3. 4. 5. 6. The Type of Crimes Committed by Inmates with Serious Mental Illness Incarcerated by BOP and Selected States’ Departments of Corrections Vary

		BOP Inmates with Serious Mental Illness Were Incarcerated for Similar Crimes as BOP Inmates Without Serious Mental Illness, But Some Differences Exist

About two-thirds of BOP inmates with a serious mental illness were  incarcerated for four types of offenses—drug offenses (23 percent), sex  offenses (18 percent), weapons and explosives offenses (17 percent),  and robbery (8 percent)—as of May 27, 2017. Specifically, our analysis found that BOP  inmates with serious mental illness were incarcerated for sex offenses,  robbery, and homicide or aggravated assault at about twice the  percentage of inmates without serious mental illness, and were  incarcerated for drug and immigration offenses at about half or less the  rate of inmates without serious mental illness. The federal and  state governments also define serious mental illness differently, and they  track different categories of crime in their respective data systems. The Washington  Department of Corrections’ definition does not include inmates who are  substance abusers or substance dependent—including alcoholics and  narcotics addicts—or persons convicted of any sex offense, who are not  otherwise diagnosed as seriously mentally ill.

	BOP Does Not Track Costs Related to Inmates with Serious Mental Illness but BOP and Selected States Generally Track Costs Related to Treating Inmates with Mental Illness

		BOP Does Not Track Costs Related to Inmates with Serious Mental Illness

According to BOP officials, the agency does not track costs specifically  associated with inmates with serious mental illness due to resource  restrictions and the administrative burden such tracking would require. Selected States’ Departments of Corrections Provided Estimated Costs for Inmate Mental Health Care

The selected state departments of corrections provided us with estimates  for different types of mental health care costs, but did not identify mental  health care costs specifically for inmates with serious mental illness. For example:
Two state departments of corrections provided us with the average  per-inmate costs of incarceration for a mental health treatment unit or  treatment center where some inmates with serious mental illness are  treated, but these per-inmate costs also included incarceration costs  for inmates without serious mental illness who were housed in these  facilities. Another state department of corrections provided total psychotropic  medication costs for all inmates and mental health care costs per  offender. Targeting Treatments Based on Risk and Coordinating Transition Plans of Individuals with Serious Mental Illness Are among Strategies Identified by Federal and Selected State Agencies and Studies

In 2012, the Council of State Governments Justice Center developed the  Criminogenic Risk and Behavioral Health Needs Framework in  collaboration with DOJ’s National Institute of Corrections and Bureau of  Justice Assistance, SAMHSA, and experts from correctional, mental  health, and substance abuse associations. It calls for correctional agencies to assess individuals’ criminogenic  risk (the risk of committing future crimes), substance abuse and mental  health needs. This guidance is for mental health, correctional, and  community stakeholders, and uses the Assess, Plan, Identify, Coordinate  model to provide procedural guidelines to reduce recidivism and promote  recovery at different points during incarceration and reentry. A case manager coordinates services in  the community to help clients sustain  recovery and prevent further involvement  with the criminal justice system. Studies Indicate Some Promising Strategies to Reduce Recidivism Among Offenders with Mental Illness

To identify strategies to reduce recidivism among offenders with mental  illness during incarceration and reentry, we searched for studies that  analyzed the relationship between programs and recidivism among  offenders with mental illness. However, other studies found that programs that offered multiple support  services did not reduce recidivism, suggesting that other factors may also  affect recidivism. The  results from these six states are not generalizable, but provide insights. To identify what is known about the costs to the federal and selected  state governments to incarcerate and provide mental health services to  incarcerated individuals with serious mental illness, we interviewed and  received written responses from officials from BOP’s Reentry Services  Division, Correctional Programs Division, Administration Division,  Program Review Division, and Health Services Division, and the  departments of corrections in selected states to discuss and obtain  documentation on the processes and systems used to track the costs to  incarcerate and provide mental health services to inmates with serious  mental illness, and obtain their perspectives on the challenges faced, if  any, in tracking such costs. We analyzed BOP obligation data from fiscal  year 2016 for the following budget categories: Psychology Services,  psychotropic medications, and Residential Reentry Center mental health  care costs. To determine what strategies for reducing recidivism among individuals  with serious mental illness have been identified by the federal and  selected state governments and in literature, we obtained and analyzed  documents and interviewed officials from BOP and the selected states’  corrections departments, as well as from DOJ and HHS organizations  that support research, training, and programs related to mental health and  recidivism. 2. Program studied was implemented in the U.S.  2.
Why GAO Did This Study

