1. SOCIOECONOMIC CONSEQUENCES AND COSTS OF MENTAL ILLNESS 1
The Socioeconomic Consequences and Costs of Mental Illness
Mika Truly
The University of Texas at San Antonio

2. SOCIOECONOMIC CONSEQUENCES AND COSTS OF MENTAL ILLNESS 2
The Socioeconomic Consequences and Costs of Mental Illness
Introduction
The deinstitutionalization of the mentally ill in the 1960s and 1970s resulted in the
release of the mentally ill from state institutions into a society that many experts in the field feel
was not fully prepared for them (Curtis, 1986, p. 34). Approximately 40 million people in the
United States have a mental illness (Garske & Williams, 1999, p. 39). Life for this population
outside of state institutions raises many unique challenges for society to handle. With a high
number of mentally ill people now living in communities, the mentally ill are striving to fulfill
normal roles in society (Diaz-Caneja & Johnson, 2004, p. 472).
This review will highlight some of the main socioeconomic consequences and costs of
mental illness. First, this review will discuss the issue of the prevalent co-occurrence of
substance abuse and mental illness and the effects of this phenomenon on society such as
increased violence perpetrated by the mentally ill (Swartz et al., 1998, p. 230). Secondly, the
considerable increase in incarceration of the mentally ill known, as the “criminalization” of
mental illness will be examined. Then, the costs of the high percentage of mentally ill homeless
people will be discussed. The literature concerning the consequences of mental illness in mothers
will also be looked at. Next, the costs to the nation of the reduced productivity that mental illness
causes in suffers will be investigated. Lastly, the monetary costs of federal programs for the
mentally will be considered.
The Common Co-occurrence of Mental Illness and Substance Abuse
Approximately half of adults with severe mental illnesses also have a substance abuse
disorder however only 8% of these adults receive treatment for both disorders (Angelo et al.,
2013, 162). These adults usually do not respond to traditional substance abuse treatments and

3. SOCIOECONOMIC CONSEQUENCES AND COSTS OF MENTAL ILLNESS 3
their substance abuse disorder often interferes with their psychiatric treatment (Ridgely & Jerrell,
1996, p. 562).
Increased Violence
In 1998, Marvin Swartz, Jeffery Swanson, Virginia Hiday, Randy Borum, Ryan Wagner
and Barbara Burns published a study that looked at the effects of substance abuse and
nonadherence to medication in the mentally ill. The purpose of the study was to better
understand violent behavior in the mentally ill (Swartz et al., 1998, p. 226). The researchers
found that “substance abuse, psychotic symptoms, and lack of contact with specialty mental
health services in the community all are associated with greater risk of adult-lifetime violence
among persons with severe mental illness” (Swartz et al., 1998, p. 227). Substance abuse is
correlated with medication noncompliance (Swartz et al., 1998, p. 227). One possible reason for
this is that when mentally ill people do not take their psychiatric medications, they instead self
medicate with illicit substances and or alcohol.
The researchers interviewed involuntarily admitted psychiatric patients. The sample was
about 2/3 black and 1/3 white. (Swartz et al., 1998, p. 228). Data from direct interviews with the
subject, telephone interviews with family and friends of the subject and hospital records was
compiled to gain information about violent acts committed by the subject. 17.8% of the subjects
had engaged in violent acts. 33.8% of the interviewees had used at least one type of illicit
substance, 53.2% had used alcohol and 58.9% had used either or both at least once a month
during the 4 months before hospitalization and 57.4% of these users either had problems related
alcohol or substance abuse or had a co-occurring diagnosis of a substance use disorder (Swartz et
al., 1998, p. 227).

