Authors’ note: The disability community is rapidly evolving to use identity-first language in place of person-first language. This is because it views disability as being a core component of identity, much like race and gender. Some members of the community, such as people with intellectual and developmental disabilities, prefer person-first language. In this issue brief, the terms are used interchangeably.
Prisons and jails are some of the United States’ largest providers of mental health services.1 Every year, more than 2 million people with serious mental illnesses are booked into jail.2 The U.S. Department of Justice’s 2011–2012 national inmate survey reported that 1 in 7 people in state and federal prisons, and 1 in 4 in jails, showed signs of “serious psychological distress.”3 The same survey reported that more than one-third of incarcerated people had a clinical diagnosis of a mental health disorder, compared with 1 in 5 nonincarcerated people.4 Individuals with mental illnesses are also 16 times more likely to be killed by police.5 The overpolicing of people with mental health disabilities has driven these disparate incarceration rates, concerning advocates, researchers, and policymakers as the nation faces an escalating mental health crisis.6
This issue brief discusses the history and causes of overpolicing of people with mental health disabilities and provides recommendations for creating long-term solutions, including increasing funding for wraparound services, reducing administrative burdens, and increasing the availability of employment services. Reducing the likelihood of individuals with mental health disabilities experiencing crises will directly reduce these individuals’ negative interactions with police.
The lack of mental health resources results in the overinvolvement of police
Due to workforce and funding shortages, community mental health providers have struggled for decades to meet demand.7 This has resulted in delays in service provision,8 individuals ending up in emergency rooms,9 and people being unnecessarily arrested, imprisoned, or killed.10 Due to limited access to mental health services, family, friends, or bystanders may call 911 for help, which often results in police involvement. Moreover, many people’s first interaction with mental health services is mandated through judicial procedures11—an unfortunate reality, as research indicates that mandated treatment is often ineffective.12 In addition to the lack of services, low engagement in care prior to judicial intervention is often due to the stigma that exists around mental health in the United States.13 The COVID-19 pandemic made this situation even worse.14
The lack of support for mental health services is a long-standing problem. During the Reagan administration, federal spending on mental health services decreased by 25 percent.15 More recently, from 2009 to 2012, states cut $4.5 billion in mental health spending.16 In 2020, the Trump administration increased federal funding for mental health services for the first time in recent history through the CARES Act, which provided $425 million to the Substance Abuse and Mental Health Services Administration, $250 million of which went to certified community behavioral health clinics.17 And in the 2023 spending bill, the Biden administration was able to invest $15 billion in mental health services—a $707 million increase from the previous year.18 However, Americans continue to report difficulties obtaining mental health care, including 43 percent of respondents to a 2022 National Council for Mental Wellbeing survey who stated they were unable to obtain care.19 The top barriers that respondents reported included costs, lack of available providers, and lack of providers who offered treatment in culturally and linguistically appropriate formats.
Current policy action at the federal and state levels
Federal policymakers are currently focused on four separate categories of intervention to address the United States’ mental health crisis: 1) increased funding to train law enforcement personnel; 2) community responder programs; 3) alternative mental health emergency call centers; and 4) the creation of diversion and dispositional alternative programs. While some of these interventions can be helpful in the short term, they do not address the root causes of the mental health crisis. Community mental health services can help reduce crises and stabilize individuals within their own communities, as well as provide lasting supportive care.27 These longer-term solutions are discussed in the following section.
Individuals with mental health disabilities are 16 times more likely to die from an interaction with law enforcement than the general population, according to a 2011 study.28 In recent years, law enforcement has received millions of federal dollars to fund training to improve interactions between police and individuals in mental health crises.29 Yet the deaths of Christian Glass,30 Anthony Hill,31 and Ezell Ford32—all shot by police while experiencing a mental health crisis—call into question whether this additional training is effective, as all the officers involved in the aforementioned shootings were found to have not followed existing police protocols. Moreover, popular models such as crisis intervention training show little evidence of reducing injuries or deaths,33 although recent research has shown evidence that some types of training, such as de-escalation training, can help decrease violent interactions between police and civilians.34
Community responder programs are also seeing some successes. Of the 50 U.S. cities with the largest police departments, 62 percent have established community responder programs since 2020.35 Community responder teams may include mental health professionals, nurses, or other trained professionals who respond to calls instead of police. Cities have found early success with such programs,36 including in Eugene, Oregon, where community responders answered an estimated 24,000 calls in 2019, only 311 of which required police back up.37 Officials estimated that in 2019, the community responder program saved $14 million in state emergency medical services.38 While these programs are necessary, they do not fully address the underlying issues. Communities still lack long-term care solutions, leaving few options for people to be connected with services once they are no longer in acute crisis.
