Darci Delgado, Ashley M. Breth, Shelley Hill, Katherine Warburton, and Stephen M. Stahl
Are We Getting Our Money’s Worth Treating Serious Mental Illness as a Crime?
U.S. health care costs are staggering, with spending at $3.5 trillion dollars in 2017.1 Additionally, criminal justice system expenditures are estimated at $270 billion dollars.2 Our nation’s most at-risk individuals are falling through the cracks and entering a vicious cycle of incarceration and temporary institutionalization, which only exacerbates these costs.
In Figure 14.1, the movement of a person through the criminal justice system is represented by squares for each institution or system that provides an individual with mental health treatment and include: county jail, state hospital, and prison. Within each of these institutions, costs for mental health treatment are staggering (Table 14.1). Estimates place jail treatment for individuals with mental illness at anywhere from $33,000 to $168,000 per person per year nationally.3,4 Additionally, once placed in state hospital treatment this cost increases to an average of $242,000 per patient per year in the United States (email correspondence, S. Melching, April 10, 2019).5 The cost of a subsequent placement in state prison depends on whether an individual’s mental health treatment necessitates outpatient or inpatient treatment. The former costs are noted at approximately $80,000 to $100,000 per inmate per year while the range increases substantially if inpatient mental health treatment is required: $300,000 to $550,000 per inmate per year (email correspondence, L. Koushmaro, August 30, 2018). Even with utilizing the most conservative numbers, an individual who commits a crime, undergoes competency restoration, and serves a two-year prison sentence will cost taxpayers somewhere in the range of $355,000 (Figure 14.2).
Cycle of the criminal justice system for a person with mental illness.
Table 14.1 Cost of treatment per person per year
||Per person per year cost range
|Local county jail4,15
|State prison inpatient treatment bed7
|State hospital treatment bed5,6
|State prison outpatient treatment bed7
Example of estimated cost of one individual’s journey through the criminal justice system.