You really have to wonder at what the folks over at White Coat Notes, a health blog by The Boston Globe, were thinking when they wrote this about a recently published study:
Two thirds of prisoners nationwide with a mental illness were off treatment at the time of their arrest, according to a new study by Harvard researchers that suggests under-treatment of mental illness contributes to crime and incarceration. [emphasis added]
How can a survey of current prisoners suggest any type of causal relationship between crime and a medical or health condition? Would anyone suggest that because the same survey data found that prisoners are 31% more likely to have asthma, 55% more likely to have diabetes, and 90% more likely to have suffered a heart attack, that people who have asthma and who are “under-treated” contribute to “crime and incarceration”?? I guess no one bothers to actually read the studies any longer, or even have any type of skepticism when a doctor throws out comments that make no sense based upon their own data.
I guess I shouldn’t blame the author of the article, who was only reporting the ridiculous comments made by one of the Harvard researchers of the study:
“For many of them, treatment of their mental illness before their arrest might have prevented criminality and the staggering human and financial costs of incarceration,” said study author Dr. Steffie Woolhandler, an associate professor of medicine at Harvard and a primary care physician at the Cambridge Health Alliance’s Cambridge Hospital campus.
Really now? And what makes you say that? Because you wrongly believe there is some sort of correlation between having a mental illness (as opposed to asthma) and being more likely to commit a crime? But then again, I wouldn’t expect a primary care physician to be, well, a psychiatrist or mental health researcher who actually is an expert in such topics. So I have to wonder why such a physician feels perfectly comfortable commenting on possible causal relationships that their research had no way of showing.
There’s no doubt that if a person is taking their prescribed psychiatric medication, they’re possibly (probably?) going to be in a better place psychologically speaking. But how that’s related to the likelihood of committing a crime is beyond me, as there is no link between the two. Most people who take psychiatric medications do not commit crimes. And most criminals are not mentally ill.
Such discrimination still exists among researchers, despite the evidence that shows no such link exists (unless the person also has a substance abuse problem). We’ve written on this issue many times because the myth constantly gets repeated, even though it has little research support.
What the study did show is that prisoners are under-treated for their health and mental health conditions. That’s it. No surprise there, as prison systems tend to be under-funded and focused on simple warehousing these days, rather than helping a person reform or really improve themselves (at least in non-criminal ways).
Read the Boston.com article: Harvard study: Under-treatment of mental illness contributes to crime
29 comments
I have to disagree with your commentary on the study’s finding and comments.
The lack of mental care facilities leads to homelessness and petty crims by those who cannot access mental health care and are therefore more likely to be arrested which leads to incareration. Mental health care has deteriorated to such a state to be non-existent to those with or without money and general practitioners are hopelessly under-trained to prescribe adequate medications for treatment.
Mental health is, as you say, under-treated while incarcerated and once offenders are released are more prone to re-offend because at least they had somewhere to go.
BTW I was a criminology major, and statistics themselves cannot be believed but rather anecdotal and case studies are the only evidentiary material to go by in these matters.
While indeed many people who are homeless have mental health issues, it does not follow that all commit petty crimes, and that all who commit petty crimes are then incarcerated.
Your other generalizations also do not follow, as mental health care — whether for the poor or for people with insurance — varies widely from state to state. Where I trained in South Florida and in the Hudson Valley, indigent mental health care was actually quite good and readily available. But that’s not true in every state, or even every county within the same state.
Again, no matter what your particular beliefs may be, research data that are descriptive or correlational cannot describe a causal relationship. This is Research 101. The fact that researchers — Harvard researchers no less — feel comfortable in going beyond what their own data show is disturbing and suggests a political or advocacy agenda, not a research one.
And while I’m all for political advocacy on behalf of increased mental health services (for both prisoners and the poor), we should do so on data that actually show legitimate causal relationships.