In 2020, Congress passed the bipartisan National Suicide Hotline Designation Act to reroute mental health emergency calls to trained mental health providers through the direct dial number 988.39 This was intended to help reduce both police interaction and the burden on 911 call centers. Yet the new program, similar to other mental health initiatives, began with little funding. And while the Biden administration provided more than $1 billion to states to address mental health through the 2021 American Rescue Plan and the 2022 Bipartisan Safer Communities Act, few of those funds went to public campaign efforts.40 The sustainability of the funding is also unclear. One year after the 988 program’s launch, only 17 percent of Americans knew about it, and Black Americans and individuals in lower income brackets were less likely to know about the program than were other communities.41 Moreover, only eight states have passed laws to sustain funding for 988,42 and problems are starting to mount, with reports of callers hanging up due to long wait times.43 The shortage of behavioral health professionals available to answer the phone, long wait times, and poor funding for in-community mental health services all mean that many calls are routed to a national call center, making it much more difficult for callers to be referred to local services and supports.44 And while 988 touts its lack of geolocating,45 at least 2 percent of 988 calls—or about 44,000—were rerouted to 911 to geolocate so police could track a caller’s location and respond.46 The fact that some calls can be rerouted to 911, and therefore geolocated by police, means that communities may become distrustful of 988. Without sustainable solutions, 988 may become one more failed mental health program.
Dispositional alternatives are another tool cities and counties have utilized in attempts to address the overcriminalization of individuals with mental health disabilities. In 2004, Congress passed the Mentally Ill Offender Treatment and Crime Reduction Act,47 providing funding for mental health courts (MHCs), which focus on the rehabilitation of adults and juveniles with mental health disabilities, particularly first-time offenders, and grants to other programs created to help these individuals. While MHCs offer treatment as an alternative to incarceration, the period over which they monitor or mandate an individual to stay in treatment is often significantly longer than the prison or probation sentence an individual would receive for similar offenses.48 Additionally, there is very little indication that these courts help reduce recidivism: Two studies have shown no significant difference between the rate of recidivism for individuals with mental health disabilities who went through MHCs and the rate of recidivism for those who did not.49 Research has also shown mixed results on the effectiveness of compulsory treatment for mental health and substance use disorders, with some studies showing negative impacts on individuals with substance use disorders.50 It is essential that the United States provide opportunities for long-term community treatment outside the court system in order to prevent individuals with mental health disabilities from going into crisis and to provide ways to resolve symptoms without using punitive pressure tactics.
Recommendations to create longer-term solutions
Preventing mental health crises and enabling long-term treatment are key parts of reducing interactions between people with mental health disabilities and police—and thus reducing these individuals’ incarceration rate. Federal and state governments can achieve these goals by funding wraparound services such as Medicaid’s home- and community-based services (HCBS), reducing administrative burdens to decrease barriers to services and supports, and increasing employment services targeted to workers with mental health disabilities.51
Increase funding for wraparound services
Congress must increase funding for Medicaid to support wraparound services such as Assertive Community Treatment (ACT) programs, which can help prevent and reduce mental health crises.52 ACT provides case management, treatment, medication management, and other supports to enable people to continue living in their homes rather than in institutionalized care. In order to fund programs such as this, Congress must substantially increase Medicaid funding to at least $400 billion, and states must seek HCBS waivers. About 656,000 people were on waiting lists for HCBS in 2021.53 And in 2020, according to Mental Health America, 42 percent of adults with mental health disabilities were unable to afford treatment, and 10.8 percent of adults were uninsured.54
Reduce administrative burdens and eliminate barriers to safety net programs
Administrative burdens are unnecessary red tape, such as complex eligibility requirements and periodic check-ins, that affect disabled people’s ability to obtain and maintain essential services and supports, costing them time, money, and energy.55 Thousands of individuals go bankrupt or die while attempting to obtain Supplemental Security Income and Social Security Disability Insurance.56 Individuals with mental health conditions often have difficulties with executive function, meaning that many, particularly those not currently connected with services, do not apply for disability benefits or give up early in the process.57 Reducing the administrative burdens of accessing programs such as Medicaid will make it easier for individuals with mental health disabilities to obtain treatment and other services.58
Increase the availability of employment services
Increasing financial stability is positively correlated with a reduction in depression.59 It also lowers the risk that an individual will go into crisis,60 and research indicates that being employed can improve mental health symptoms.61 Individuals with chronic mental health disabilities are much more likely to be unemployed or underemployed than their peers without mental health disabilities.62 For this reason, federal policymakers must fund evidence-based employment models, such as individual placement and support, that help individuals with mental health disabilities obtain and maintain partial or full-time employment.63 With the correct support, research shows that individuals with significant mental health disabilities are better able to obtain and maintain competitive employment.64
While the Biden administration has made strides in addressing the overinvolvement of police in responding to individuals experiencing mental health crises, it must do more to alleviate the root causes of crises with longer-term, more holistic solutions. Approximately 2 million people with mental health disabilities will continue to be arrested yearly65 unless government undertakes longer-term change.