America’s Continuing Struggle with Mental Illnesses: Economic Considerations

TY - JOUR

T1 - America’s Continuing Struggle with Mental Illnesses

T2 - Economic Considerations

AU - Frank, Richard G.

AU - Glied, Sherry A.

N1 - Funding Information: Sources: Percent of people receiving HUD housing assistance, SNAP, and TANF who had indicators of mental illness determined from 2019 National Health Interview Survey data using the GAD-7 and PHQ-8 scales (authors’ analysis of NHIS data). Number of households in subsidized housing and average expenditure per household from 2019 HUD Picture of Subsidized Housing data; number of households receiving SNAP monthly and average expenditure per household from Supplemental Nutrition Assistance Program 2019 National Level Monthly Summary; number of families receiving TANF monthly and average expenditure per family from the 2019 Characteristics and Financial Circumstances of TANF Recipients (HUD 2020; USDA 2020; HHS 2020). People with indicators of mental illness receiving SSI and SSDI based on recipients who had severe persistent mental illness, listed in one of the following diagnostic categories: Schizophrenic and other psychotic disorders; Mood disorders; Organic mental disorders; Other mental disorders. Number of people with serious and persistent mental illness (SPMI) and average annual spending per person from 2019 SSI Annual Statistical Report and the Annual Statistical Report on the Social Security Disability Insurance Program (SSA 2020a, 2020b). A survey of the homeless is the 2019 Point-in-Time count, completed by Continuums of Care (CoC) (HUD 2019), but this survey has no standardized diagnostic interview or screening instrument for mental illness, and so no estimate is given for number of people in this category. For the estimate of annual spending for the homeless mentally ill, most federal funding for homelessness is distributed through CoC grants and Emergency Solutions Grants (Lucas 2017). The spending number in the table was calculated from the sum of these grants in 2019 times the fraction of people experiencing homelessness classified as severely mentally ill from the PIT counts (HUD 2018a, 2018b). For calculations relevant to incarcerated people, prevalence of mental illness among people in jail from the Bureau of Justice Statistics’s Indicators of Mental Health Problems Reported by Prisoners and Jail Inmates, based on the National Inmate Survey (NIS-3) from 2011-2012 (Bronson and Berzofsky 2017). Prevalence of mental illness among people in prisons from the BJS’s “Indicators of Mental Health Problems Reported by Prisoners,” based on the 2016 Survey on Prison Inmates (Maruschak and Bronson 2021). The number of incarcerated people in jail is the average daily population of people in jail from the BJS’s “Jail Inmates in 2019” report (Zeng and Minton 2021). The number of incarcerated people in prison is taken from the number of people in prison at year end in 2019 from the Prisoners in 2020 Statistical Tables (Carson 2021). Spending per inmate in jail is the annual cost per inmate in 2017 inflated to 2019 dollars (Horowitz 2021). Spending per inmate in state prisons is the annual average per inmate from the National Institute of Corrections’ data on 2019 National Averages (NIC 2019). Spending per inmate in federal prison on average in 2019 is taken from the Federal Register’s Annual Determination of Average Cost of Incarceration Fee (BOP 2021). Numbers on mental illness among people involved in police responses are inconsistent and limited by lack of data collection. Police spending on people with mental illness based on research from the Treatment Advocacy Center (2019), which found that 10 percent of law enforcement budgets were spent on calls involving people with mental illness, and research from the Urban Institute (2020), which found that state and local government spent $123 billion on police in 2019, using data from the US Census Bureau Annual Survey of State and Local Government Finances.

PY - 2023/3

Y1 - 2023/3

UR - http://www.scopus.com/inward/record.url?scp=85162203533&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85162203533&partnerID=8YFLogxK

U2 - 10.1257/jep.37.2.153

DO - 10.1257/jep.37.2.153

M3 - Article

AN - SCOPUS:85162203533

SN - 0895-3309

VL - 37

SP - 153

EP - 178

JO - Journal of Economic Perspectives

JF - Journal of Economic Perspectives

IS - 2

ER -