Mental Health and Public Safety Funding

Unmet mental health needs among at-risk populations can increase public safety costs.

Police regularly arrest and jail detainees with substance use disorder (SUD) and mental health crises (DPS 2019). As a result, mental illnesses are overrepresented in the criminal justice system compared to the general population, which can increase public safety costs for local and state governments (see our Science Note on Mental Health and Reincarceration).

• U.S. public safety (policing, prosecution, imprisonment) cost $290 billion in 2017.
• Individuals with mental illness and SUD account for a substantial portion of these costs, representing about 44% and 37% of of US jail and prison populations, respect-ively (Bronson & Berzofsky 2017).

Missouri has about 23,000 prisoners, each costing about $34,000 per year (NIC 2020).

• About 24% of these inmates have mental illnesses; the number of incarcerated indiv-iduals with mental health needs in MO has increased by 7% since 2016 (DOC 2021).
• 21% of MO’s Dept. of Corrections funds are allocated to health care providers (DOC 2021, Mai & Subramanian 2017).

Deflection programs can prevent or reduce criminal justice involvement for individuals with mental illnesses.

Deflection programs are collaborations between law enforcement and healthcare services to prevent people with mental illnesses from entering the criminal justice system. These include crisis teams, call centers, and co-responder models (teams including both police officers and mental health professionals) which align appropriate healthcare needs for mental illnesses and help reduce the burden on criminal justice systems (NCSL 2022).

There are five deflection pathways outside of traditional law enforcement:

• Self-referral: Individuals in need of care turn themselves in without fear of arrest.
• Active outreach: First responders or officers seek out and refer individuals needing care to treatment, often with peer assistance.
• Post-overdose outreach: First responders or officers connect individuals to treatment after recovery from overdose.
• Prevention: Referral for treatment occurs in routine activities, without fear of arrest.
• Officer intervention: Officers issue non-criminal citations to complete treatment; charges issued may be dropped after program completion.

The presence of SUD treatment facilities and health and community-oriented nonprofits are associated with lower local crime rates and financial savings to municipal governments (Bondurant et al. 2018, Sharkey et al. 2017).

• Low-income individuals with access to Med-icaid are less likely to be incarcerated than those without insurance (Jacome 2022).

25 states have deflection programs in place, although the programs and funding mechanisms vary widely by state (Figure 1; NCSL 2022). A full list of deflection programs and their funding mechanisms by state can be found here.

Research is limited on how much state mental health funding can reduce public safety costs.

It is unclear whether there are financial savings from reappropriating funding from public safety to mental healthcare. However, there is evidence that deflection programs can lead to state savings in some cases. Interventions that include non-police support may reduce costs to municipalities and states compared to police intervention (Marcus & Stergiopoulus 2022).

• The use of Crisis Intervention Teams in KY resulted in $1.02 million in annual savings for the state (El-Mallakh et al. 2014).
• OK reduced non-violent crime punishments and diverted corrections funds to mental health programs, saving about $10 million in 2020 (State of Oklahoma 2020).
• AZ, CT, and MA saw financial savings by connecting individuals in criminal justice systems to Medicaid (Ryan et al. 2016).
  • AZ estimated saving $30 million in 2015; MA has saved $4.2 million since 2015.

MO’s Justice Reinvestment Initiative (JRI) aims to address behavioral and mental healthcare needs by collaborating with the MO Dept. of Mental Health, HealthNet, Behavioral Health Council, and the Trauma Initiative. JRI-associated programs can be found in Supplemental Table 1. JRI impacts on imprisonment rates are still unclear (DOC 2021).

See our Science Notes on Behavioral Healthcare Deficits and Interventions and Behavioral Health Crisis Response Strategies for more information.

References 

Bondurant, S. R., Lindo, J. M., & Swensen, I. D. (2018). Substance abuse treatment centers and local crime. Journal of Urban Economics, 104, 124-133. Substance Abuse Treatment Centers and Local Crime (nber.org)

Bronson, J., & Berzofksy, M. (2017). Indicators of Mental Health Problems Reported by Prisoners and Jail Inmates, 2011-12. Bureau of Justice Statistics of the U.S. Department of Justice. Indicators of Mental Health Problems Reported by Prisoners and Jail Inmates, 2011-12 (ojp.gov)

Buehler, E. (2021). Justice Expenditures and Employment in the United States, 2017. Justice Expenditure and Employment Series, U.S. Bureau of Justice Statistics. Justice Expenditure and Employment in the United States, 2003 | Office of Justice Programs (ojp.gov)

Council of State Governments Justic Center. (2019). Behavioral Health Diversion Interventions: Moving from Individual Programs to a Systems-Wide Strategy. Accessed on January 30, 2023 at Behavioral Health Diversion Interventions: Moving from Individual Programs to a Systems-Wide Strategy - CSG Justice Center - CSG Justice Center. 

