The mental illness-criminal justice nexus: Evaluating practice and theory

People with mental health needs have staggeringly disproportionate involvement with the U.S. criminal justice system. This is not a new phenomenon; get-tough policies responding to people with serious mental illness who committed crimes prevailed for decades. Over the past 20 years, researchers and practitioners have developed a range of interventions to try to reduce the escalating levels of contact. The interventions, including criminal justice models such as crisis intervention teams, mental health courts, and specialty probation models, and mental health programs such as Forensic Assertive Community Treatment (FACT), were hailed as long overdue reforms to national practices and policies that have produced the world’s highest rate of incarceration, strained the social and economic fabric of many communities, and reinforced racial and class inequalities.8

However, recent research on these interventions demonstrates that they have not succeeded in reducing the number of people with mental illness involved in the criminal justice system. The efficacy of interventions is typically assessed by their impact on recidivism.Careful reviews of program effectiveness, however, have found only mixed or modest evidence that existing programs reduce recidivism.9 Little research on program effectiveness has collected mental health outcome data, and studies that have drawn on this data have been unable to show that improved psychiatric symptoms and mental health status lead to improved criminal justice outcomes.10

A growing body of scholarly literature argues that prevailing interventions— or “first-generation” interventions—have not achieved their goals because they are based on a faulty premise: that people with serious mental illness engage in criminal behavior primarily because of their mental illness.11 Much has been written about the criminalization of mentally disordered behavior in the wake of deinstitutionalization, a hypothesis suggesting that a decrease in the range of options for responding to people with mental illness led to an increase in the number of them in the criminal justice system.12  Many analysts cite the criminalization hypothesis to argue that mental health disorders are causal factors for involvement in the criminal justice system, and that mental health treatment would therefore be a remedy for that involvement.13 Although this hypothesis is a key driver of policy, it fails to account for evidence that untreated symptoms generally do not explain criminal justice involvement; nor does it square with evidence that connecting people to mental health treatment often fails to prevent further involvement.14