4. SOCIOECONOMIC CONSEQUENCES AND COSTS OF MENTAL ILLNESS 4
The main finding of the study is that respondents with both nonadherence to medication
and substance abuse problems were more than twice as likely to commit violent acts (Swartz et
al., 1998, p. 230). One weakness of this study is that all of the subjects interviewed were
involuntarily admitted to the psychiatric hospital meaning that they were individuals who were
“judged to be at risk for poor outcomes in community treatment” (Swartz et al., 1998, p. 230).
Therefore, the sample used in this study is hardly representative of all mentally ill people.
Higher Costs in Psychiatric Care
In 1996, Barbara Dickey and Hocine Azeni published a study that looked at the costs of
psychiatric treatment of individuals who have a substance abuse problem and are also mentally
ill (Dickey & Azeni, 1996, p. 973). The study examined the costs of treatment for all adult
psychiatrically disabled Medicaid beneficiaries in the Commonwealth of Massachusetts during
1992. The vast majority of the participants were white and 43% were male (Dickey & Azeni,
1996, p. 974).
The study made a distinction between three groups of people: people who had been
treated for a comorbid substance disorder, people who showed proof of a disorder but had not
been treated, and those who showed no evidence of a substance abuse disorder (Dickey & Azeni,
1996, p. 974). The people who were identified to have a substance abuse disorder were more
likely to be male, younger and to be diagnosed with a major affective disorder (Dickey & Azeni,
1996, p. 974). The people who had substance abuse problems and a mental illness were four
times more likely to be inpatients of a psychiatric hospital and spent more time hospitalized over
the course of a year (Dickey & Azeni, 1996, p. 975).
The costs of treatment in the three groups showed that mentally ill persons without a
known substance abuse problem had much lower mean treatment costs at $13,930 annually.

5. SOCIOECONOMIC CONSEQUENCES AND COSTS OF MENTAL ILLNESS 5
Those with treated substance abuse problems had annual mean treatment costs of $22,917 and
those with untreated substance abuse problems had treatment costs of $20,049 annually (Dickey
& Azeni, 1996, p. 975). Dickey and Azeni expressed that funds spent on psychiatric treatment
would be better spent in “treatment programs that emphasize treatment of both disorders”
(Dickey & Azeni, 1996, p. 977).
The Incarceration of the Mentally Ill
Currently, there are more mentally ill individuals in prison than in psychiatric units at any
given time (Pearson, 2001, p. 165). The deinstitutionalization of the mentally ill and the tougher
sentences for drug charges have both contributed to the increase in incarceration (Dumont, Allen,
Brockmann, Alexander, & Rich, 2013, p. 28). Over half of prison inmates are mentally ill
(Dumont, Allen, Brockmann, Alexander, & Rich, 2013, p. 28).
Monetary Costs of Incarceration
Currently 1% of the population is in prison or jail and supporting this population of
inmates is maintained at a great cost to tax payers (Henrichson & Delaney, 2012, p. 68). States’
corrections spending on prisons have virtually quadrupled over the past twenty years making it
the fastest-growing budget item after Medicaid (Henrichson & Delaney, 2012, p. 68). The full
price of prisons to taxpayers is $39 billion. The average total per-inmate cost is $31,286 and
ranges from $14,603 in Kentucky and $60,076 in New York (Henrichson & Delaney, 2012, p.
70). Incarceration also affects the families of inmates by straining them financially (Henrichson
& Delaney, 2012, p. 69).
Lack of Opportunities Subsequent to Imprisonment
Because of higher than average rates of unemployment and their common histories of
family instability, the lives of mentally ill inmates are particularly negatively affected by

6. SOCIOECONOMIC CONSEQUENCES AND COSTS OF MENTAL ILLNESS 6
incarceration (Rich, 2009, p. 106). In 2012, Rocio Dominguez Alvarez and Maria L. Loureiro
published a study to analyze the economic consequences of imprisonment for ex-inmates. The
majority of the interviewees were male (90.13%) and 53.95% held a job prior to incarceration
(Dominguez Alvarez & Loureiro, 2012, p. 472). The variables in the study include if the
respondent had been arrested previously for murder, age of the respondent, if the respondent had
no job training, if the respondent had university training, if the respondent had no educational
qualifications, total time spent in prison, and if the respondent had a parent or sibling with a
criminal record (Dominguez Alvarez & Loureiro, 2012, p. 474). The researchers surveyed prison
inmates in 31 German prisons between the years 2003 and 2004 (Dominguez Alvarez &
Loureiro, 2012, p. 470). One possible shortcoming of this study is that some differences in the
abilities of the convicts may have been indiscernible because the surveys and the responses
generated from them do not allow for elaboration.
The researchers estimated four OLS models and represented estimates provided by these
models in a table. Model one and two in the table include the full sample, while model three only
includes individuals who have never been imprisoned and model four includes individuals who
have been in prison before their last conviction (Dominguez Alvarez & Loureiro, 2012, p. 475).
Some findings of the OLS models are that imprisonment has an effect of inmates’ wages
especially if the inmate committed murder, which always has a negative effect on wages
(Dominguez Alvarez & Loureiro, 2012, p. 475). Another finding is that the lack of training
negatively influences wages and university training increases wages. The wage of individuals
with university training is even higher when they have never been imprisoned (Dominguez
Alvarez & Loureiro, 2012, p. 475).

