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Treat or Repeat

A State Survey of Serious Mental Illness, Major Crimes and Community Treatment

September 2017

Individuals with serious mental illness who have committed major crimes represent 2% of the estimated 8.2 million individuals with a severe psychiatric disease in the United States. Although this is a small segment of the total population, research shows that, without treatment, these individuals are at heightened risk of being re-arrested after their release from jail or prison or discharge from a forensic hospital.

Because the timely and effective treatment of individuals with the most severe mental illness is the focus of its mission, the Treatment Advocacy Center conducted a survey of selected state systems and structures available to individuals with serious mental illness who have committed major crimes. The states were graded from A to F based on the availability and comprehensiveness of these practices.

The result, Treat or Repeat: A State Survey of Serious Mental illness, Major Crimes and Community Treatment, finds this population is often overlooked in programming and funding decisions. The report recommends prioritizing evidence-based treatment to reduce re-arrest of individuals with serious mental illness who have a history of violence.

Top Takeaway

Evidence-based programs for individuals with serious mental illness who have committed major crimes allow individuals to succeed in the community following reentry from jail or prison or after discharge from a forensic psychiatric bed by providing complete and intensive treatment. However, no state in the United States utilizes them comprehensively or effectively.

Fast Facts

• No state received an A grade. The majority of states do not provide adequate support in the community for individuals with serious mental illness who have committed major crimes, resulting in higher re-arrest rates and all the attendant human and economic costs of re-incarceration.
• Evidence-based programs can reduce the risk of re-arrest for individuals with serious mental illness living in the community from an average rate of 40%-60% to only 10% or less.
• The four states that received the best grades under this study – Hawaii, Maine, Missouri and Oregon—are all models that other states should look to for various aspects of their successful programming. Other states with exemplar programs and practices were also identified.

Recommendations

• Federal, state and local governments must create policies to stop the criminalization of individuals with serious mental illness.
• Federal, state and local governments must prioritize treatment for individuals with serious mental illness who are involved in the criminal justice system.
• State and local governments must implement evidence-based treatment programs for individuals with serious mental illness who have committed major crimes.
• Researchers and government agencies must conduct research and evaluate programs for individuals with serious mental illness who have committed major crimes to inform best-practices.