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Fixing Our Mental Health System

The recent tragedy in Newtown has finally woken Americans up to the pitiful state of our mental health system.  We have had many dozens of these tragedies over the last three decades, and certainly, the pattern has been clear since at least 2000: people with recognized serious mental-illness problems are about half of these mass murderers, and it seems likely that much of the rest had unrecognized or perhaps merely undocumented problems.  (What sane person murders a bunch of complete strangers, then commits suicide?)

I have been banging the drum on this for several years, and each time, someone asks, “How are you going to pay for all this?” Mental hospitals are expensive to build, especially because so many states have either closed or demolished their state institutions.  Once built, operating costs are substantial.  In an era when many state governments are already in financial trouble, where is the money coming from to create a safer and more humane society?

We are already spending the money; we just aren’t spending it very efficiently, because we are spending it on cleanup.  Drawing chalk marks around bodies, having medical examiners do autopsies, assigning extra police to schools across the country after each disaster -- these aren’t free.

Many of these mass murderers do not commit suicide, and trying them is expensive.  The public defender costs alone for capital murder trials in Clark County, Nevada, for 2009-2011 were $229,800; for non-capital murder cases, $60,100.  It seems quite believable that including prosecution costs, time spent operating the courts and investigating the crime, and the inevitable appeals a non-capital murder trial can easily cost the government $500,000, especially because mentally ill defendants are almost always indigent, and thus receive public defenders.  I almost forgot: because these are mentally ill murderers, the costs of experts to evaluate the defendant’s mental competency for trial almost certainly drives these costs up even higher.

Once convicted (even if found not guilty by reason of insanity), one can reasonably expect life in prison.  As an example, Colorado spends more than $32,000 per year per inmate; that’s almost a million dollars per inmate for 30 years.  The spending is just starting, however: mentally ill inmates cost almost twice as much as sane inmates, because of the costs of mental health care once they are in the slammer.  It seems a good bet that each mentally ill murderer costs the state $2.5 million over his lifetime.  If they get the death penalty for the murder (as sometimes happens), it will be much more expensive than that: at least ten years in prison waiting for the ACLU to lose the battle, but all the legal costs of the appeals.

There were 14,022 murders and non-negligent manslaughters in the U.S. in 2011.  Of these, 12,706 were cleared by arrest.  If we assume that 10% of these persons charged were mentally ill (based on studies of murderers and mental illness), that’s about 1270 murders by the mentally ill a year (minus a few suicides among the mass murder set).  We could easily be accruing more than $3 billion a year in current and long-term costs.  How much mental health care can you pay for with $3 billion?

Of course, this isn’t really fair.  If we successfully divert people into the mental health system before they commit crimes like murder, we will also make substantial inroads into other social costs that are somewhat harder to quantify: fewer homeless people begging on the streets; fewer requests to local governments to fund homeless shelters; fewer homeless people making a nuisance of themselves in public libraries. And I have not even considered the other major and minor crimes committed by mentally ill people who fall through the cracks.

I found myself wondering a little while back, how is it that I grew up in California at a time when community college tuition was free, the University of California's costs were quite reasonable, and yet it was far less wealthy of a society than today? How did they manage to provide so many services, so effectively, with relatively little revenue? I am beginning to wonder if the problems of state or local government that have developed over the last forty years might be because we are spending money trying to clean up disasters, rather than prevent them.