Annually, just shy of 20% of adults in the United States suffer from a mental illness.
Despite this overwhelming statistic, roughly half remain untreated. Several factors work together to stifle an appropriate response to these very real issues. Major obstacles to receiving necessary care include a perpetual stigma surrounding mental health, socioeconomic status, and race.
An initial struggle when confronting mental illness is overcoming the social stigma. Our society does not provide the same safe place for mental healing as we do a physical injury. This is not a new issue. In Addington v. Texas, a case that considered due process in civil commitments, the Court found treatment for mental illness creates “adverse social consequences” for individuals. In Vitek v. Jones, the Court determined that “the stigmatizing consequences of…the subjection of the prisoner to mandatory behavior modification as a treatment for mental illness” was a drastic enough consequence to require procedural protection. Of course adhering to due process is a good thing, but this precedent demonstrates society’s negative association with mental illness.
Social stigma affects everyone who seeks treatment for mental illness. A lower socioeconomic status adds an additional barrier to receiving necessary care. The Mental Health Parity and Addiction Equity Act (MHPAEA) requires insurers to provide access to mental illness or substance abuse treatment at a level not more restrictive than medical or surgical benefits. While this is progress, many people are still restricted by the socioeconomic barriers to accessing healthcare in general. Additionally, despite the mandates of the MHPAEA, there is still the problem of healthcare providers not accepting all insurance for mental health services.
White people receive better healthcare – mental or physical – than Black, Indigenous, and People of Color (BIPOC) communities. Such is the case even when at issue are comparable health conditions provided for by similar insurance coverage. Despite being more likely to report symptoms of mental illness compared to white people, only 33% of Black adults in need are provided treatment for mental illness. Even if a non-white person is provided care, the vast majority (roughly 80%) of psychologists are white. This overwhelmingly dominant white perspective can lead to underestimating the effects of racism on BIPOC communities’ mental health, thus leading to a lower quality of treatment – or no treatment at all.
What does this have to do with the criminal justice system? Our society’s failure to provide adequate care across the board – especially so for BIPOC and lower socioeconomic communities – contributes to the issue of mass incarceration. Without proper treatment, people with mental illnesses are more likely to end up incarcerated. Those imprisoned with a mental illness enter a vicious cycle where their mental health needs are not met, their condition worsens, upon release their criminal record makes it difficult to secure a job and permanent housing, many then become homeless and are often re-arrested.
Dusky v. United States was a landmark decision in 1960 where the Supreme Court held that for a person to competently stand criminal trial they must have a “rational as well as factual understanding of the proceedings against [them].” Upon review, this case provides little protection for people with mental illnesses. In the United States, it is more likely for a seriously mentally ill individual to be incarcerated than hospitalized. In some cases, treatment is only ordered to provide “competency-restoration.” This allows the state to treat an individual up to the point they can appreciate the court proceedings. As as the individual is deemed “competent,” they are criminally charged. This process takes a detour when there is no room in the state hospital. Then the individual must be detained through the criminal system until space opens up for psychiatric treatment. This detainment occurs without a conviction and without a trial. Due to the inadequate treatment options in prison – when actually convicted – people with mental illnesses typically see their condition worsen, consequently they end up serving sentences significantly longer than people without a mental illness who might reduce their sentences through good behavior.
How do we fix this system that so disproportionately harms people suffering from mental illness? Significant reform. We do not currently have appropriate methods of response to mental health or substance abuse crises. Usually, police are the first ones called. Since 2015, almost 25% of people killed by police suffered from a known mental illness. In March of this year, Daniel Prude, a Black man, was killed by police after they found him acting “irrationally.” Daniel was released from the hospital after suffering a mental crisis. Once home he ran away and his brother reported him missing. When police found him they pressed his head into the ground until he stopped breathing. He died a week later after his family took him off of life support. A person experiencing a mental health or substance abuse crisis is typically not able to comply with the demands of the police, nor are police officers trained to deal with mental health crises appropriately.
Mental illness is criminalized in the United States. Our society’s insufficient method of dealing with mental illness disparately impacts BIPOC communities who experience additional barriers to healthcare. The United States’ inappropriate response to the needs of those struggling with mental illness perpetuates the problem of mass incarceration. To help alleviate this issue we must consider a different societal approach to people with mental illnesses – particularly, when they commit a criminal offense.
– L. Moose
Further Reading:
Access to Mental Health Care and Incarceration
The Marshall Project – Mentally Ill Prisoners
Stephanie C. Stimpson, State v. Cowan: The Consequences of Montana’s Abolition of the Insanity Defense, 55 Mont. L. Rev. 503 (1994). Available on Westlaw
Criminal Injustice System 
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