Mental Health, Crime, and Criminal Justice – Part 1

EKU Online > Mental Health, Crime, and Criminal Justice – Part 1

This article series is designed to raise awareness about the prevalence of persons with mental illness (PMIs) in the criminal justice system and the challenges it creates for organizations, working professionals, and the PMIs themselves.  National statistics suggest that:

  • 20% of police calls for service involve mental health or substance abuse crises.
  • 28% of people in jail report experiencing serious psychological distress in the past 30 days as compared to only 4% of the general population.
  • 74% of people serving sentences in state prisons have some type of mental health or substance abuse problem.
  • 32.3% of people on probation and 36.6% of people on parole have a mental illness compared to 18.2% in the general population.

But what accounts for the overrepresentation of PMIs in the criminal justice system, and what are agencies doing to address their specialized needs?  These are just a few of the questions explored within this four-part series.

The Complicated Relationship Between Mental Illness and Criminal Behavior 

In this post-COVID era, an increase in a range of mental health problems is garnering attention, especially as it relates to crime and the criminal justice response to persons presenting mental health problems.  Recent media coverage of school shootings and use of force by the police inevitably invoke a debate about their causes with one of the most vocal groups attributing these problems to the mental illness of alleged perpetrators. Given that these public debates often find their way into policy and law, it behooves us to develop a better understanding of the relationship between mental illness and criminal behavior. 

There is a broad range of mental health disorders from low level anxiety and depression to more serious psychotic disorders such as schizophrenia.  It is this latter category of disorders that are commonly believed to be associated with violent behavior.  Most of us have experienced someone on the streets exhibiting bizarre behavior (e.g., talking to themselves, preaching loudly, thrashing their arms around).  These types of behaviors are often triggered by a state of psychosis during which people lose touch with reality and experience hallucinations, delusional thinking, and paranoia.  And it is these behaviors that make people quick to attribute violent crime and other social problems to individual-level mental health problems.  But are these assumptions rooted in empirical data regarding the relationship between mental health disorders and violence?  The answer is not as straightforward as we might like.

The Overrepresentation of Persons with Mental Illness in the Criminal Justice System

Despite common perceptions about violence among persons with mental illness (PMIs), available research suggests that the relationship between mental illness and criminal behavior is relatively weak.  Repeated studies suggest that the risk of violent behavior is only slightly elevated for PMIs, and close examination of crimes committed reveals that only about 10% are directly related to symptoms of severe mental illness.  How, then, do we explain the overrepresentation of PMIs at all stages of the criminal justice system?  According to Skeem and colleagues [i] there are strong, competing risk factors among samples of justice-involved PMIs including impulsivity, antisocial attitudes, and engagement with criminal others which are much stronger predictors of criminal behavior.  In the moment, however, it is difficult to distinguish between mental illness and these other drivers of criminal behavior, and thus, we may feel a heightened risk of danger when presented with the unpredictable and bizarre behavior of someone in a mental health crisis. 

The problem for criminal justice professionals is that perceptions of risk guide their responses to situations.  This can lead to the criminalization of mental illness [ii] and negative outcomes for PMIs.  For example, the unpredictable behavior of people experiencing a mental health crisis and their failure to respond to simple commands, combined with a lack of training for officers, elevate the risk of police use of force.  While it is true that low-level use of force tactics are most common, it is also true that 23% of US police fatalities [iii] in 2015 involved PMIs.  The problem, however, doesn’t stop with police intervention.  In correctional settings PMIs struggle to comply with rules and directives. 

Jail and prison inmates with mental health problems are about 15% more likely to be charged with violating facility rules as compared to inmates without mental health problems.  These charges can lead to placement in segregation units and lengthen their period of incarceration.  Similarly, rule violations rather than new arrests are what drive high rates of recidivism among PMIs on probation and parole, and the official response to these violations is to return the individual to prison at a rate that is two times higher than the rate for violations committed by persons without mental illness. 

Improving the Criminal Justice Response to Persons with Mental Illness

Over the past two decades, the US Department of Justice and non-profit advocacy organizations have supported national initiatives aimed at improving the criminal justice response to PMIs [iv].  Since 2010, the International Chiefs of Police has joined forces with the US Bureau of Justice Assistance to provide law enforcement training and promote the development of collaborations between police and mental health professionals.  Probation and parole agencies have developed specialized caseloads for PMIs that are supervised by agents with expertise in the treatment of mental illness, and correctional institutions have improved their intake and classification processes to better identify PMIs in need of medical resources and protection from victimization by other inmates. 

Despite recent progress, there is still a lot of work to be done to address the needs of PMIs in the criminal justice system.  Increased knowledge about the relationship between mental illness and criminal behavior can guide improved criminal justice responses to this vulnerable population.  The remaining blogs in the series talk about the rights of PMIs within our nation’s prisons, how professionals across Kentucky’s criminal justice system are responding to the challenge of PMIs, and what can be done to support the mental health and well-being of criminal justice professionals themselves. 

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About the Author

Betsy Matthews is an Associate Professor in EKU’s College of Justice, Safety and Military Science, and the program coordinator for the online Corrections and Juvenile Justice Studies program. She received her Ph.D. in criminal justice from the University of Cincinnati and has a blend of practical and academic experience.

Betsy began her career as a childcare worker in a residential treatment facility for behaviorally disordered adolescents before moving into an adult probation officer position in Greene County, Ohio. She also served as a research associate on federally funded grant projects for the American Probation and Parole Association. Dr. Matthew’s research interests include community corrections, correctional rehabilitation, and women, crime, and criminal justice.


[i] Skeem, J. L., Winter, E., Kennealy, P. J., Louden, J. E., & Tatar, J. R. II. (2014). Offenders with mental illness have criminogenic needs, too: toward recidivism reduction.

[ii] Risdon N. Slate, Kelly Frailing, W. Wesley Johnson, Jacqueline K. Buffington (2021). The Criminalization of Mental Illness: Crisis and Opportunity for the Justice System, Third Edition.

[iii] Amam Z. Saleh a, Paul S. Appelbaum b, Xiaoyu Liu b, T. Scott Stroup b, Melanie Wall b (2018). Deaths of people with mental illness during interactions with law enforcement.

[iv] Gosselin, Denise Kindschi (2019). Crime and Mental Disorders: The Criminal Justice Response, Second Edition.

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