Mental Health, Race, & the Justice System

Black adults are disproportionately arrested and incarcerated compared to whites, while also less likely to receive or seek treatment for a mental health condition.

"[M]ore than half of all prison and jail inmates had a mental health problem, including 705,600 inmates in State prisons, 78,800 in Federal prisons, and 479,900 in local jails," Bureau of Justice Statistics (BJS) statisticians Doris J. James and Lauren E. Glaze reported in 2006. "The estimates represented 56% of State prisoners, 45% of Federal prisoners, and 64% of jail inmates."

There were over 2 million people incarcerated (jail or prison) in the United States in 2016, according to the BJS. The total estimated number of "persons under correctional supervision" (probation, prison, parole, jail) in the US peaked at over 7 million in 2007. In 2008, the US held almost 25 percent of the world's nearly 10 million prisoners.

The US Census Bureau reports a 2019 population estimate of nearly 330 million. People identifying as white account for 76.5 percent of the population (roughly 252 million). People identifying as Black or African American make up 13.4 percent of the population (about 44 million). Despite whites outnumbering blacks by nearly 6 to 1, "African Americans constituted 2.3 million, or 34 [percent], of the total 6.8 million correctional population" in 2014, according to the National Association for the Advancement of Colored People (NAACP). African Americans are 5 times more likely to be incarcerated than whites. Black women are twice as likely to be imprisoned as white women.

A 2015 report from the Substance Abuse and Mental Health Services Administration (SAMHSA) found white adults (16.6 percent) were almost twice as likely to use mental health services than black adults (8.6 percent). White adults (14.4 percent) were more than twice as likely to use a prescribed psychiatric medication than black adults (6.5 percent). Inpatient mental health services were more commonly used by black adults, while white adults used outpatient services nearly twice as often.

"Cost of services/lack of insurance coverage was the most common reason for not using mental health services across all racial/ethnic groups," the National Institute for Mental Health (NIMH) states. "Believing that mental health services would not help was the least cited reason across all racial/ethnic groups."

Leah Pope, a Senior Research Fellow in the Policing Program at the Vera Institute of Justice, suggests the prison system has the potential to widen the already existing gap between mental health care along racial and ethnic lines. Citing the U.S. surgeon general's report on mental health, Pope writes, "racial and ethnic minorities have less access to mental health services than white people, are less likely to receive needed care and are more likely to receive poor-quality care when they are treated."

Continues Pope:

Additionally, there may be unique dynamics at play once people enter the criminal justice system that contribute to even greater racial disparities in the screening, evaluation, diagnosis and treatment of people with mental health problems. 

For example, there is evidence that prosecutors are more likely to grant pretrial diversion to white defendants than to black or Latinx defendants with similar legal characteristics. This could have especially negative effects for people of color with mental illness, since pretrial jail incarceration has significant negative health impacts. Other evidence shows that mental health screening tools used by jails reproduce racial disparities, resulting in fewer black and Latinx people screening positive and thus remaining under-referred and undetected in the jail population. 

Incarceration itself also impacts important factors of health, such as housing. Formerly incarcerated people are nearly 10 times more likely to be homeless, and rates of homelessness are especially high among people of color. Lack of housing can significantly worsen mental health problems. 

African Americans are more likely to get arrested than whites by a significant margin, and also far less likely to receive adequate mental health care services. Systemic biases in the court and prison system along racial lines may also contribute to what Pope calls the "overrepresentation" of the mentally ill within the criminal justice system.

Pope is the co-director of the Serving Safely program which looks to improve law enforcement responses to people with mental illness and other disabilities in crisis.

"Without a conscious commitment to racial equity in this work, communities risk recreating patterns of unequal justice even as they strive to improve responses to people with mental illness," Pope writes. "Indeed, advancing racial equity is a commitment that must go hand-in-hand with reform to both the criminal justice system and the mental health system."