I agree with Dr. John here. There’s no evidence of causation with the information we’re presented here. Given that this is nothing more than a correlation, it’s also perfectly plausible that crime and incarceration lead to under-treatment of mental illness. This is another completely legit way to interpret the results, & it may have some truth. Granted, I don’t know much about our prison systems here in the US, but if good mental health care isn’t accessible to all inmates, then of COURSE their mental health conditions would be under-treated.
Nonetheless, Harvard should probably pony up & follow a group for a period of time if they want to establish ANYTHING about causation.
I am not a Dr. of any kind, however I can tell you that in California over 60% of those incarcerated have some sort of mental illness that has been at least partly responsible for their incarceration. 80% have dependency issues. The California medical and mental for our prisons has been placed in Federal Receivership because of the poor or non-existent medical and mental health that has resulted in hundreds of preventable deaths. Mental illness does seem to have a connection to crime from what I have seen.
I haven’t read the article, but I must say that some of your arguments are quite specious. The article seemed to suggest that inmates were not being treated at the point of incarceration, rather than they were untreated in prison as your commentary seems to suggest. Additionally, just as severe physical illness makes it difficult to maintain a job, maintain a social net, and maintain housing, so obviously can mental illness. These factors are well known to impact criminality. Further, while mental illness taken as a whole may not increase violent behaviors, clearly severe mental illnesses such as bipolar and schizophrenia put individuals at risk of becoming violent. If this were not the case we would never have come up with NGRI pleas and John Lennon would be alive today. Yes, we all know that correlation does not equal causation, but when a priori predictions are confirmed by results it certainly lends weight to the causal model proposed. So stop being silly.
Just did a quick lit search and found that the bulk of the evidence, including from population studies (e.g. New Zealand, Finland, and Sweden) and metaanalyses show an increased risk of violence with schizophrenia.
Now of course most violent crimes are not committed by the mentally ill. But what people typically feel afraid of are “random acts of violence,” that cannot be predicted or prevented. It is precisely the “randomness” and unpredictability of the behaviour of individuals with psychotic disorders that makes people afraid. Acts such as “spree killings” are particularly associated with individuals suffering from active psychosis. Most people know that most violence exists either in relationships or in crummy neighbourhoods. Those of us who live in good enough neighbourhoods with good enough relationships tend to feel pretty safe from violence – except from a “raving lunatic.” Even individuals in lousy relationships or living in crummy neighbourhoods often feel in control by knowing “what not to say to may him mad” or knowing who not to look in the eye on the block, or what times not to leave the house. That is what is why people became terrified of “drive-by” shootings, because rules changed and “innocent bystanders” were at risk of being shot.
Its like lions and tigers. We know not to be afraid when we are at the zoo because they are behind fences. When an idiot jumps in the cage and gets mauled we don’t suddenly become afraid of lions and tigers – it was predictable, and we know we don’t have any plans to do the same.
So to summarize, it is not the fact that there is a small percentage of individuals suffering from psychosis out there who become violent, it is the fact that we don’t understand their idiosyncratic motives for choosing their victims. That is what people find scary. That it could be them or their loved ones and you have no practical way of protecting yourself. Well, except for insisting on better treatment of those people suffering from mental illness.
Well, a more nuanced reading of the literature would discover the research decidedly mixed on any relationship, with both negative and positive findings. And the positive findings being very weak when they are there at all.
Which is exactly the same argument one can make for any criminal. Does any of us understand why a burglar might choose our home over our next door neighbors when it can boil down to the fact that one house is white and another is green and the burglar doesn’t like green houses?
I am not a mental health professional, but I work for an organization that works with persons with mental illness and substance abuse diagnoses. A lot of clients commit crimes, a lot do not. What I’ve noticed about those persons that commit crimes is that they have inability to see the consequences of their actions. Having a mental illness does not mean that one cannot understand that actions have reactions. However, drug use and/or low intelligence (not necessarily mental retardation, but simply having a slightly lower I.Q. than the average) seem to play a part in some of our clients’ poor decision-making skills.
