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Mental Health

Why We Must End the Criminalization of Severe Mental Illness

John Snook

Executive Director, Treatment Advocacy Center

Of the estimated 8.3 million adults in the United States living with severe mental illness, approximately half are untreated at any given time. This tragedy is attributable to more than 60 years of flawed national mental health policies. Among many devastating consequences, it has forced law enforcement onto the front lines of mental illness crisis response.


In 2016, the Treatment Advocacy Center documented that the United States had fewer state hospital beds per capita than at any point since 1850. Some may view this as a triumph of “deinstitutionalization,” the 1960s movement to eschew confinement for community care. In reality, we have not reduced confinement at all – we have only transferred vulnerable individuals from clinical to correctional settings. Today, there are 10 times more people with severe mental illness in jails and prisons than in hospitals.

With limited treatment options, dire bed shortages, and outdated civil commitment laws in many states, those in need of mental illness support often don’t receive it until a crisis necessitates law enforcement involvement. This raises safety risks to both the individual in crisis and the officer – people with untreated mental illness are 16 times more likely than other civilians to be killed during a police encounter.

Reducing pressure on law enforcement

Law enforcement officers do not sign up to be mental health practitioners. Foisting that role upon them diverts them from their core mission, damages their community relationships, needlessly criminalizes a medical issue, and ultimately disserves both the individuals in need and the system attempting to provide care.

However, there is reason for hope. The path to improving outcomes for the untreated severely mentally ill, and reducing the burden on law enforcement, is clearly marked by the undeniable success of a number of reform-minded jurisdictions across the nation. And others are beginning to take notice.

Signs of progress

Recent changes to federal law, empowering communities to expand their mental health treatment options, are most welcome. Individualized, community-based programs such as “assisted outpatient treatment” (court-ordered, closely monitored outpatient care for severely mentally ill individuals with histories of disengaging from treatment) are shown to greatly reduce hospitalization and arrest. Now, states must prioritize implementation. At the national level, we must make more treatment beds available for individuals in crisis and do more to support comprehensive education and training of police and other first responders to seek and find alternatives to arresting individuals in psychiatric crisis.

We have the tools to stop the endless cycles of hospitalization, homelessness, and incarceration. By encouraging – and implementing – programs proven to engage at-risk individuals in community-based treatment, strengthen our integrated crisis response systems, and ensure access to hospital care when it’s needed most, we can address the systemic issues that for too long have fed our neglect and criminalizing of severe mental illness.

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