7. SOCIOECONOMIC CONSEQUENCES AND COSTS OF MENTAL ILLNESS 7
The researchers used quantitative techniques to analyze the labor-market-related
consequences of incarceration. By employing a Heckman selection model the researchers
extended the OLS models and were able to determine the effect of the variables such as age,
university training etc. on the individuals’ employment and wages (Dominguez Alvarez &
Loureiro, 2012, p. 478). The researchers hypothesized that factors such as the length of time
spent in prison would have a negative effect on employment and wages (Dominguez Alvarez &
Loureiro, 2012, p. 478). By modeling wages based on the characteristics of the inmates, the
researchers were able to find the effects of these features on the likelihood of finding a job
(Dominguez Alvarez & Loureiro, 2012, p. 482). The researchers were partially correct in their
hypothesis concerning the effect of the length of time spent in prison on labor outcomes. The
Heckman model results show that total time spent is prison and the family background of the
inmate only decreases the wage received, and the decrease isn’t statistically noteworthy in the
job equation (Dominguez Alvarez & Loureiro, 2012, p. 479).
Next, by using a Blinder-Oaxaca decomposition based on a Heckman selection model a
wage gap between inmates and non-inmates of €735.46 per month was found (Dominguez
Alvarez & Loureiro, 2012, p. 483). 21.11% of this gap is explained by the more fortunate
circumstances of the non-inmates such as their educational attainment and non-criminal family
background (Dominguez Alvarez & Loureiro, 2012, p. 483). A second possible weakness in this
study is that the wage gap found between inmates and non-inmates in the Blinder-Oaxaca
decomposition may be explained by the effects of having a parent or sibling with a criminal
record on social stigma. Therefore the variable “family background” is possibly an endogenous
variable. An improvement could be made to this study by expanding upon the information

8. SOCIOECONOMIC CONSEQUENCES AND COSTS OF MENTAL ILLNESS 8
gained in this study with data acquired incrementally through time such as in a longitudinal
study.
Recidivism
The widely held consensus is that the use of psychiatric medications raises the likelihood
of recovery in mentally ill individuals (Rich, 2009, p. 106). However, more than 25% of state
correctional facilities do not disperse psychiatric medications to their inmates (Rich, 2009, p.
107). The lack of medication combined with the lack of therapy, precipitates harmful effects in
mentally ill individuals (Rich, 2009, p. 106). Mentally ill inmates will often be in even worse
condition upon their release into society than when they were first incarcerated leading to higher
risks to public safety and higher treatment costs (Rich, 2009, p. 118). The lack of proper
psychiatric medication during incarceration and the minimum follow-up care upon discharge is
highly likely to cause mentally ill ex convicts with a substance abuse problem to self medicate
with illicit substances upon release from prison (Rich, 2009, p. 115). This drug use will often
quickly be detected in urine tests by parole supervision leading to recidivism in the mentally ill
(Rich, 2009, p. 115). Recidivism leads to higher costs to taxpayers. Offenders who receive
treatment rather than being incarcerated have been found to be less likely to reoffend (Dumont,
Brockmann & Rich, 2013, p. 28).
The High Prevalence of Mentally Ill Homeless Individuals
Since the deinstitutionalization of the mentally ill in the 1960s and 1970s, the number of
homeless people has grown greatly (Murphy & Tobin, 2014, p. 275). Some scholars attribute the
high growth of homeless people to deinstitutionalization (Salit, Kuhn, Hartz, Vu, & Mosso,
1998, 1734). 26% of homeless people are mentally ill. While less than 5% of the general
population has a mental illness (Pearson, 2001, p. 165).

