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 one of the introductory scenarios 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 the right to understand the charges against them, and to participate in their own defense. If Jamie’s ability to exercise these rights is excessively diminished due to a mental disorder, their case cannot be resolved until they are stabilized, re-evaluated, and declared mentally fit to proceed. This evaluative and treatment process often occurs in a hospital setting. (See further discussion of these Constitutional issues in Chapter 6.)

Rounds of incarceration and hospitalization are very expensive – and very slow. Financial costs include jail, lawyers, courts, psychological evaluations, and perhaps treatment at a state psychiatric hospital, producing (in our Oregon example) a bill of around a quarter of a million dollars per year (Disability Rights Oregon, 2020). If the person continues on to prison, having gotten caught up in the criminal system, the average bill for a year in federal prison is around $40,000 (Bureau of Prisons, 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).

4.3.1 Human Costs of Criminalization

The costs associated with criminalization of mental illness are not, of course, limited to finances. There are enormous human costs. 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, might never have resulted in arrest, and in any case would have been resolved in short order.

Any time at all spent in jail, for a person with a mental disorder, comes at a high cost. People with mental health disorders who are kept in a jail or prison environment are less likely to get the treatment they need than they would in the community. This is due to institutional staffing shortages as well as low quality care in institutions. For example, patients may be treated with only medication, when they would benefit from thoughtful treatment planning, including counseling or therapeutic groups.

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 the treatment they need to meet expectations in prison, and they are more likely to spend time in solitary confinement (Kaba et al., 2015).

As burdensome as the human costs of incarceration are, these situations represent some of the better outcomes for people with mental disorders encountering the criminal justice system. People with mental illness are sixteen times more likely than other people 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 shot to death by police; 72% of those people were affected by mental illness, substances or some combination of those (Selsky & Willingham, 2022).

4.3.2 Combatting Criminalization

Voices in opposition to the problem of criminalization cite the human costs, particularly, in rallying against activities that tend to criminalize mental illness. The National Alliance on Mental Illness (NAMI), a nationwide advocacy organization for people experiencing mental illness and their families, has been a vocal advocate of reducing criminalization of mental illness. 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.

The education approach should be effective, because the numbers are jarring. Among NAMI’s published statistics:

• Nearly 1 in 4 people shot and killed by police officers between 2015–2020 had a mental disorder.
• About 2 million times each year, people with serious mental illness are booked into jails.
• 66% 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, non-white people are more likely to be held in solitary confinement, be injured and stay longer in jail. (National Alliance on Mental Illness, n.d.; National Alliance on Mental Illness, 2022)

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 first-hand experiences shared on NAMI’s public website. NAMI also encourages those with lived experience to share that directly with law enforcement officers in their Sharing Your Story With Law Enforcement (SYSLE) program. The SYSLE program supports individuals in describing their valuable lived experience to educate officers at law enforcement training programs. According to NAMI, these personal presentations are highly impactful for the law enforcement officers, enabling them to bring understanding and empathy into future interactions with people experiencing mental illness (National Alliance on Mental Illness, n.d.).

The short video in figure 4.3 describes NAMI’s SYSLE program. As you watch it, consider the benefits to the law enforcement officers, and to the larger community they serve, offered by these generous personal presentations.

Figure 4.3. NAMI Sharing Your Story With Law Enforcement Program [YouTube Video]. Video providing officer perspective on NAMI’s Sharing Your Story With Law Enforcement Program.

4.3.4 The Costs of Criminalization Licenses and Attributions

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

Figure 4.1 “Woman Prison Jail Free Stock Photo” by Matthew Henry is in the Public Domain, CC0

Figure 4.2 – “Toronto Police Officer and homeless man in 1995” by Ivaan Kotulsky , City of Toronto Archives is licensed under CC BY 4.0

Figure 4.3 – NAMI Sharing Your Story With Law Enforcement Program is  Licensed under Standard YouTube License.

Figure 4.4 – “Decriminalize Mental Illness” © 2019, Disability Rights Oregon. License Terms: Standard YouTube License.