The Role of Mandated Mental Health Treatment in the Criminal Justice System
Introduction
In North Carolina, judges can mandate that convicted individuals seek mental health treatment as a term of their probation sentence. Affected individuals are those who, following the structured sentencing laws in place at the time, were eligible for probation as a sentence based on the severity of their offense and the number of prior offenses. Probationers sentenced to mental health treatment are generally required to pay for that treatment themselves. There is a large amount of flexibility in what treatment entails, generally determined by the probation officer and the mental health practitioner.
Nesbit (2023) evaluates the effect of judge-mandated mental health treatment on three-year recidivism. The paper uses administrative court data from 1994-2009 and an instrumental variables strategy based on the conditionally random assignment of judges. Intuitively, the judge instrument approach takes advantage of the fact that judges vary in how likely they are to mandate mental health treatment, and therefore the probability that a convicted individual is assigned to seek mental health treatment is driven in part by which judge they are randomly assigned. The paper estimates a 12 percentage point (36 percent) decrease in the likelihood of recidivism within three years of conviction. The paper uses these estimates to construct the MVPF of mental health treatment for probationers (all monetary amounts are reported in 2022 dollars).
MVPF = 19.3
Net Cost
The treatment in this case is being assigned to seek mental health treatment. To relate this to the net cost to the government, the paper assumes that the treatment is being funded through Medicaid and relies on Medicaid reimbursement tables for the costs of the components of treatment.
1. Direct cost of treatment: For the purpose of estimating the costs of seeking treatment, the paper defines mental health treatment as one initial intake evaluation combined with weekly counseling sessions for the average duration of probation. The paper includes the average cost of daily antidepressants scaled by the likelihood of being prescribed those medications. The paper also adjusts the cost of treatment by including the marginal excess burden due to deadweight loss if all those funds were raised through an increase in taxes. On average, providing treatment for one individual would cost the government $3,230.
2. Fiscal externalities: The paper finds that mandated mental health treatment decreases future recidivism; this represents a cost savings to the government through lower spending on the criminal justice system. In addition, there are tax benefits from the reduction in incarcerated individuals who are not able to work. To quantify the size of the savings, the paper uses separate estimates of the costs and the effect of mental health treatment within different classes of crime, since there is large variation in costs associated with different crimes. However, there are multiple sources of uncertainty in these calculations: uncertainty from estimating the effect of treatment and uncertainty due to the disagreement in the literature on the magnitude of the costs of crime. On average, the paper estimates reduced costs to the government of $2,480.
Combining these two components, the estimate of the net costs to the government is $750 (with a range from -$790 to $2,720).
Willingness to Pay
The willingness to pay is the value that comes from the convicted individual avoiding the negative effects of future contact with the criminal justice system, including incarceration (lost earnings, increased risks of sexual abuse and mortality, broken family connections, etc.), work disruptions from trial-related procedures, and court fees and fines. In addition, the paper includes the benefits that come from the reduced likelihood that a representative member of society is a victim of crime. Tangible benefits include reduced likelihood of the loss of property and medical treatment. Intangible benefits, much harder to measure, include reductions in fear of crime and the psychological effects of being a victim of crime. As with the net costs, the paper uses separate estimates of the reduction in costs associated with different crime types to address the large variation in the incarceration risk and social costs associated with different crimes.
The willingness to pay is estimated at $14,530 (with a range between $4,070 and $31,650).
MVPF Summary
Combining the willingness to pay with the net cost to the government, the paper estimates an MVPF of 19.3, with a range between 1.5 and infinity.
The paper notes that this analysis likely represents an underestimate of the MVPF. These cost-benefit exercises focus only on the effect of mandated mental health treatment on criminal behavior. If receiving mental health treatment makes it easier for probationers to find and maintain employment or achieve more education, then the benefits of mandated therapy may be even larger. In addition, the estimates are based on benefits due to reductions in recidivism in the three years since trial. Additional analysis in the paper suggests that recidivism risk in later years remains lower for probationers who are sentenced to mental health treatment. The true lifetime benefits of mandated mental health treatment among probationers are therefore likely larger than calculated here.
References
Nesbit, Rachel (2023). “The Role of Mandated Mental Health Treatment in the Criminal Justice System.” Working Paper. https://www.aeaweb.org/conference/2024/program/paper/F465Yk2A
Policy Features
- Category
- Criminal Justice
- Sub-Category
- Recidivism Programs/Counseling
- Beneficiary Type(s)
- Adults
- Average Age
- 30
- Country of Implementation
- United States
- Empirical Method
- IV
- Research Type
- Primary
- Peer Reviewed
- No
- MVPF Publication Link
- www.aeaweb.org/conference/2024/program/paper/F465Yk2A