Differential Use of Mental Health Services by Race and Ethnicity in Prison

• Published date: 01 July 2023
• DOI: http://doi.org/10.1177/00938548231165530
• Author: Katlyn C. Fritz,Adam D. Vaughan
• Date: 01 July 2023
• Subject Matter: Articles

CRIMINAL JUSTICE AND BEHAVIOR, 2023, Vol. 50, No. 7, July 2023, 996 –1015.

DOI: https://doi.org/10.1177/00938548231165530

Article reuse guidelines: sagepub.com/journals-permissions

© 2023 International Association for Correctional and Forensic Psychology

996

DIFFERENTIAL USE OF MENTAL HEALTH

SERVICES BY RACE AND ETHNICITY IN PRISON

KATLYN C. FRITZ

ADAM D. VAUGHAN

Texas State University

Research in community settings indicates that Black persons are less likely to receive mental health treatment than White

persons. Research on whether these disparities persist in prisons is limited and fails to include other racial and ethnic groups,

such as Latino persons. This study examines racial and ethnic differences in the use of mental health services among incarcer-

ated persons. Using the 2016 Survey of Prison Inmates, logistic regression assessed the effects of race/ethnicity among those

receiving mental health treatment while incarcerated. Results suggest Black and Multiracial/Other incarcerated persons were

15.8% and 15.0% more likely to participate in treatment than White incarcerated persons, respectively. No significant differ-

ence between Latino incarcerated persons and White incarcerated persons was found. The differences between racial/ethnic

groups and participation in mental health treatment found in this study suggest that more attention needs to be paid to diver-

sity in the accessibility of treatment in prisons.

Keywords: mental health; prison; ethnicity; race; treatment; mental illness; corrections; incarceration; mental health

treatment

INTRODUCTION

Research in community settings indicates that Black persons1 are less likely to receive

mental health treatment than White persons (Snowden, 2003; Youman et al., 2010). Biases

in mental health assessments and intervention (Merino et al., 2018; Snowden, 2003; Youman

et al., 2010), cultural factors (Davenport & McClintock, 2021; Nelson et al., 2021; Wallen,

1992; Whaley, 2001; Youman et al., 2010), and differential access (Cook et al., 2007;

Dinwiddie et al., 2013; Lillie-Blanton & Hoffman, 2005; Mutchler & Burr, 1991; Youman

et al., 2010) have been examined as explanations for the inequities observed in treatment

utilization. In comparison to community settings, research on the disparities in mental

health treatment utilization in correctional settings is more sparse, and those that have been

done do not agree on the extent to which race affects utilization. For instance, one study

AUTHORS’ NOTE: The authors declare that the research was conducted in the absence of any funding or

other financial relationships which could be viewed as a potential conflict of interest. Correspondence concern-

ing this article should be addressed to Katlyn C. Fritz, School of Criminal Justice and Criminology, Texas State

University, 601 University Dr., San Marcos, TX 78666; e-mail: kmc243@txstate.edu

1165530CJBXXX10.1177/00938548231165530Criminal Justice and BehaviorFritz and Vaughan / Differential Use of Mental Health Treatment

research-article2023

Fritz, Vaughan / DIFFERENTIAL USE OF MENTAL HEALTH TREATMENT 997

found that compared with White incarcerated persons, Black incarcerated persons with

mental illness (PWMI) had decreased odds of receiving psychotropic medication and

accessing mental health treatment but were more likely than White incarcerated persons to

participate in self-help programming (Koons-Witt & Crittenden, 2018). Another study

found no differences between Black incarcerated persons and White incarcerated persons

who chose to seek mental health services (Morgan et al., 2004). Finally, one study reported

that while there were race differences in treatment history, no such discrepancies were

found in treatment-seeking over the course of incarceration (Youman et al., 2010).

Given the lack of consensus among scholars as to the degree of significance of a person’s

race in their usage of mental health services in correctional settings, there may be additional

insight that can be extracted from further studies, especially studies which explore more

than simply the difference between Black incarcerated persons and White incarcerated per-

sons. The current study aims to examine whether there are racial and ethnic differences in

receiving mental health treatment among incarcerated persons in the U.S. prison system

who show symptoms of mental illness. We use data from the 2016 Survey of Prison Inmates

(SPI) to address whether there is differential use of mental health services among those who

need it by race and ethnicity in prisons.

LITERATURE REVIEW

Although only 4% of the general population is considered to have a severe mental ill-

ness (Sayers et al., 2017), mental illness affects between 10% and 16% of those incarcer-

ated in state prisons (Metraux, 2008). It is important to note how pervasive mental illness

is in a correctional setting because incarcerated PWMI have been found to have an

increased probability of serving their full sentence and a decreased probability of being

released on parole (Metraux, 2008). Given that incarcerated PWMI are likely to have a

harder time adjusting to prison conditions (Koons-Witt & Crittenden, 2018), it can be

important for them to participate in mental health treatment. Incarcerated persons who

utilize mental health treatment services have been found to be better able to handle the

prison environment due to improved symptoms (Severson et al., 2020). Improved symp-

toms can lead to a decrease in the number and severity of prison infractions (Gagliardi,

2005; Shaw & Morgan, 2011). In addition, incarcerated persons who utilize mental health

services are less likely to be socially isolated (Severson et al., 2020), victimized (Severson

et al., 2020), hospitalized (Gagliardi, 2005), and recidivate postrelease (Youman et al.,

2010).

Since there is limited race-based research on mental health care in prisons, it is worth-

while to present and discuss, as a comparison, the known racial correlates that are likely to

be associated with increased or decreased mental health treatment in community settings. We

follow this discussion with a look at other, nonracial barriers that incarcerated persons expe-

rience when considering accessing mental health treatment in prison. Considering these two

areas of research helps bolster our understanding of what goes into an incarcerated person’s

decision to access treatment, and whether this decision may be different for those of different

races and ethnicities. Though the racial differences in mental health treatment in the com-

munity are multifaceted and complex, one can still distill this information into three main

themes that are correlated with mental health treatment-seeking behavior: (a) access to men-

tal health care, (b) assessments and treatment, and (c) sociocultural factors.