In 2016, SAMHSA estimated that about 10.4 million adults in the United States suffered from a serious mental illness, which generally includes conditions such as schizophrenia and bipolar disorder. As of May 27, 2017, BOP was responsible for overseeing 187,910 inmates and 7,831 of these inmates were considered to have a serious mental illness. Research has shown that inmates with serious mental illness are more likely to recidivate than those without.
The 21st Century Cures Act directed GAO to report on the prevalence of crimes committed by persons with serious mental illness and the costs to treat these offenders—including identifying strategies for reducing recidivism among these individuals. This report discusses (1) what is known about crimes committed by inmates with serious mental illness incarcerated by the federal and selected state governments; (2) what is known about the costs to the federal and selected state governments to incarcerate and provide mental health care services to those individuals; and (3) what strategies have the federal and selected state governments and studies identified for reducing recidivism among individuals with serious mental illness.
GAO selected six states that varied in their adult incarceration rates and provided geographic diversity. At BOP and the six states' departments of corrections, GAO analyzed criminal offense and incarceration and mental health care cost data and interviewed officials about strategies for reducing recidivism for inmates with serious mental illness. The results from these six states are not generalizable, but provide insights. GAO also reviewed studies that analyzed the relationship between various programs and recidivism among offenders with mental illness.

What GAO Found

About two-thirds of inmates with a serious mental illness in the Department of Justice's (DOJ) Federal Bureau of Prisons (BOP) were incarcerated for four types of offenses—drug (23 percent), sex offenses (18 percent), weapons and explosives (17 percent), and robbery (8 percent)—as of May 27, 2017. GAO's analysis found that BOP inmates with serious mental illness were incarcerated for sex offenses, robbery, and homicide/aggravated assault at about twice the rate of inmates without serious mental illness, and were incarcerated for drug and immigration offenses at about half or less the rate of inmates without serious mental illness. GAO also analyzed available data on three selected states' inmate populations and the most common crimes committed by inmates with serious mental illness varied from state to state due to different law enforcement priorities, definitions of serious mental illness and methods of tracking categories of crime in their respective data systems.
BOP does not track costs related to incarcerating or providing mental health care services to inmates with serious mental illness, but BOP and selected states generally track these costs for all inmates. BOP does not track costs for inmates with serious mental illness in part because it does not track costs for individual inmates due to resource restrictions and the administrative burden such tracking would require. BOP does track costs associated with mental health care services system-wide and by institution. System-wide, for fiscal year 2016, BOP spent about $72 million on psychology services, $5.6 million on psychotropic drugs and $4.1 million on mental health care in residential reentry centers. The six state departments of corrections each used different methods and provided GAO with estimates for different types of mental health care costs. For example, two states provided average per-inmate costs of incarceration for mental health treatment units where some inmates with serious mental illness are treated; however, these included costs for inmates without serious mental illness housed in those units.
DOJ, Department of Health and Human Service's Substance Abuse and Mental Health Services Administration (SAMHSA), and criminal justice and mental health experts have developed a framework to reduce recidivism among adults with mental illness. The framework calls for correctional agencies to assess individuals' recidivism risk and substance abuse and mental health needs and target treatment to those with the highest risk of reoffending. To help implement this framework, SAMHSA, in collaboration with DOJ and other experts, developed guidance for mental health, correctional, and community stakeholders on (1) assessing risk and clinical needs, (2) planning treatment in custody and upon reentry based on risks and needs, (3) identifying post-release services, and (4) coordinating with community-based providers to avoid gaps in care. BOP and the six states also identified strategies for reducing recidivism consistent with this guidance, such as memoranda of understanding between correctional and mental health agencies to coordinate care. Further, GAO's literature review found that programs that reduced recidivism among offenders with mental illness generally offered multiple support services, such as mental health and substance abuse treatment, case management, and housing assistance.