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.

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.

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