Criminalization of mental illness. What does this mean?

Advocates and social policy critics are using this expression liberally these days, in some sense in a philosophical way.

Criminalization in the philosophical sense can be articulated as follows:

Too many thousands of people with SMI are not getting the medical help that they need. The consequence of this lack of medical treatment is that people are committing criminal offenses. If this population were getting the medical care and other supports that they need, they would not be engaging in the behaviors that lead to arrest, prosecution, conviction, and punishment in the form of incarceration.

More often than not, this type of advocacy does not directly critique the criminal justice system. So what is the solution set for “criminalization” within this mode of advocacy?

Increase treatment beds, remove barriers to treatment, and increase funding for treatment. Implement AOT for people who lack awareness of their illness. Improve all aspects of care delivery, coordination of services, and supportive housing. Connect people to all of these services in order to curtail engagement with the criminal justice system.

  • Improve mental healthcare services for the inmate population, eliminate solitary confinement, coordinate care upon release to reduce recidivism.
  • Compassionate treatment of people with SMI who commit crimes. Proliferate mental health courts and promote diversion of people who commit non-violent crimes through various diversion models. Expand use of felony mental health courts for some (non-violent) crimes.
  • Promote training programs for law enforcement to reduce arrests that channel people into the criminal justice system.
  • A subset of advocates call for reduction of stigma – believing that stigma is a hindrance to willing engagement with treatment (which does not reckon with the fact that anosognosia plays the predominant role in disengagement with pharmaceutical treatment).

 

Due Justice Project attaches an explicit meaning to the term criminalization in the context of SMI:

Unjust conviction and punishment, and in many cases, unjust prosecution. The basis of the injustice is not about lack of compassionate treatment or failure of the mental health system to keep people out of jails and prisons. The basis is the medical science of illnesses that disorder waking consciousness – causing neurological (not psychological) detachment from reality, incapacity to self-audit, self-regulate, and incapacity to conform behaviors to the requirements of the law.

The solution to criminalization:

  • First of all, do not let the perfect be the enemy of the good – actively advocate for all measures in the solution set above but do not cooperate with the philosophical definition.
  • Educate the populace to reduce widespread misunderstanding of SMI.
  • Reform the laws and the mechanics of due process that directly lead to unjust conviction and punishment.