9. SOCIOECONOMIC CONSEQUENCES AND COSTS OF MENTAL ILLNESS 9
Higher Costs of Hospitalization in the the Mentally Ill Homelessness Population
In 1998, Sharon Salit, MA, Evelyn Kuhn, PhD, Arthur Hartz, MD, PhD, Jade Vu, MPH,
and Andrew Mosso, B.A. conducted a study on the hospitalization costs associated with
homelessness in New York City. The researchers compared homeless patients with other low-
income but non-homeless patients including public-hospital patients who are known to be
disadvantaged but were not identified as homeless and patients covered by Medicaid discharged
from private general hospitals in New York City (Salit, Kuhn, Hartz, Vu, & Mosso, 1998, 1735).
19,355 homeless people were identified in hospital databases (Salit, Kuhn, Hartz, Vu, & Mosso,
1998, 1735). Patients who had been admitted to the hospital for childbirth were excluded from
the study because after being discharged this group was often placed in special housing (Salit,
Kuhn, Hartz, Vu, & Mosso, 1998, 1735). After the exclusion of this group of mothers, the
sample for the study included 18,864 homeless people. The “vast majority” of homeless patients
in the study had a dual diagnosis of mental illness and substance abuse (Salit, Kuhn, Hartz, Vu,
& Mosso, 1998, 1738).
On average, the homeless patients stayed 49% longer than the private-hospital patients,
and 25% longer than the public-hospital patients (Salit, Kuhn, Hartz, Vu, & Mosso, 1998, 1737).
Physicians reported that the discharge of homeless people was often delayed for months because
of their lack of housing (Salit, Kuhn, Hartz, Vu, & Mosso, 1998, 1739). In most cases, the extra
days of hospitalization in the homeless patients were accounted for by the patents’ with a mental
disorder (57%) (Salit, Kuhn, Hartz, Vu, & Mosso, 1998, 1739). Hospital stays could be reduced
for these patients by as many as 70 days with better access to supportive housing (Salit, Kuhn,
Hartz, Vu, & Mosso, 1998, 1739). The cost of seventy days in a general-hospital psychiatric unit

10. SOCIOECONOMIC CONSEQUENCES AND COSTS OF MENTAL ILLNESS 10
costs $17,500 while the cost of a unit of supportive housing with social services for whole year
costs $12,500 in New York City.
Consequences of Mental Illness in Mothers
The percentage of severely mentally ill people becoming parents is on the rise (Diaz-
Caneja & Johnson, 2004, 472). Mentally ill women are much more likely to become parents than
mentally ill men. Approximately 63% of women and 26% of men with a mental illness have at
least one child (Diaz-Caneja & Johnson, 2004, 472). Since it has been found that the child’s
development is more impaired when the mother instead of the father is mentally ill, it is of
particular concern when mentally ill women become parents (Gross & Semprevivo, 1989, p.
108). There is not much education given to the mentally ill on the managing of sexual
relationships such as how to avoid unwanted pregnancy (Diaz-Caneja & Johnson, 2004, 473).
When mentally ill women become pregnant, those around her often see it as a tragedy although
many mentally ill mothers wanted to become pregnant (Diaz-Caneja & Johnson, 2004, 473).
Increased Psychosocial Stress in Children of Mentally Ill Women
According to Fritz Mattejat and Helmut Remschmidt in the article “The Children of
Mentally Ill Parents”, children with mentally ill parents are at a higher risk of numerous
disastrous events (Mattejat & Remschmidt, 2008, p. 413). A child with a parent who has a
mental illness is much more likely than the general population to have a substance abuse
problem (Mattejat & Remschmidt, 2008, p. 413). Additionally, the risk of developing a mental
illness is greatly increased by having a parent with a mental illness (Mattejat & Remschmidt,
2008, p. 414). This is caused by genetic as well as environmental factors (Mattejat &
Remschmidt, 2008, p. 414). A mother’s behavior toward her child is affected by mental illness
and is one environmental factor that can interfere with the development of her child (Mattejat &

