Facts about mental illness and crime

This year's Howard Law Journal symposium challenged participants to search for ideas that can reduce criminal gun violence, and do so while respecting Second Amendment rights. My contribution is an article on mental illness and crime. The co-authors are historian Clayton Cramer, who is the author of the book My Brother Ron: A Personal and Social History of the Deinstitutionalization of the Mentally Ill, and Dr. Carolyn Dobbins, a psychotherapist who is author of the book What a Life Can Be: One Therapist's Take on Schizo-Affective Disorder. The draft article is available here. Some of our key findings:

• Mentally ill people are disproportionately victimized by violent crime. The largest crime-reducing benefit of helping persons with mental illness would be in reducing crimes against the mentally ill.
• Some types of severe mental illness increase the risk that a person will perpetrate a violent crime. Risk varies based on many other factors, such as substance abuse, or unemployment. Many of the risks are from secondary effects of the mental illness; for example, cognitive difficulties make employment difficult or impossible.
• Many mental illnesses have a genetic component, although the genetic effects are far from fully understood.
• Untreated severe mental illness is particularly significant in homicide-the extreme end of the criminal spectrum. Such illness is even more significant for mass murders of strangers.
• Treatment of severe mental illness-best accomplished by a combination of therapy and drugs-can greatly reduce violence by and against the mentally ill.
• Many mental ill persons who seek treatment do not receive it. Mental hospital beds per capita in the U.S. are lower than they have been since 1850.
• Over the last half-century, mental hospital capacity has dwindled, while prison and jail capacity has vastly expanded. Mentally ill prisoners comprise a large fraction of the jail and prison population.
• Compared to imprisonment, treating a mentally ill person in a mental hospital is at least four times as expensive, on month-by-month basis.
• Nevertheless, expanded availability of treatment in mental hospitals could be cost-effective in the long run. Ninety days in a mental hospital might avoid the need for 10 years in prison. Considering the costs suffered by victims of violent crime, greater availability of mental health treatment would provide major savings to society and to crime victims. Besides that, mentally ill persons who receive appropriate aid can be more constructively productive, and helpful to others.
• Because many untreated mental illnesses (such as schizophrenia) are degenerative, early treatment is especially helpful. Preventing a first episode of psychosis (loss of contact with reality) can have major lifetime benefits.
• In situations where a severely mentally ill person presents a grave danger to other persons, involuntary commitment may be necessary. Due process should be scrupulously protected-such as the right to neutral decision-maker. Involuntary commitment should not require that the danger to others be "imminent."
• Instead of commitment to a mental hospital, "involuntary outpatient commitment" is a less-restrictive alternative for many persons. After hearing the evidence, a judge may order a person to attend therapy and/or to take medication, as a condition of not being committed to a hospital. Such programs have been successful, and should be expanded.
• Some notorious mass murders could have been prevented if persons who knew about a very dangerous individual had informed the appropriate authorities. For example, officials at Pima Community College in Tucson, and at the University of Colorado's Aurora medical campus, might well have prevented the mass attacks perpetrated by ex-students, if they had informed law enforcement about the known danger. The laws of Arizona and Colorado were more than sufficient for the individuals to have been committed for observation, with longer commitment possible after the observation.

Helping people who have severe mental illness is compassionate, expensive, and one of the best long-term investments that our society can make.