Mental illness and crime

SIGNIFICANCE: The importance of mental health issues in criminal justice can be measured, in part, by the fact that a significant portion of jail and prison inmates suffer from some type of mental illness. However, it is also important not to over associate mental illness with crime.

Mental disorders are common. There are a variety of mental illnesses, and their severity ranges from mild to life-threatening. Many of these disorders are disabling and can profoundly affect the way a person thinks, behaves, and relates to other people. It has been estimated that one in five Americans suffers from one or more types of mental disorder during any given year, though most such afflictions are relatively minor. However, the National Institute of Mental Health estimated that in 2021, more than thirteen million American adults, or 20 percent of the population, or 57.8 million people, suffered from a mental illness, defined as a mental illness resulting in serious functional impairment or disability. While estimates of the rates of mental illness among those incarcerated in the United States vary widely, reports have indicated that some percentage of US prisoners suffer from serious forms of mental illness such as schizophrenia, and many inmates have reported mental health concerns of some sort.

Affective disorders, also known as mood disorders, are mental disorders characterized by disturbance of mood. They include depression, mania, manic depression, and bipolar disorders. Mood disorders often affect sufferers’ attitude and behavior. Depression causes sufferers to become withdrawn from their families, friends, and social activities and to lose interest in their work. Depression affects different people differently. Some sufferers become sad, others may become irritable or fatigued. Many lose their vitality and experience a sense of worthlessness and hopelessness. Often, their sense of judgment gets distorted or severely impaired.

Anxiety disorders are characterized by intense anxiety or by maladaptive behavior designed to relieve anxiety. These include generalized anxiety and panic disorders, phobic and obsessive-compulsive disorders, social anxiety, and post-traumatic stress disorder.

Psychotic disorders involve a loss of contact with reality. They have been grouped in three general classes: schizophrenia, manic depressive disorders, and paranoid states. The central feature of these disorders is loss of contact with reality, characterized by delusions; hallucinations; disorientation of time, place, and person; and general confusion.

Schizophrenia is the most chronic and disabling of all mental illnesses. Sufferers grow out of touch with reality and become unable to separate real from unreal experiences. Other symptoms may involve social isolation or withdrawal. In some cases, unusual speech, thinking, or behavior may precede or follow the psychotic symptoms. Persons suffering from auditory hallucinations hear voices and noises that are not heard by others.

Suicide

Suicide and suicidal behavior are not typically responses to the stresses experienced by most people. However, mental illnesses often alter brain chemistry in potentially dangerous ways so that some people suffering from such illness eventually take their own lives. Many people who kill themselves suffer from diagnosable mental disorders; a vast majority of them suffer from more than a single disorder.

Mental illness is a disorder of the mind, and there are no objective tools to assess what actually goes on inside human minds. Psychiatry therefore defines and diagnoses mental disorders on the basis of subjective symptoms that are reported by the patients or observed by the doctors. Mental health professionals can only speculate about the causes of mental illness. Most emphasize biological causes, such as genetic inheritance or chemical imbalances in the brain. Others view mental illness as rooted primarily in environmental factors, such as family upbringing or social stressors. Relatively few attribute mental illness to individual culpability.

Increasingly, many health professionals agree that mental illness is caused, or triggered, by complex interactions between genetic and environmental factors, such as troubled family upbringing. Advances in psychiatric research point out the role of neurotransmitters, or brain chemicals, in mental illness. According to the prevailing theory, depression and suicide are linked to low levels of the neurotransmitter serotonin, and the drugs known as selective serotonin reuptake inhibitors (SSRIs) are expected to restore the chemical to healthy levels in the brain. SSRIs are widely prescribed as antidepressants for varying levels of depression and anxiety disorders.

Biological theories of the causes of mental illness are appealing to researchers because they have the potential to be directly identified and treated, unlike social factors. If a patient is sick because of a deficiency in brain chemicals, drugs should restore the patient to a better level of mental health. In actual practice, however, some drugs have triggered suicides and bipolar disorders in patients, and the effectiveness of others has been questioned. Research continues to explore the causes and potential treatments for mental illness. According to a 2021 article on News-Medical.net, some mental illnesses have a strong genetic factor, such as bipolar disorder, schizophrenia, and autistic spectrum disorder.

Mental Illness in Prison Populations

A 2024 article published by the Substance Abuse and Mental Health Services Administration (SAMHSA), 44 percent of those in jail and 37 percent of those in prison have a mental illness. The Bureau of Justice Statistics reported in 2021 that according to a 2016 survey, 14 percent of state and 8 percent of federal inmates reported an incident in the last thirty days that met the threshold for serious psychological distress. American prisons house three times as many people suffering from mental illness as psychiatric hospitals. People with mental illnesses in the United States are ten times more likely to be incarcerated than hospitalized. About two million people with mental illnesses are arrested each year.

Prison environments are especially dangerous and debilitating for prisoners who have mental illness. Prisoners suffering from mental illness are more likely to be victimized by other inmates. Inmates with mental illness are often punished for such behavior as being disruptive and engaging in acts of self-mutation and attempted suicide. Moreover, their punishments often take the form of being placed in solitary confinement—restrictive isolation cells that can exacerbate their mental health problems.

The factors that contribute to prisoners landing in jail are often related to their inadequate access to high-quality mental health services. Without these services, people with mental illnesses may engage in behaviors that capture the attention of law enforcement and lead to their arrest. As a consequence, a large number of people are drawn into the criminal justice system because of their psychiatric disorders, and they may not receive adequate treatment in prison. This can also put serious stress on law enforcement resources, as time and money must be spent on dealing with people who are mentally ill, sometimes fielding repeated calls by or about the same individuals. The National Alliance on Mental Illness estimates that 20 percent of service calls at many police departments involve mental illness, and police officers may not be properly trained or equipped to deal with such cases. Debates about how best to respond to such service calls continued into the mid-2020s. Some experts argued that more studies needed to be conducted regarding the efficacy of Crisis Intervention Team (CIT) programs, which had been increasingly adopted across the United States (according to the University of Memphis CIT Center, there were approximately 2,700 programs in 2019) as part of an overall effort to keep people with mental illness from being automatically incarcerated rather than treated through psychiatric facilities and to reduce injury or fatalities (as well as the general use of force) that have occurred during police encounters with people with mental illness. According to a 2019 review of research literature pertaining to CITs in the Journal of the American Academy of Psychiatry and the Law, the authors cited a statistic finding that of the around one thousand people fatally shot by police officers in 2018, about 25 percent involved people with mental illness. Some experts, noting that there were limitations to CIT, argued for more community-organized response teams consisting of individuals such as mental health professionals rather than police.

Despite the overrepresentation of people who have mental illness in the prison system in the United States, society also tends to over associate mental illness with crime, when in fact several studies have shown that the majority of those with mental illness are not criminals and even fewer are violent. According to the University of Washington School of Social Work, public perception of mental illness as connected to violent and dangerous behavior has steadily increased, spurred by depictions in news media and entertainment sources. This misperception can lead to stigmatization of and discrimination against people with mental disorders, creating social conditions that can worsen the challenges facing those with mental health problems.

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