Here's another reason for states to expand Medicaid: preventing crime by mentally ill offenders.
In the wake of the Newtown tragedy, many Americans wonder how we might do a better job preventing violence by disturbed, violent offenders. This is a huge challenge because it is almost impossible to predict that a specific individual will commit a mass atrocity.
Some politicians call for a national registry of the mentally ill. It's not clear what this would accomplish. Millions of Americans suffer from bipolar disorder, schizophrenia and other serious mental illness. Only a small minority will ever commit a violent crime. Stigmatizing people who seek help for these conditions is both unjust and unwise.
There is a subset of the mentally ill that poses genuine public safety concerns—young men who are “dual-diagnosed” with mental health and substance-use disorders. Many of these men (and some women) are frequent fliers within the criminal justice system, cycling between secure institutions, mental health facilities, shelters and the street. On any given day, Cook County Jail in Chicago houses about 2,000 inmates with significant psychiatric disorders.
No one quite knows how best to serve and monitor this population. At least one immediate opportunity hides in plain sight: Expand and improve Medicaid services for mental health. Medicaid has always provided an important financial foundation in mental health. If anything, the program has become even more important since the Great Recession. Since 2008, cash-strapped states and localities have imposed punishing cuts in community-based services for low-income uninsured patients.