Just an observation…
I appreciate your comments. Mental illness does not make one a criminal. However, people with mental illnesses are too frequently incarcerated and treated as a criminal when they should have been sent through a mental health court. Too frequently we find that people who have mental health problems are warehoused in the prison system instead of being treated for their illnesses. For some reason it seems that state governments would rather spend the money on the penal system and not on improving the availability of community mental health services. A well-funded community health program would keep jails and prisons from having folks there who do not belong there. Too many people who wind up there have uninformed judges and courts who know little about the possibilities of treatment and exercise a fundamentalist approach to someone who is in fact ill. It is sad.
PBS did an excellent program on this – http://www.pbs.org/wgbh/pages/frontline/shows/crime/
This program is not for the faint of heart.
If 2/3 of people taken into custody were found to have untreated asthma at the time of their conviction, I would certainly ask wtf is going on.
With all due respect to your article I must disagree with much of what you say. I do believe strongly that a persons mental state can and sometimes does lead a person to commit a crime or do other things he/she may not do if they were being treated for any one of numerous disorders that afflict so many people. now let me say up front that I do not have a p.h.d , and am no expert on the subject. I am simply someone who lives with mental illness everyday who wishes to express there opinion. growing up I had many issues with depression, anxiety as well as bi polar disorder, now it wasn’t until my late 20’s that I was finally able to see a professional to understand why I was the way I was. I am now 33. I did commit a crime about 4 years ago now, I opened a couple accounts in my mothers name all the time believing that I was not stealing, rather I was just borrowing from her. of course now I know that was not the case. I plead guilty to the charges of 1st degree theft. all the time this was happening my anxiety, depression and mood disorders grew worse. it seemed that no matter how hard I tried to seek help no one wanted to offer it to me, you see I had no medical insurance and the thought of paying a ” shrink ” over 100 dollars an hour was out of the question. it was not until I entered the prison system that I finally was treated for my disorders. for the first time someone sat down with me and showed me how I could manage my mental illness. I was prescribed medications and attended classes to help me better understand mental illness and how it did in fact affect my ability to reason and function like others in society. you are wrong when you suggest that mental illness did not have a role in my committing a crime. depression and anxiety had left me unable to work a job for long, and I had little faith in myself to be able to make my own way in the world. and the bi polar disorder left me moody and tired constantly. I could barely function day in and day out. I know in my individual experience that had I understood my disorders better and had I been better equipped to deal with life the way those without mental disorders are able too that I would have never committed the crime I did in 2004. as proof I offer the fact that since being released from a prison after serving 6 months and being properly treated for my disorders I have not been in trouble for anything not even a traffic citation. the reason? well to me its simple, now I know and understand my disorders and treat them effectively with medication as well as other techniques that allow me to function normally and enjoy a much much higher quality of life. unfortunately I am now a convicted felon which makes gainful employment a bit more difficult to obtain, which is ironic as I have seen many people with mental disorders like mine returning to prisons because they are unable to find employment and support there families or themselves which unfortunately leads to them committing more crime. I do not in any way condone the actions of any one breaking the law, however I believe our justice system is horribly uneducated when it comes to mental illness. treatment instead of prison with the exception of violent crimes is much more useful to our society in my opinion. I hope the future brings a better understanding about mental illness to so many who seem to understand so little. thank you very much for allowing me to post my feelings on your article.-
Danny P.
I disagree with your assessment of the article for a very simple reason. Many mental illnesses cause issues with judgment (Bipolar for one, check the DSM for a plethora of others). Why is it hard for you to believe that impaired judgment can contribute to the commission of a crime?
