Among prisoners in the Los Angeles County jail, those with mental health conditions are disproportionately older, black, or white, according to findings published in Psychiatry Services. Furthermore, women and individuals charged with a misdemeanor were overrepresented in the mental health population.

Los Angeles County has the largest incarcerated population in the United States, and in California, the jail system accounts for the major share of mental health treatment facilities. Prisoners in the jailed population are disproportionately black, and black people are less likely to receive psychiatric treatment.

Researchers analyzed data from the LA County Sheriff’s Department on race and ethnicity among the jailed mental health population. They focused on individuals incarcerated in LA county, including those in “jail mental health housing” on February 14, 2019. Incarcerated individuals are placed in jail mental health housing based on a brief mental health screening conducted upon booking. Those in need of mental health care are seen by a clinician and then referred to a psychiatrist. Age, race, ethnicity, gender, and type of charges were compared between the mental health population (n=5134) and the overall LA County jail population (N=16,975).

Within the jail mental health population, there was a significantly higher proportion of black (41% vs 30%; P <.001) and white individuals (19% vs 15%; P <.001) and a lower proportion of Hispanic individuals (35% vs 52%; P <.001). The mental health sample was older, with a smaller proportion of people ages 18 to 25 years (16% vs 24%; P <.001) and more people over age 45 years (26% vs 20%; P <.001). Women were slightly overrepresented in the mental health population compared to the general sample (15% vs 13%; P <.001).


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Notably, compared to the overall sample, the population with mental health conditions had a significantly lower felony rate (91% vs 80%; P <.001). As the investigators noted, this finding is at odds with Los Angeles Sheriff’s Department policy, which aims to not retain inmates on misdemeanor charges. They stated, “Expanding community services to provide robust and comprehensive care would likely reduce “quality-of-life” crimes.”

Study limitations included the inability to account for confounding factors due to the lack of individual-level data from the overall LA County jail population.

This study could have implications for equitable diversion efforts to reduce health disparities in incarcerated populations. “The racial disparities present in our sample may reflect the potentiating effects of racism at various stages in the carceral and mental health systems,” noted the researchers.

Reference

Appel O, Stephens D, Shadravan SM, Key J, Ochoa K. Differential incarceration by race-ethnicity and mental health service status in the Los Angeles county jail system [published online ahead of print, 2020 Apr 28]. Psychiatr Serv. 2020;appips201900429.