SMI Research Digest: Criminalization of SMI
SMI Research Digest is a monthly publication from TAC’s Public Education and Research (PER) team that summarizes recently published research on topics related to severe mental illness (SMI). This month, we feature three articles about criminalization and crime among people with SMI.
New prevalence estimates on the criminalization of schizophrenia. A January 2026 article published in “Schizophrenia Research” examined the electronic health records of over 125,000,000 individuals to estimate the prevalence of schizophrenia among people who have been incarcerated. The study reported that people with a schizophrenia spectrum disorder were 21.6 times more likely to have been incarcerated than people with no schizophrenia spectrum disorder. People with a history of incarceration were also 20.3 times more likely to have a schizophrenia spectrum disorder than people with no incarceration history in their electronic health record. The authors note that research suggests that the relationship between schizophrenia and incarceration may be bidirectional. While some people with schizophrenia may encounter law enforcement and become incarcerated due to behaviors caused by their illness, others may develop schizophrenia after an incarceration due to conditions like stress, sleep deprivation, and isolation, which may prompt the onset of psychotic symptoms among people with a genetic predisposition to the illness.
Americans feel criminal sanctions less justified for people with schizophrenia. Researchers assessed public perceptions of the criminalization of schizophrenia by having 795 people read case records of a criminal offense and answer questions about the fairness of the sentence in this recent article from “Behavioral Health Sciences and the Law.” Overall, criminal offenders with schizophrenia were perceived to be less deserving of incarceration than offenders with no mental health diagnosis, regardless of if the crime was violent or non-violent. Participants also reported feeling that the punishments received by criminal offenders with schizophrenia were less fair than the same punishments for people with no mental health diagnosis. These findings may suggest increasing levels of support among the public for diverting people with schizophrenia from the criminal system.
More research is needed on the relationship between assisted outpatient treatment and criminal offending. A 2025 meta-analysis published in “Epidemiology and Psychiatric Sciences” examined the impact of assisted outpatient treatment (AOT) orders on criminal offending across eleven studies and found no differences in the rates of aggression and criminal offending between people on AOT and people in voluntary services. The authors note that despite danger to self or others being a common criterion for commitment, few AOT studies have focused on criminal behavior or aggression as a primary outcome. The quality of these studies was also limited by a lack of information about potential differences in the risk of criminal offending between the experimental and control groups, making it difficult to draw conclusions about whether AOT impacts criminal behavior in a way not captured by this data. While more high-quality research is still needed to draw definitive conclusions about the overall impact of court-ordered treatment on criminal offending, existing AOT programs may want to note that many risk factors for criminal offending such as comorbid substance use, recent victimization, and a parental history of criminal offending are largely the same for people with severe mental illness and the general population.
SMI Research Digest is a monthly public service by TAC that highlights new, impactful research on topics related to severe mental illness. If you would like to support TAC programs and publications, please consider making a donation today.
