Mental Health Disparities Among the Incarcerated and Unhoused

Context: It is well-known that there are racial disparities among the incarcerated and unhoused. Mental illness and substance use disorder are highly prevalent among these populations. As part of a larger study on the economic and health burden of mental health inequities, we sought to describe and calculate the cost burden of mental illness and substance use disorder among the unhoused and incarcerated populations.

Study Design: Ecological analysis of published data on mental illness and substance use disorder among unhoused and incarcerated populations.

Data Set: Published literature from multiple federal and state agencies and national advocacy organizations.

Population studied: 1) Unhoused 2) Incarcerated.

Outcome Measured: Costs of mental illness and substance use treatment, cost of incarceration, and life expectancy. Excess cost burden of untreated mental illness among these populations.

Results: Black, Hispanic, and Native Americans are over-represented in both the unhoused and incarcerated populations. Based on shorter life expectancy among the unhoused, the United States suffers greater than $23 billion annual burden due to years of life lost. Incarceration of those suffering mental illness or substance use disorder results in an annual cost burden of over $50 billion related to high cost of incarceration compared to mental illness treatment, substance use treatment, and averted post incarceration crime.

Conclusion: The unhoused and incarcerated suffer from undertreatment of mental illness and substance use disorder. And incarceration may replace community treatment for many individuals. The prominent racial disparities among the unhoused and incarcerated lead to serious inequity in mental health outcomes and costs. Adequate treatment could save $60-90 billion dollars each year. Policies that address mental illness leading to improved diagnosis and treatment among these vulnerable populations represents good strategy, good health care, and good business.