Psychiatric Disorders and Crime in the US Population

The US has one of the highest rates of incarceration in the world, and people with substance use disorder (SUD) and mental health disorders are often overrepresented among correctional populations. However, we know little about these individuals’ risk for criminal involvement in the general population. Why is that important? Understanding who is at risk for criminal involvement can help inform prevention and intervention efforts in communities rather than relying on the justice system, where resources for treating SUDs and mental illness are seriously limited. Also, the majority of people who come into contact with the criminal justice system return to the community at some point, highlighting the need to study community-based populations.

In a study published in The Journal of Clinical Psychiatry, my colleagues and I examined self-reported crime, incarceration, and legal problems (eg, arrest) among people with SUDs and mental health disorders in a nationally representative sample of 36,309 non-incarcerated US adults. Our study showed that criminal involvement was common in the US. More than 1 in 4 people reported committing crimes as an adult, and around 1 in 10 reported having been incarcerated. Recent legal problems (in the past year) were less common: 1.8% of adults reported current general legal problems, 2.7% reported legal problems related to drug use, and 0.8% reported current legal problems related to alcohol use. Adults with SUDs and mental health disorders reported criminal behavior, incarceration, and legal problems at a rate 4 to 5 times that of people without such disorders. Adults with drug use disorders, co-occurring substance and mental health disorders, or multiple mental disorders were especially at risk; rates of criminal behavior, incarceration, and legal problems were 3 to 23 times that of people without these types of disorders. People with a diagnosis of posttraumatic stress disorder or bipolar I disorder were among the most at risk for criminal involvement. People experiencing manic episodes or serious trauma symptoms may engage in reckless behavior that could get them arrested—making it important for practitioners working with these clients to ask about crime in their routine clinical encounters.

On the whole, preventive measures, such as increasing community members’ access to mental health and substance use treatment as well as targeting risky behavior among people with mental health problems, may reduce criminal involvement in the US. In addition, the US community mental health system should strive to better serve individuals who are at risk for or have previous criminal involvement—the stigma toward “criminals” continues to limit treatment options for this population both inside and outside correctional facilities.

Financial disclosure:Dr Moore has no personal financial relationships to report.