Does cutting mental health care increase the prison population?

Posted at 05:20 PM ET, 06/02/2011

By Suzy Khimm

State-supported mental health care, like many social services, has been especially vulnerable in the recent rounds of budget cuts. Over the past two years, some $1.6 billion has been slashed from non-Medicaid state spending on mental health, according to the National Alliance on Mental Illness. But a growing number of law enforcement officials — along with mental health advocates — are voicing concerns that such cutbacks not only hurt mental health beneficiaries but also overburden the country’s prison system.
In Illinois, where mental health spending has dropped 15 percent since 2009, the Cook County sheriff may file a lawsuit against the state for allow the county jail to “essentially become a dumping ground for people with serious mental health programs,” reports a local ABC affiliate, WLS-TV. The details:

Sheriff Tom Dart says it has gotten so bad Cook County Jail is now the largest provider of mental health treatment in the state. … As much as 20 percent of the jail's population has been diagnosed with some type of mental illness. That's 1,300 to 1,400 people receiving psychiatric care while behind bars.

“What ends up happening is, there’s no safety net to catch them, so they end up committing crimes, getting swept up by the police and coming to jail,” said jail psychiatrist Dr. Jonathan Howard.

The head of Illinois’ mental health department says that the state is trying to make do with limited resources — but acknowledges that it still can’t afford treatment programs such as community-based care that might be more effective, as WLS-TV points out.
Similarly, the Los Angeles Times has examined a public safety program in Nevada that’s also under threat because of mental health budget cuts. The effort pairs police officers in Reno with mental health counselors to reach out to the mentally ill, whether they’ve committed crime, are a threat to themselves, or could be in the future. “Already starved for services, troubled citizens sometimes tumble into homelessness and alcoholism and tussle violently with police, who are usually ill-equipped to help them,” the story explains.
In Nevada and Illinois, as in states across the country, mental health services will continue to be vulnerable to budget cuts. According to University of Chicago Professor Harold Pollack, states deliver many mental health and behavioral services outside of Medicaid and are thus freed from federal coverage requirements — as well as matching dollars — making these services a more tempting target for legislators committed to fiscal austerity.
Mental health advocates have long banged the drum about the connection between mental health and crime, noting especially strong links between recidivism and mental illness. In a recent report on the phenomenon, “Cost-Shifting to Criminal Justice,” NAMI notes that as much as a quarter of prisoners in the United States suffer from a serious mental illness, citing a 2006 Department of Justice study. The group adds that 50 percent of previously incarcerated individuals with serious mental illnesses end up returning to jail — at times because untreated mental illness has led them to violate parole, citing the Council of State Governments.
Such findings may undercut the economic rationale for cutting mental health benefits if states are simply shifting — or increasing — costs to the prison system in doing so. As I've reported previously, many states are also battling to contain prison costs as well as health services. So budget-conscious legislators may be especially willing to think twice if research continues to support this argument.
Suzy Khimm is a staff reporter in the Washington bureau of Mother Jones.