Mental Health Laws, Incarceration, and the Cost of Reoffending: A Review of Secondary Evidence
DOI:
https://doi.org/10.64137/31080030/IJFEMS-V2I4P101Keywords:
Mental Health Law, Incarceration, Recidivism, Diversion, Forensic Assertive Community Treatment, Cost-EffectivenessAbstract
People with mental illness are over-represented in prisons in every region where this has been measured, and many leave custody without the care they need and later return. This paper reviews secondary evidence on how mental health law and service provision relate to incarceration and recidivism, and what these outcomes cost. Using a qualitative, comparative approach, it draws on fifteen sources published between 1939 and 2024: systematic reviews, a randomized trial, cross-national studies, a cost analysis, a study protocol, an economics preprint and one advocacy report. The evidence shows that prisoners carry a much higher burden of psychosis, depression and substance use than the general population. The link between falling psychiatric bed numbers and rising imprisonment is supported in South America but not across Europe. Psychological programs delivered inside prisons have modest effects on reoffending once small-study bias is accounted for. In contrast, models that connect treatment to the community and the courts, including therapeutic communities with aftercare, forensic assertive community treatment, mental health courts and mandated treatment on probation, show more promising but uneven results. Economic evidence is thin yet consistent in direction: completing a mental health court was associated with 12-month costs about 57% lower than for a comparison group. The paper argues that continuity of care around release matters more than any single legal provision, and it identifies gaps in direct tests of legal reform, cost-effectiveness research and evidence from low- and middle-income countries.
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