11. SOCIOECONOMIC CONSEQUENCES AND COSTS OF MENTAL ILLNESS 11
Remschmidt, 2008, p. 415). For example, during infancy, mental illness reduces a mother’s eye
contact, smiling, speaking, imitating, and caressing with her infant (Mattejat & Remschmidt,
2008, p. 415).
In a study by Knutsson-Medin, Edlund, and Ramkilnt published in 2007, a questionnaire
was sent to a group of children with parents who were once psychiatric inpatients. The purpose
of the study was to examine the experiences of children of mentally ill patients and their opinions
about their contact with psychiatric services growing up (Knutsson-Medin, Edlund, & Ramkilnt,
2007, 745). Thirty-six adults raised by a parent who was once a psychiatric inpatient were
interviewed. They ranged in age from 19 and 38 years old. (Knutsson-Medin, Edlund, &
Ramkilnt, 2007, 745).
The participants reported mixed feelings concerning their experiences with psychiatric
services. Some children said that they felt relieved when their parent was hospitalized others said
that their parent’s time in the hospital was too short (Knutsson-Medin, Edlund, & Ramkilnt,
2007, 748). The children reported a lot of worrying about their mentally ill parent and about their
healthy parent concerning how they would cope while the other parent was hospitalized. The
participants also mentioned increased responsibility for care of the household and their siblings
(Knutsson-Medin, Edlund, & Ramkilnt, 2007, 749). Surprisingly, Knutsson-Medin, Edlund, and
Ramkilnt reported that participants in the study were well-adjusted adults based on their
educational attainment and rates of employment (Knutsson-Medin, Edlund, & Ramkilnt, 2007, p.
750).
A weakness of this study is that the experiences of the children are reported in retrospect.
The adults interviewed answer questions about their childhood experiences as they remember
them. This method of interviewing can result in skewed responses because memories of

12. SOCIOECONOMIC CONSEQUENCES AND COSTS OF MENTAL ILLNESS 12
childhood are often faulty once several decades have passed. This weakness could be changed in
future studies by asking children of mentally ill parents about their experiences while they are
still young.
Impaired Ability to Provide Care Caused in Mentally Ill Mothers
In 2004, Angeles Diaz- Caneja and Sonia Johnson published a qualitative study about
motherhood in the mentally ill. The overriding purpose of Angeles Diaz- Caneja and Sonia
Johnson’s study is to contribute to the body of knowledge concerning the experiences of
mentally ill mothers and their perspectives on the mental health services they receive (Diaz-
Caneja & Johnson, 2004, p. 473). Women who had been diagnosed with schizophrenia,
schizoaffective disorder, delusional disorder, bipolar affective disorder or depression with
psychotic symptoms, had at least one child who was under 16 years old and had been in touch
with specialist community mental health services for at least 6 months were recruited to
participate in the study (Diaz-Caneja & Johnson, 2004, 474). Twenty-two women were
interviewed. Half of the women were the main caretaker of their children or shared responsibility
with the father (Diaz-Caneja & Johnson, 2004, 475). The majority of the participants were 40
years and over, white, receiving benefits and had at least one child between ten and fifteen years
old (Diaz-Caneja & Johnson, 2004, 475). The participants chose where the interview would be
conducted, either at the community mental health center, a day center or their own homes and
children were not present (Diaz-Caneja & Johnson, 2004, 474). The women were asked a set of
predetermined open-ended questions about their personal experiences and challenges with
motherhood, the mental health services they received and how they felt about these services
(Diaz-Caneja & Johnson, 2004, 474).