I disagree with your take on this article Dr. John. As a mental health consumer who has found herself in conflict of the law; not due to lack of mental faculties I have an interrupted college education; not due to malice; not due to drugs though the wrong ones have triggered things; due to an undiagnosed case pf bipolar affective disorder. I had my very first severe manic episode complete with psychotic break and was arrested for very serious charges. No violence, no damages to property no physical attacks. I was arrested without incident. I had been misdiagnosed with chronic unipolar depression occuring since 18 (I can now attest undiagnosed at 12) and on a series of several different antidepressants over 20 years. Amytriptaline being the last one, it triggered my episode. I have co current borderline personality disorder (although it is a mild case), anxiety disorder, post traumatic stress disorder and claustrophobia. I find the article you commented on to be Very Accurate. It is all in how you read it. had I been able to access better and more informed professionals, and recieve the Lithium and antipsychotic medication I now take, This would NEVER have happened. I am now paticipating in group therapy using CBT, and one on one councelling. If incarcerated, I will only have medication, while that is a necessity, it is not enough. There needs to be some serious re structuring of the judicial system for the mentally ill, as well as many other things. There needs to be significant changes to the accesibility of psychiatrists by low income people as well as the average joe. I was let down by the health care system, then in dealing with the justice system let down againn by not being referred to Mental Health Court. I am slipping through the cracks, just as i am getting the treatment I should have had all along.
Thank you Angela and Daniel for your inside takes on this issue. I agree with you, as well as the Harvard research article. Whether the under-treatment is a result of lack of health care, knowledge of resources, or unwillingness to be treated, I think it is clear that too often the mentally ill are treated as criminals without consideration of medical or therapeutic needs. This only creates a vicious cycle and locks people inside the system. Good points made by all!
How can you make a completely untrue blanket statement that most criminals are not mentally ill?
I believe that is one of the most ignorant things I have ever read.
It would seem obvious that mental illness can impact judgment in ways that asthma does not. Many crimes are, at bottom, poor choices- bad judgement. Denying any connection is wrong.
Dr. Grohol
I find your pretentious ramblings to be the most ignorant I have ever read or heard of on any topic.
This particular subject is very important to me and you have just given me that much more incentive to forge on in my quest to bring mental health issues to light for children who are suffering in silence and for men and women incarcerated for crimes committed that may have been avoided had they been on proper medications or given counselling that was much needed.
It’s time to make treatment for mental illness not a privelege, but a right.
It will happen and you will see that crime rates will drop.
That I will stake my entire career and life’s work on
Yours in disgust, but a fire fuelled to make change,
Ally Brown
Ontario Canada
Ahh well just found this web site and added this to my favorites I am a 31 year old man I went to college for 3 and a half years for natural resources at steven’s point wisconsin, I was the top student in my class and made the presidents list 2 times and the deans list 2 times I am a very book smart and street smart person. When i turned 21 I ended up getting diagnosed with bi-polar and clinical major depression a year later i was in jail do to my illness I beat up my dad. 3 years later i beat up my dad and my girlfriend and the time I have 4 assalts on my criminal record now none of them felonies. During the time I was ill none of my medications were working for me and I gained 120 pounds of extra weight from my anti-psycotic medication. Ok, who ever says that people with mental illnesses that end up in jail do to just poor jugdgement and choices is a very uneducated person about this topic and should not be making any kind of comment about this issue. During the time that i was sick i could hardly even walk at times let alone get out of bed for an entire 3 years and I went manic for an entire 7 months and did not sleep for and entire 28 days with my illnes I think anybody would be a little angery after that. I had a rule 20 at the time i was in jail which is a test to fined if the person is ether to be found commpetent or incommpetent for their crime I barley even remeber what i did wrong and was lucky i did remember otherwise i probably be still stuck in some state hospital indefenetly. If I never had a mental illness or was being properly treated i highly dought i would have never ended up in jail and that is the truth for me and many other people with mental illnes.
