them while incarcerated (Pelaez, 2014). There is no incentive on the part of the state to address the mental health needs of inmates, even though there is a high correlation between crime and poor mental health (Evans Cuellar, McReynolds & Wasserman, 2006).

What the Data Shows

According to Morgan, Flora, Kroner, Mills, Varghese, and Steffan (2013), there is a clear overrepresentation of persons with mental illnesses in the criminal justice system. This finding aligns with that of Vogel, Stephens, and Siebels (2014), as will be discussed further below. Morgan et al. (2013) applied meta-analytic techniques to a total of twenty-six empirical studies, producing a reliable research synthesis that evaluated relevant interventions. Notably, the article goes beyond examining what works and also highlights approaches that have been shown to have minimal chances of success. It is unsurprising that solitary confinement is not depicted as a positive solution to mental health problems among inmates.

The National Conference of State Legislatures (NCSL, 2020) demonstrates that the various interventions put in place to minimize the interaction between the criminal justice system and persons with mental health needs remain insufficient. As the NCSL observes, "nationally, people experiencing a mental health crisis are more likely to encounter law enforcement than medical assistance." These individuals are in need of mental health care — but mental health care providers are not the ones patrolling the streets, prosecuting defendants, or rendering verdicts in courtrooms. Mental health care providers operate out of healthcare facilities, while people in clear need of that care are locked away behind bars. There is no logic to the system at all, unless one views the private prison system as a for-profit industry and sees the incarcerated as exploitable labor in an unjust system. That is how activist Angela Davis frames it, and she has decried the system on numerous occasions. As Lentin (2020) points out, "Angela Davis argues that the 'prison industrial complex' uses for-profit companies to disappear problems" (p. 260).

As a bipartisan entity serving the diverse needs of sitting state legislators, the NCSL has access to important data and resources on this subject. The information it provides is thus important to consider when demonstrating the need and relevance of early intervention programs designed to make the criminal justice system more responsive to persons experiencing mental health crises. Without such programs, individuals are simply treated as problems to be disappeared into the for-profit prison industry (Lentin, 2020). There is nothing noble or humane about such treatment, and it must be addressed as a cultural issue.

Semenza and Grosholz (2019) document another important finding: that inmate misconduct has been associated with poor physical and mental health among inmates. Their study finds that "people in prison dealing with concurrent mental and physical health problems are significantly more likely to engage in prison misconduct than healthy incarcerated individuals" (p. 103). This is significant because it shows that even within prison the problem is not resolved — the mental instability of the incarcerated continues to cause harm. Semenza and Grosholz (2019) draw on data from a comprehensive survey of state correctional facility inmates, and their conclusion indicates that the issue is systemic.

It should be noted that although the sample size in the Semenza and Grosholz (2019) study is sufficient for research of this nature, the survey was conducted in 2004, which could limit the direct applicability of its findings to contemporary circumstances. Nevertheless, as Vogel et al. (2014) show, the system has not meaningfully improved in the intervening years. The study remains valuable as a foundation for understanding why the mental health of inmates should be treated as a priority issue, and it supports the intervention measures proposed across the other literature reviewed here.

Yi, Turney, and Wildeman (2016) observe that from a social justice perspective, prisons are considered a critical instrument of justice, yet insofar as the health and wellbeing of prisoners is concerned, prisons fail to promote certain societal aspirations (Yi et al., 2016). Yi et al. (2016) sought to establish whether there was any association between incarceration and mental health, and found the answer to be an unambiguous yes.

Vogel, Stephens, and Siebels (2014) further demonstrate that people with mental health problems are over-represented in prisons — meaning that a disproportionate share of the prison population suffers from mental health conditions relative to the general population. Just as the overrepresentation of Black Americans in prisons suggests that systemic racism is embedded in the criminal justice system, so too does the overrepresentation of people with mental health issues suggest discrimination against this population within that same system. That indicates a serious and compounding problem.

To summarize, the empirical research on this issue shows that inequality in prisons is a serious concern, as those with mental health issues are not afforded their full rights. Data from the Fragile Families and Child Wellbeing Study (FFCWS) have indicated that a significant percentage of inmates have a long history of mental illness. According to Yi et al. (2016), that data is particularly valuable because "the longitudinal nature of the FFCWS provides critical information for estimating models that account for factors that precede incarceration" (p. 903). Additionally, Morgan et al. (2013) used meta-analysis to review 26 empirical studies and found a clear overrepresentation of persons with mental illnesses in the criminal justice system. This corroborates the conclusions of Vogel et al. (2014), who state that "mentally ill persons are disproportionately represented at all stages of the criminal justice system, from arrest to conviction to incarceration" (p. 627). Vogel et al. (2014) relied on a comprehensive review of literature on the prison population, drawing on numerous peer-reviewed sources to support the credibility of their findings. Each of these studies helps demonstrate that this is not merely a matter of interpretation: the facts and statistics thoroughly support the view that crime is largely a mental health issue. If the mental health of inmates were genuinely treated with equity, the prison population could potentially be reduced by nearly 40%.

Conclusion

The prison industry needs to do a better job of addressing the mental health needs of prisoners. Currently it treats those who are convicted of crime as though it were merely a black-and-white matter of guilty or not guilty. The problems lie much deeper than this superficial reading of crime. Crime is not simply a criminal justice issue; it is also a mental health issue. One reason crime rates remain so high in America is that mental health goes untreated at scale.

As a final illustration, one might consider what the COVID-19 lockdown has done to the mental health of people across America. People have lost their jobs and income, and many have relied on food banks for basic sustenance. Support networks have broken down as communities struggle collectively. People have become increasingly anxious about disease even where the actual risk is low. Tensions over public health measures have fueled anger and division. This mounting pressure has contributed to civil unrest, riots, looting, and surges in violence. Crime has risen sharply in cities like Portland and Chicago. There is a reason mental health has been linked to crime — the pandemic has made that connection visible for anyone willing to look. The criminal justice system, and society as a whole, must reckon with this reality and commit to reform that treats crime as the mental health crisis it so often is.