The vast majority of persons with a mental illness are not dangerous, yet may be stigmatized by the public due to perceptions of danger. However, studies in several countries have shown the risk of violence and criminal offending is elevated among those with certain mental illnesses, especially when combined with substance abuse. These factors also place persons at greater risk of being the victims of crime.
In an earlier study in the U.S., I found that cities with less public psychiatric hospital beds had higher rates of crime, in part due to increased homelessness. However, most treatment for mental illness currently takes place not in hospitals, but in community, or outpatient settings. Because of the lack of a universal healthcare system and available services in the U.S., many persons do not receive adequate care, ‘fall through the cracks’, and are at risk of homelessness and incarceration. Moreover, the lack of data makes it difficult to adequately examine questions of how community mental health services are related to crime and incarceration.
Finland provides a unique context to examine community-level relationships between provision of mental health services and criminal justice outcomes. Despite its universal healthcare system, comparatively low level of inequality, and strong social safety net, a substantial portion of prisoners in Finland have histories of mental illness, substance abuse problems, and homelessness. With support from Fulbright Finland Foundation and the University of Helsinki Institute of Criminology and Legal Policy, I compiled data on all municipalities and hospital districts in Finland over a two-decade period to examine the relationships between a wide array of mental health services, including inpatient, outpatient, primary care, specialty care, supportive housing, and rates of crime and imprisonment.
In my recent article in Nordic Journal of Criminology, taking into account a range of economic and demographic indicators, I found that communities with more residents hospitalized for psychiatric illness also have higher rates of violent crime, often committed while intoxicated. However, this is largely due to the underlying association of offending with the prevalence of mental health problems and alcohol use. At the same time, I found that provision of supportive housing for persons with a serious mental illness and visits with non-physician mental healthcare personnel, such as nurses, may have potential crime-reducing effects.
Together, my findings suggest that, beyond individual clinical outcomes, to the extent that multifaceted mental health services, including supportive housing are well-integrated, they may lead to better outcomes, including community safety. As health care and social service system reforms are currently being implemented in Finland to consolidate administration, it will be necessary to reevaluate these types of relationships in the future. Many aspects of the relationships between mental health treatment, housing, offending, and reintegration—at both macro and micro-levels—remain to be examined.
Markowitz, Fred E. (2023). Community-Level Relationships Between Mental Health Treatment and Criminal Justice Outcomes in Finland. Nordic Journal of Criminology
Fred Markowitz is Professor of Sociology and Criminology at Northern Illinois University. He was recently a Fulbright Scholar at the University of Helsinki Institute of Criminology and Legal Policy. His research interests are in the areas of crime, mental illness, stigma, and social control.