558,922 37,650
psychiatric beds · 1955 psychiatric beds · today
One Hundred Years of The Untreated
America closed its psychiatric hospitals. It never built what was supposed to replace them.
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One Hundred Years of

The Untreated

What America pays per person, per system. The cheapest option is treatment. The most expensive is avoidance.
Report   06 / 10
Systems   7 compared
Outpatient treatment
$4,500/yr
community-based care
State prison
$85,000/yr
19× outpatient cost
ER boarding
$2,200/day
$803,000 annualized
Cost ratio
19:1
prison vs. outpatient
Figure 04 Annual cost per person

The cost of not treating

America does not save money by refusing to treat mental illness. It spends more — orders of magnitude more — routing people through emergency rooms, jails, and prisons.
The arithmetic

The cost comparison is not subtle. Community-based outpatient mental health treatment costs $4,500 per person per year. Incarcerating someone in a state prison costs $85,000 per year — nearly 19 times as much.

Emergency room psychiatric boarding costs $2,200 per day. Many patients board for days or weeks waiting for a psychiatric bed that doesn't exist. Annualized, this is the most expensive option in the system at over $800,000.

The spending inversion

Federal and state spending on criminal justice for people with SMI exceeds $15 billion annually. Federal community mental health spending is approximately $5.5 billion. The system spends roughly 3 times more to incarcerate people with mental illness than to treat them.

This is not an argument for any particular policy. It is arithmetic. The cheapest intervention is treatment. The most expensive is its absence.