It is important to acknowledge that criminalization is not an unfortunate byproduct of a functioning system. Rather, it is incredibly costly, both in financial terms and human terms, and fails to solve problems effectively.

Financial Costs of Criminalization

The financial burdens of incarcerating people with mental disorders are large. For example, lengthy and unintended hospitalizations can become an expensive element of even a low-level arrest when a mental disorder is a factor. In this chapter’s introductory scenario with “Jamie,” it was imagined that this person with serious mental illness might be arrested and jailed for a minor criminal offense but be too mentally ill to understand their present circumstances. But Jamie has a constitutional right to understand the charges against them and to participate in their defense. If Jamie’s ability to exercise these rights is excessively diminished due to a mental disorder, the case cannot be resolved until Jamie is stabilized, reevaluated, and declared mentally fit to proceed. This evaluative and treatment process may need to occur in a psychiatric hospital setting. These complex issues are discussed further in Chapter 6 and Chapter 9.

Rounds of incarceration and hospitalization are very expensive—and very slow. Financial costs include jail, lawyers, courts, psychological evaluators, and perhaps treatment at a state psychiatric hospital that can produce (in our Oregon example) a bill of around $250,000 per year (Disability Rights Oregon Mental Health Rights Project, n.d.). If the person continues on to prison, having gotten caught up in the criminal system, the average bill for a year in federal prison, based on 2020 figures, is around $40,000 (Annual Determination, 2021), and a year in a state prison may be even higher. In Oregon, the cost of a year in prison is estimated at closer to $45,000 (Mai & Subramanian, 2017). These expenses would be covered by taxpayers.

Human Costs of Criminalization

The costs associated with criminalization of mental illness are not, of course, limited to finances. There are enormous human costs borne by individuals and their communities. Criminalization has a continuing impact on individual mental health and ongoing community safety. In our jail-to-hospital scenario, the accused person is moved from one very restrictive environment to another, legally unable to resolve their case without achieving mental stability. A person may spend months jailed, hospitalized, and jailed again awaiting resolution of a case that, if they had no mental disorder, would have been resolved in short order and might not have even resulted in an arrest in the first place.

For a person with a mental disorder, any time spent in jail comes at a high cost. People with mental health disorders who are kept in jail or prison environments are less likely to get the treatment they need than they would in the community, even as they live in environments that are very likely to exacerbate mental disorder symptoms (Bryant, 2023). They may also be left to manage difficult and rule-dense prison environments with few or no accommodations for their disabilities. Failure to adhere to rules may result in additional trauma and harsh treatment, such as solitary confinement (Fellner, 2006). Young men of color, specifically, are more likely to be met with punishment for behavioral problems than to receive the treatment they need to meet expectations in prison, and they are more likely to spend time in solitary confinement (Kaba, et al., 2015). These issues are discussed in more detail in Chapter 7 of this text.

As burdensome as the human costs of incarceration are, these situations represent some of the better outcomes for people with mental disorders who encounter the criminal justice system. People with mental disorders are far more likely than people without mental disorders to be killed by police in a law enforcement encounter. In Portland, Oregon, for the years 1975 to 2020, a total of 85 people were killed in police-involved shootings; 72% of those people were affected by mental disorders (Selsky & Willingham, 2022).

Awareness of Human Costs

Voices in opposition to criminalization cite the human costs when rallying against activities that tend to criminalize mental disorders. The National Alliance on Mental Illness (NAMI), a nationwide advocacy organization for people experiencing mental illness and their families, has been a vocal advocate for reducing the criminalization of mental disorders. NAMI opposes laws that result in criminalization (such as zero-tolerance policing in the face of nuisance offenses) and seeks to educate for change through outreach.

Education should be impactful because the numbers are jarring. Among NAMI’s gathered statistics:

• Nearly one in four people shot and killed by police officers between 2015 and 2020 had a mental disorder.
• About 2 million times each year, people with serious mental illness are booked into jails.
• Sixty-six percent of women in prison reported having a history of mental disorder (twice the number of men in prison).
• Among incarcerated people with a mental disorder, people of color are more likely to be held in solitary confinement, be injured, and stay longer in jail (National Alliance on Mental Illness, n.d.-b.).

NAMI’s efforts to combat criminalization also include sharing powerful personal accounts from people with mental disorders who have experienced mental health crises—often resulting in interactions with law enforcement. If you would like, you can read firsthand experiences shared on NAMI’s website. NAMI also encourages those with lived experience to share that information directly with law enforcement officers in their Sharing Your Story with Law Enforcement (SYSLE) program. The SYSLE program supports individuals in describing their life experiences to educate officers in law enforcement training programs. According to NAMI, these personal presentations are highly impactful for law enforcement officers, enabling them to bring understanding and empathy into future interactions with people experiencing mental disorders (National Alliance on Mental Illness, n.d.-a).

The short video in figure 4.5 describes NAMI’s SYSLE program. As you watch it, consider the benefits to law enforcement officers, and to the larger community they serve, offered by these generous personal presentations.

https://www.youtube.com/watch?v=3HKBBzFifuU

Licenses and Attributions for the Costs of Criminalization

Open Content, Original

“The Costs of Criminalization” by Anne Nichol is licensed under CC BY 4.0.

“SPOTLIGHT: Homelessness and Criminalization of Mental Disorders” by Anne Nichol is licensed under CC BY 4.0.

All Rights Reserved Content

Figure 4.5. NAMI Sharing Your Story with Law Enforcement Program is licensed under the Standard YouTube License.

Figure 4.6. Decriminalize Mental Illness by Disability Rights Oregon is licensed under the Standard YouTube License.