Racial/Ethnic Disparities in Mental Health Service Use in U.S. Prisons Open Access

Kleeberger, Katie (Spring 2020)

Permanent URL: https://etd.library.emory.edu/concern/etds/37720d76d?locale=en
Published

Abstract

Black and Hispanic individuals are more likely to be incarcerated than non-Hispanic (NH) white

individuals. In addition, those with mental health disorders are over-represented in the U.S.

correctional system, which is the largest provider of mental health services in the nation.

Although racial/ethnic disparities in mental health treatment have been reported in community

settings, little is known about whether these disparities persist in correctional settings. This paper

aimed to determine if racial/ethnic disparities exist in receipt of any mental health treatment

services (psychotherapy or psychotropic medication), any psychotherapy, or any psychotropic

medication since admission to prison when compared to non-Hispanic white individuals. Data

were analyzed from the 2004 Survey of Inmates in State and Federal Correctional Facilities in

weighted logistic regression models, controlling for a robust set of predisposing, enabling, and

need-related characteristics. Results from these analyses found that compared to non-Hispanic

white individuals, non-Hispanic black individuals (Marginal Effect [M.E.]= -3.8%, 95% CI= -

4.0%, -3.7%), Hispanic individuals (M.E.= -2.8%, 95% CI= -3.0%, -2.6%), and non-Hispanic

American Indian/Alaskan Native individuals (M.E.= -6.3%, 95% CI= -6.7%, -6.0%) were less

likely to receive any mental health treatment since admission to prison. This same pattern was

also observed for receipt of each type of mental health treatment. While incarceration may

eliminate many structural barriers to accessing care, such as geography and cost, other barriers

may still exist. Further research is needed to determine if these disparities persist given recent

political focus on criminal justice and mental health reform. Additionally, future research should

aim to identify the mechanisms that perpetuate these disparities in correctional settings.

Table of Contents

Contents

Chapter 1: Introduction 1

Chapter 2: Literature Review 4

Mental Health Disorders and Treatment in the U.S. 4

Disparities in Mental Health Treatment and Criminal Justice Involvement 5

How the US Penal System Became the Largest Provider of Mental Healthcare 7

Mental Health Treatment in Prisons 8

Summary 10

Chapter 3: Methods 10

Theory 10

Focal Relationship 13

Mechanisms 13

Individual Confounders 15

Contextual Confounders 16

Data Description 17

Measurement 18

Focal Independent Variable 18

Dependent Variables 18

Mechanisms 20

Individual Level Confounders 20

Contextual Level Confounders 25

Table 1: Construct and Measurement Mapping 26

Analytic Sample 28

Analytic Plan 29

Hypotheses 30

H1: Racial/ethnic minorities are less likely than non-Hispanic whites to use any mental health services in U.S. prisons. 30

H2: The negative association between racial/ethnic minority identity and the use of mental health services is partially attenuated after controlling for predisposing, enabling and need characteristics. 30

Chapter 4: Results 31

Table 2: Weighted Descriptive Statistics of Nationally Representative Sample of Individuals in State and Federal Prisons in the US in 2004 by Race/Ethnicity 33

Table 2: Weighted Descriptive Statistics of Nationally Representative Sample of Individuals in State and Federal Prisons in the US in 2004 by Race/Ethnicity 33

Table 3: Weighted Outcomes of Nationally Representative Sample of Individuals in State and Federal Prisons in the US in 2004 37

Table 4: Weighted Logistic Regression of Race/Ethnicity on Any Mental Health Treatment Service Use since Admission to Prison using the Survey of Inmates in State and Federal Correctional Facilities, 2004 (Partial Table) 40

Table 5: Weighted Logistic Regression of Race/Ethnicity on Psychotropic Medication Mental Health Treatment Service Use since Admission to Prison using the Survey of Inmates in State and Federal Correctional Facilities, 2004 (partial table) 42

Table 6: Weighted Logistic Regression of Race/Ethnicity on Counseling/Psychotherapy Mental Health Treatment Service Use since Admission to Prison using the Survey of Inmates in State and Federal Correctional Facilities, 2004 (partial table) 44

Table 7: Weighted Logistic Regression of Race/Ethnicity on Receipt of Counseling/Psychotherapy and Psychotropic Medication for Mental Health Treatment since Admission to Prison using the Survey of Inmates in State and Federal Correctional Facilities, 2004 (partial table) 46

Sensitivity Analyses 47

Chapter 5: Discussion 47

Strengths and Limitations 52

Future Research 53

References 54

Appendix A: Cross-walk for mental health disorder screening 63

Appendix B: Criteria for alcohol abuse or dependence 64

Appendix C: Complete regression results for Table 4 through Table 7 65

Table C4: Weighted Logistic Regression of Race/Ethnicity on Any Mental Health Treatment since Admission to Prison using the Survey of Inmates in State and Federal Correctional Facilities, 2004 65

Table C5: Weighted Logistic Regression of Race/Ethnicity on Psychotropic Medication since Admission to Prison using the Survey of Inmates in State and Federal Correctional Facilities, 2004 68

Table C6: Weighted Logistic Regression of Race/Ethnicity on Receipt of Psychotherapy since Admission to Prison using the Survey of Inmates in State and Federal Correctional Facilities, 2004 71

Table C7: Weighted Logistic Regression Results of Race/Ethnicity on Receipt of Psychotropic Medication and Psychotherapy since Admission to Prison using the Survey of Inmates in State and Federal Correctional Facilities, 2004 73

Appendix D: Complete regression models for sensitivity analyses 76

Table D4: Weighted Logistic Regression of Race/Ethnicity on Any Mental Health Treatment since Admission to Prison using the Survey of Inmates in State and Federal Correctional Facilities, 2004 76

Table D5: Weighted Logistic Regression of Race/Ethnicity on Psychotropic Medication for Mental Health Treatment since Admission to Prison using the Survey of Inmates in State and Federal Correctional Facilities, 2004 79

Table D6: Weighted Logistic Regression of Race/Ethnicity on Counseling/Psychotherapy for Mental Health Treatment since Admission to Prison using the Survey of Inmates in State and Federal Correctional Facilities, 2004 82

Table D7: Weighted Logistic Regression of Race/Ethnicity on Receipt of Psychotherapy and Psychotropic Medication for Mental Health Treatment since Admission to Prison using the Survey of Inmates in State and Federal Correctional Facilities, 2004 85

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