I guess all i have to say is wow!! The crimial justice system needs to be reformed and the mental health system also. People need to understand this especially if you work in one of these systems these are some of the reasons I am a bleeding heart liberal. During the time that I went to jail I was not only extremly mentally ill and I was being abused mentally, emtionally, physicaly and finacialy before I ended up there by my girlfreind at the time ,I was living in a group home at the time too. When I was sick lying on the floor she would take a zippo lighter and click it in my ear for hours. Do to my illnes I was not even caplable of tell her to stop it or did know even how to get out of the situation. We ended up having a kid together which made matters much worse. Before that The threats, insults, and hitting me got even worse. She grew up that way she was abused by her sister and her grandmother who raised her would watch her sister abuse her. Combine this with me being manic and deppresed with clinical major deppresion I also have pariniod schizophrenia and she has bi-polar. As of today I am doing a hell of a lot better I have coustady of my little girl and my mom is helping me in raising her and my x took off to seattle. I forgot to say the she is also a major drug addict and in chips court my lawer said that she is the kind of person that will eventually destroy her self. After being abuse by her in this way for a year I blew up and ended up assalting her I tried to leave her but was so affraid for the safty of my child I did not what my little girl to grow up being abuse by her mother this way. Things are not so black and white or idealistc like people like to make things out but my mental illness was a major contributing factor to the reasons why i end up being abuse and ending up in jail. During that time I ended up in a state hospital in my home town and in that time things got even worse my x was abusing me over the phone and the staff at this state hospital did not care and even started to abuse me emotionaly and pyhcologicaly also the other clients were doing the same thing. Everytime I left the state hopital I commited an assult 1 time on my dad and one time 1 times on my x and one time after leaving jail on my x. During the time in jail I was being extremely harrased and abuse by innmates to how hell does somebody get threw a sitiuation like this and survive even is seriously beond me I was surounded by men who where going to prison for fare worse crimes the me and sometimes was literally fighting for my life in more then one way. I dont judge people like I used to and have a far different perspective on things these days. More then anything I do not judge people that are mentally ill and end up in the criminal justice system in minnesota 25-40 percent of people with mental illness end up in jail prison or probation this is a real problem and the truth is we are all in this toghter weather you like it or not we need to find better solutions for these problems maybe even a cure for mental illness someday.
thank you for reading this
Mark
“clearly severe mental illnesses such as bipolar and schizophrenia put individuals at risk of becoming violent.”
No, they certainly do not. I’m not sure if you didn’t go to college or simply lack critical thinking skills, but do you understand the idea of correlation not equaling causation? Research does not support your offensive simplistic claims.
This whole article troubles me. I am a 36 year old male, I suffer from multiple “Mental Illnessies” as they have been labled here.
This is in my opinion, and I speek with ALOT of experience, my “MI” and jail, prison, and mental health commitments, IS NOT an issue with our corrections departments. That is simple, you commit a crime, you pay for it. People without “MI” commit crimes due to reasons unknown to some, that they would not “normaly” commit as well. Using a “MI” as an excuse to be released or receive a lesser charge or punishment is not only a play of our justice system, but “unfair” to those without “MI” who would “normaly” not commit the same crime. If you receive a D.U.I. do you compalian because people who dont drink cant get that charge? No..
The lapse here is NOT the justice system, If you claim the people with “MI” wouldnt do these crimes with proper care, and medications, or what have you, then does the problem not fall short of our HELATH CARE SYSTEM? Clearly if all these people could get the help needed WHEN needed, they wouldnt be in the jails/prisons.
I have been found disabled from my “MI” and receive disability payments for this, the amount is minimal, I can not receive any medical assistance from my state or county, and 1/2 of my payments go to paying my medicare premiums, and I am responsible for 20% of all medical costs. So, does this consititue help, not in my eyes, If it werent for friends and family support, id probly be in prison. I do not have my medications for lack of $1863.76 a month to pay for them, yet im not in prison. I have issues, yes, but I know not to commit crimes, and though our health system does not recognize that help is needed for these situations, I beleive our Health care system is faulty beyond help, my meds costs far exceed my means, I cannot obtain employment, and with the rsdi payments can not afford to even have a place to live let alone eat. I have had legal issues, and bad ones, and I have “MI”, can they be related, sure, should one excuse the other? NO.
Could you please provide data that supports the statement “most criminals are not mentally ill”?
I agree with Dr Grohol’s assessment of the “research.” I get so sick of people acting as if mental illness = criminal behavior. Talk about reinforcing stigma.
Most people with mental illness are law abiding citizens. Oddly enough, even with a serious mental illness, I’ve never committed a crime. Shocking, I know.