13. SOCIOECONOMIC CONSEQUENCES AND COSTS OF MENTAL ILLNESS 13
A trend found in this study and several others on the topic of mental illness in mothers
was that the vast majority of the mothers commented on the positive aspects of motherhood.
However, nearly all of them also commented on difficulties intensified by their mental illness
(Diaz-Caneja & Johnson, 2004, 476). Mentally ill mothers interviewed expressed a desire for
more “practical help with parenting and to talk about difficulties” (Diaz-Caneja & Johnson,
2004, 478). One such difficulty cited was the complications that medication had on their ability
to care for their children, saying that their psychiatric medication “slowed them down and
reduced their concentration” (Diaz-Caneja & Johnson, 2004, 476). Mothers also said that the
symptoms of their mental illness interfered with their role as a mother. Psychotic symptoms
along with depression and mania were said to make parenting harder (Diaz-Caneja & Johnson,
2004, 476).
Diaz-Caneja and Johnson found that mentally ill mothers felt that mental health services
were ready to take away their children and had few other options for mentally ill women
struggling to take care of their children. Only about 20% of mentally ill mothers still have
custody of their children (Diaz-Caneja & Johnson, 2004, 473). Fear of losing custody of their
children was a common theme found in interviews with mentally ill mothers and could be a
reason why mentally ill mothers do not talk about their difficulties with motherhood with mental
health service professionals (Diaz-Caneja & Johnson, 2004, 477).
Consequences and Costs of the Reduced Productivity of the Mentally Ill
Indirect costs to society of the mentally ill include the loss of productivity caused by their
illness. The cost to society of this reduction in work has interested scholars in the field for a long
time (O’Neill & Bertollo, 1998, p. 505). Rice and Miller did a study in 1985 on the societal costs
of affective disorders (Garske & Williams, 1999, p. 40). They found that the morbidity costs, the

14. SOCIOECONOMIC CONSEQUENCES AND COSTS OF MENTAL ILLNESS 14
value of reduced or lost productivity due to affective disorders amounted to $1.7 billion or 22%
of total indirect costs of affective disorders (Garske & Williams, 1999, p. 40).
In the article “WORK AND EARNINGS LOSSES DUE TO MENTAL ILLNESS:
PERSPECTIVES FROM THREE NATIONAL SURVEYS”, Dave M. O’Neill and David N.
Bertollo look at three national surveys that examine the link between mental illness and work
loss across all DSM categories including a prevalence study done 1981-83 known as The
Epidemiological Catchment Area (ECA) study, the National Comorbidity Survey (NCS) done in
1991 and The National Health Interview Study (NHIS) taken in 1989 and 1994 (O’Neill &
Bertollo, 1998, p. 507).
The ECA and the NCS both asked survey participants comprehensive questions then
based on their responses diagnosed them with a mental disorder using DSM-III or DSM-IIIR
categories. In the NHIS, survey participants were identified as mentally ill if they reported
having one or more of the major DSM disorders in the past year (O’Neill & Bertollo, 1998, p.
508). The self-identification strategy used by the NHIS survey, showed a lower pervasiveness of
mental illness and also a lower employment rate in those individuals identified as mentally ill
(O’Neill & Bertollo, 1998, p. 508). Suggesting that this strategy identifies the most severely
mentally ill people (O’Neill & Bertollo, 1998, p. 508).
Analysis of the three surveys, found that mentally ill people, including those with
disorders considered less severe, had significantly lower employment rates (O’Neill & Bertollo,
1998, p. 522). Another finding was that personal traits such as education history are influential in
determining whether that particular individual will work (O’Neill & Bertollo, 1998, p. 522). One
weakness of this analysis is that it did not separate individual characteristics affecting
employment in mentally ill individuals. Using a Heckmann selection model in the analysis of the

