OBJECTIVES: To assess the one-year direct mental health costs of treating crisis-prone schizophrenia patients. METHODS: Data were drawn from a large multi-site prospective naturalistic study of schizophrenia patients in the United States, conducted between July, 1997 and September, 2003. Participants were treated at large mental health systems, including the Veterans Health Administration, community health centers, community and state hospitals, and university health care delivery systems. Total mental health cost and component costs (psychiatric hospitalizations, antipsychotic medications, other psychotropic medications, day treatment, emergency psychiatric services, psychosocial/rehabilitation group therapy, individual therapy, medication management, and case management), were calculated for 1557 participants with complete medical information. Propensity score adjusted bootstrap re-sampling methods were used to compare one-year direct costs of five crisis-prone subgroups, defined as having: prior suicide attempt (in past four weeks, yes/no), psychiatric hospitalization (in past six months, yes/no), prior arrest (in past six months, yes/no), prior violent behaviors (in past four weeks, yes/no), and comorbid diagnosis of substance use disorder (yes/no). RESULTS: The average annual mental health cost was highest for patients who attempted suicide (yes $46,024, no $15,865), followed by patients with psychiatric hospitalization in the past six months (yes $37,329, no $12,229), patients with arrests (yes $31,081, no $15,655), prior violent behaviors (yes $18,778, no $16,113), and those with comorbid substance use disorder (yes $19,034, no $15,038). CONCLUSIONS: Crisis-prone patients, particularly those with a recent suicide attempt or psychiatric hospitalization tend to incur substantial mental health costs. Findings also suggest that patients who are involved in the criminal justice system also accrue high costs within the mental health delivery system.