Is it possible that many criminals (even those with mental illness) also happen to be jerks? Is it possible that it’s the jerk part of them that caused them to commit a crime?
I am about to cite this argument in my MA-Criminology assignment. I also agree with Dr Grohol that mental illness on its own is unlikely to cause crime. Reading the response posts above and considering people’s personal experiences in this area it is clear (and no disrespect intended) that some of the arguments intending to disagree with Grohol, unwittingly agree with him. A number of posts mention an effect of alcohol/drug (prescription or other) that contribute to their criminal behaviour and this is one of the major issues current research is trying to get at: MI contributes yes, but in most cases criminality results only as a result of MI in conjunction with substance & alcohol abuse. Semantics perhaps, but fact all the same.
As Grohol points out in his review, there are other disorders and medical conditions (kidney disease, HIV, Hepatitis) that are more prevalent than MI in prison populations, yet there is no argument that asthma is a predictor of criminal behaviour…
I am currently studying criminal psychology and have found this article along with the comments very interesting. I am on the fence on this topic.
Through my course I have looked in detail at the effects of mental illnesses on crime and have found that there is some correlation but we do not know why or how. Although I am not saying every criminal who says they have a mental disorder should be treated like a wounded puppy, but should be evaluated in recognition of the statement. There are cases where people say they have a mental disorder in order to get leniency. We can not argue that which we do not understand fully, I do not have a mental illness and I believe those people who wrote in detailing their stories have more experience and knowledge on this topic than any person can, even psychologists devoted to the studies.
I do however believe that the issues raised about health care are accurate. All society’s have issues surrounding their health care institutes and funding. My mother works at an institute of mental health for criminals and she said that it is adequate but nothing special.
I believe there is still so many questions to be answered and some that we may never have the ability to answer in order to fully understand the issues surrounding mental illnesses and crime…
I have three members of my family that suffer from mental disordories. Wounded puppies they aren’t ill-treated human beings they are and under treatment for their mental disorders contributes greatly to crimes and incarceration that they experience. Compassion they deserve, especially since there is much indifference and negativity built-in our supposedly fair and equal justice system, particularly, when my family members that are under treated for their mental illness appears in court they are viewed as a meal ticket. Look into the prison business, the cost to house an inmate. Mental illness doesn’t equal crime but police, sheriffs correction officers and prison staff like their fat pay checks, so who cares about my family members’ special needs. The issues of mental illness and crime, psychologists I appeal stay devoted to the studies.
I can provide support to the study. My family members and friends are of the two thirds, at the time of their arrests, now, incarcerated with mental illnesses. Sufferers of the outcome of under treatment of their mental illness, ,and the inequality built into our political and justice system. My love ones experience hurt and humiliation as a result of the unhealthy attitudes about positive healthcare reform. The antiquated behaviors in both major parties that don’t permit a healthcare bill to pass that helps especially persons with mental illness is why much social injustice continues in our supposedly liberated society. My love ones without affordable healthcare, on disability, didn’t have an equal income to paid for the high cost of, quality, medicine. Medication that addresses their chronic asthma, serious insomnia and depression that debilitates Chemicals in their bodies, it is a fact, regulate thoughts and control behaviors, but persons in my family with mental health disorders also have asthma they are hindered and weaken, more so, is the results of under treatment. They are vulnerable to many systematic abuses and that includes persons in power that misuse their citation sway and judicial authority. True, violence and mental illness perceived to go hand and hand, aren’t jointed at the hip. Your point is clear and necessary as is Dr. Steffie Woolhandler intention to make understandable that under-treatment of mental illness that definitely be a factor in the inability to prevent crime and greatly takes account of the high cost of unnecessary incarceration. Where is the study of salaries, money made from prison warehousing in counties, states and federal correctional facilities? Where is the study that shows why rehabilitation of inmates, particularly, African-Americans isn’t an essential focus or taken seriously? Where is the study that shows how warehousing prisons negatively impacts the incarcerated, particularly, the majority, African-American males?