El-Mallakh, P. L., Kiran, K., & El-Mallakh, R. S. (2014). Costs and savings associated with implementation of a police crisis intervention team. Southern medical journal, 107(6), 391-395. Costs and savings associated with implementation of a police crisis intervention team - PubMed (nih.gov) 

Fazel, S., Hayes, A. J., Bartellas, K., Clerici, M., & Trestman, R. (2016). Mental health of prisoners: prevalence, adverse outcomes, and interventions. The Lancet Psychiatry, 3(9), 871-881. The mental health of prisoners: a review of prevalence, adverse outcomes and interventions - PMC (nih.gov)

Jácome, E. (2020). Mental health and criminal involvement: Evidence from losing medicaid eligibility. Job Market Paper, Princeton University. Jacome_JMP.pdf (elisajacome.github.io)

Lamberti, J. S. (2016). Preventing criminal recidivism through mental health and criminal justice collaboration. Psychiatric Services, 67(11), 1206-1212. Preventing Criminal Recidivism Through Mental Health and Criminal Justice Collaboration | Psychiatric Services (psychiatryonline.org)

Legislative Analysis and Public Policy Association. (2021). Deflection programs: Summary of State Laws. Deflection Programs - Summary of State Laws (legislativeanalysis.org) 

Mai, C., & Subramanian, R. (2017). The price of prisons. Vera Institute of Justice. The Price of Prisons | Vera Institute

Marcus, N., & Stergiopoulos, V. (2022). Re‐examining mental health crisis intervention: A rapid review comparing outcomes across police, co‐responder and non‐police models. Health & Social Care in the Community, 30(5), 1665-1679. Re‐examining mental health crisis intervention: A rapid review comparing outcomes across police, co‐responder and non‐police models - Marcus - 2022 - Health & Social Care in the Community - Wiley Online Library

National Council of State Legislatures. (2023). Connecting Recently Released Prisoners to Health Care—How to Leverage Medicaid. Accessed on January 30, 2023 at Connecting Recently Released Prisoners to Health Care—How to Leverage Medicaid (ncsl.org). 

National Council of State Legislatures. (2022). Mental Health Emergencies, Law Enforcement and Deflection Pathways. Accessed on January 30, 2023 at Mental Health Emergencies, Law Enforcement and Deflection Pathways - National Conference of State Legislatures (ncsl.org). 

National Institute of Justice. (2008). Measuring Recidivism. Accessed on January 30, 2023 at nij.ojp.gov:
https://nij.ojp.gov/topics/articles/measuring-recidivism. 

National Institute of Justice. (2020). State Statistics: Missouri 2020. Accessed on January 31, 2023 at Missouri 2020 | National Institute of Corrections (nicic.gov). 

Ryan, J., Pagel, L., Smali, K., Artiga, S., Rudowitz, R., & Gates, A. (2016). Connecting the justice-involved population to Medicaid coverage and care: findings from three states. Menlo Park, CA: Kaiser Family Foundation. Connecting the Justice-Involved Population to Medicaid Coverage and Care: Findings from Three States (aurrerahealth.com)

Sarteschi, C. M., Vaughn, M. G., & Kim, K. (2011). Assessing the effectiveness of mental health courts: A quantitative review. Journal of criminal justice, 39(1), 12-20. Assessing the effectiveness of mental health courts: A quantitative review - ScienceDirect

Schmitt, J., Warner, K., & Gupta, S. (2010). The high budgetary cost of incarceration. The Center for Economic and Policy Research. Microsoft Word - incarceration-2010-06.doc (givewell.org)  

Smith, J. L., Khatri, U. G., Olubiyi, O., Hadley, T., Lim, S., Mandell, D., & Kang‐Yi, C. (2022). Behavioral health service use post‐jail release and reduced risk of return to jail. Journal of Community Psychology, 50(7), 3044-3053. Behavioral health service use post‐jail release and reduced risk of return to jail - Smith - 2022 - Journal of Community Psychology - Wiley Online Library

The State of Oklahoma. (2020). Smart Justice Reform Act (SQ 781) FY 2020 Calculations Report. Office of Management and Enterprise Services. Accessed on January 30, 2023 at Smart Justice Reform Act (SQ781) FY 2020 Calculations Report (oklahoma.gov)