15. SOCIOECONOMIC CONSEQUENCES AND COSTS OF MENTAL ILLNESS 15
effects of individual characteristics on employment in mentally ill individuals could be isolated
which would be better evidence for causal relationship between individual characteristics and
employment rates in the mentally ill.
The Costs of Federal Programs for the Mentally Ill
After congress passed the Community Mental Health Centers (CMHC) Act in 1963,
services for the mentally ill were no longer the responsibility of the state (Garske & Williams,
1999, p. 40). Subsequently, mentally ill people become eligible for various federal programs
including Supplemental Security Income (SSI), Social Security Disability Income (SSDI),
Medicaid and Medicare (Garske & Williams, 1999, p. 40). Mentally ill individuals comprise
31% or 1.4 million of the 4.5 million consumers receiving SSI (Garske & Williams, 1999, p. 40).
They receive an average of $392 per month per person, which amounts to $6.6 billion spent
annually on maintenance payments for the mentally ill (Garske & Williams, 1999, p. 40).
Furthermore, 2% or 900,000 of the 4.5 million people receiving SSDI benefits have a mental
illness diagnosis (Garske & Williams, 1999, p. 40). About one third of mentally ill people do not
get paid enough to receive SSDI benefits (Garske & Williams, 1999, p. 40). This population of
mentally ill persons is therefore not able to pay taxes and contribute to the Social Security
System (Garske & Williams, 1999, p. 40).
Conclusion
The deinstitutionalization of the mentally ill has resulted in unforeseen costs and
consequences. Scholars are examining data and conducting studies to find solutions to the unique
issues raised by deinstitutionalization. One such issue- frequent co-occurrence of mental illness
and substance abuse- is a complex issue. Scholars have found that substance abuse and
medication noncompliance correlate and often lead to violence and increased costs of psychiatric

16. SOCIOECONOMIC CONSEQUENCES AND COSTS OF MENTAL ILLNESS 16
care. A consensus widely held by scholars on the issue is that treatment programs for the
mentally ill should integrate treatment of substance abuse disorders and mental disorders rather
than treating the two separate treatment systems (Dickey & Azeni, 1996, p. 977).
Many experts blame deinstitutionalization for the substantial growth in the percentage of
mentally ill inmates (Rich, 2009, p. 91). Scholars on the topic of the incarceration of the mentally
ill stress that treatment rather than imprisonment has better outcomes for the inmate and society
as a whole (Dumont, Brockmann & Rich, 2013, p. 28). Mental Health Courts (MHCs) are a
relatively new solution to the criminalization of the mentally ill. Rather than incarcerating
mentally ill offenders, MHCs divert non-violent mentally ill offenders to treatment (Kaplan,
2007 p. 1). Studies to examine the effect of MHCs on outcomes in offenders are needed.
The costs of the high portion of homeless people who are mentally ill are very high. This
review looked at one cost of homelessness, which is hospitalization in the mentally ill. The
mentally ill homeless are hospitalized for longer periods due to their lack of housing (Salit,
Kuhn, Hartz, Vu, & Mosso, 1998, 1739). The costs of providing housing to these individuals are
less than the costs borne by the health care system (Salit, Kuhn, Hartz, Vu, & Mosso, 1998,
1739). With mental illness, substance abuse and homelessness often occurring conjointly, most
scholars express a need for substance abuse services for the homeless mentally ill to reduce the
rates of homelessness among this population (Pearson, 2011, p. 166).
Because the majority of mentally ill women are mothers (63%) the effects that mental
illness has on these women and their children is important to examine (Diaz-Caneja & Johnson,
2004, 472). When interviewed, many mentally ill mothers express a lack of concern in mental
health professional for their family lives (Diaz-Caneja & Johnson, 2004, p. 477). Difficulties
reported by mentally ill mothers bring into question how mental health services can best serve

17. SOCIOECONOMIC CONSEQUENCES AND COSTS OF MENTAL ILLNESS 17
this population and their children. Going forward, mental health professionals should form
trusting relationships with mentally ill mothers in order to help them cope with the role of
mother.
The direct and indirect costs of mental illness were estimated to total $150 billion in 1990
(Garske & Williams, 1999, p. 39). The direct costs include federal programs for the mentally ill
such as SSI and Medicare. The reduced productivity in the mentally ill is one indirect cost of
mental illness to society. Mentally ill individuals experience much lower employment rates
(O’Neill & Bertollo, 1998, p. 522). If mentally ill people were given more intensive care, it may
be possible to decrease the reduced productivity of the mentally ill by counteracting sick leave.
Hence an increase in direct costs could be warranted if it results in a decrease of indirect costs
(Hertzman, 1983, p. 366).

18. SOCIOECONOMIC CONSEQUENCES AND COSTS OF MENTAL ILLNESS 18
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