Two Systems, One Population: Achieving Equity in Mental Healthcare for Criminal Justice and Marginalized Populations

October 21, 2020 Sarah Y. Vinson

Historically, the mental health system has never been readily accessible, culturally responsive, or a reliable source of effective interventions for vulnerable, at-risk populations. While marginalized groups plagued by failing systems (housing, education, etc.) face greater risks of developing mental illnesses, the individuals within these populations are cycled through the criminal justice system at alarming rates.

The United States criminal justice system, whose incarceration rates have increased by more than 500% in the last 40 years, has a lackluster approach to addressing issues of mental illness. This, in turn, warrants serious consequences that result in the mass incarceration and criminalization of a declassed group.

In an article published in Psychiatric Clinic: Achieving Mental Health Equity, Two Systems, One Population: Achieving Equity in Mental Healthcare for Criminal Justice and Marginalized Populations, five subject matter experts, including Lorio Forensics consultants, Dr. Sarah Vinson, Dr. Courtney McMickens, and Dr. Nicole Jackson, breakdown the following:

The interplay of mental health and criminal justice inequities;
The historical context for the prevailing extant approaches to correctional mental health treatment;
And programmatic approaches to addressing these inequities.

Overall, mental illness affects society’s most vulnerable, “including but not limited to, people of color, lesbian, gay, bisexual, transgender, queer (LGBTQ+) populations, and the poor,” in a unique way. Although these groups are impacted by deeply-rooted systemic issues, making them more susceptible to traumatic exposures, they lack the ability to gain access to proper health care. Because of this, the authors of Two Systems, One Population argue that these disadvantaged peoples are likely to be placed in the criminal justice system because they are:

Highly visible to law enforcement because they are overrepresented among homeless populations;
More likely to be arrested for the same behavior and tend to stay in jail and prison longer and less likely to be approved for parole or probation;
And more likely to be re-arrested, particularly those with co-occurring illnesses.

Rectifying a multilayered issue of this enormity requires a response that begins a fundamental understanding of mass incarceration’s impact on mental health. This basic knowledge should foundational for all public sector mental health professionals. Outside of clinical settings, advocacy efforts and intersystem collaboration are imperative.

According to the authors of the article in question, patient-centered care and the medical ethics principle of justice insist mental health providers are “aware of criminal justice system inequities but are also actively working within and across systems to eliminate them.”

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Contributing Authors

Sarah Y. Vinson, MD, corresponding author

Associate Professor of Psychiatry and Pediatrics, Morehouse School of Medicine

Principal Consultant, Lorio Forensics

Timothy T. Coffey, MS

Project Coordinator, Eleventh Judicial Circuit of Florida, Criminal Mental Health Project

Nicole Jackson, DSW

Forensic Mental Health Consultant, Lorio Forensics

Courtney L. McMickens, MD, MPH, MHS

Forensic Mental Health Consultant, Lorio Forensics

Brian McGregor, PhD

Associate Dir. of Research, Kennedy Satcher Center for Mental Health Equity, Satcher Health Leadership Institute

Assistant Professor of Psychiatry

Morehouse School of Medicine

Steven Leifman, JD

Associative Administrative Judge, Miami-Dade County Court Eleventh Judicial Circuit of Florida

Education Now | Helping Children Cope with Racial Trauma | Harvard Graduate School of Education

October 13, 2020 Sarah Y. Vinson

This summer, we’ve seen a new generation of young people calling out to demand racial justice — finding their voice in the fight for a more equitable society. And yet behind those demands is the fear, pain, stress, and trauma that Black Americans, including children, struggle with every day. Images of police brutality, instances of daily discrimination large and small, and even the need to think, talk, and educate white people about the black experience are draining. All of it— with the inequitable effects of the pandemic — creates serious challenges for social emotional wellness and readiness to learn.

Parents of children of color provide support at home, but how can schools and educators acknowledge and help students navigate racial trauma? How can educators and communities acknowledge their own stress and pain?

During this conversation, we addressed this critical question and identify concrete ways that educators and school leaders of all races can guide students through this traumatic time. Tracie Jones, HGSE’s Director of Diversity, Inclusion, and Belonging, joined by James Huguley, Ed.M.’04, Ed.D.’13, who is the Interim Director at University of Pittsburgh’s Center on Race and Social Problems; and Sarah Vinson, a physician who specializes in adult, child & adolescent, and forensic psychiatry. She is also an Associate Clinical Professor of Psychiatry and Pediatrics at Morehouse School of Medicine.

Ethnic adjustment abuses of intellectual abilities

October 6, 2020 Sarah Y. Vinson

The history of psychological assessment, specifically intellectual assessment, is complicated. From a lack of ethnic minority representation in standardization samples to attempts to prove the intellectual superiority of one racial group over another, intellectual assessment has its challenges in accepted validity across ethnic groups. In the context of forensic assessment, the consequences of an IQ score can be life or death. In 2002, The United States Supreme Court declared the execution of individuals classified as “mentally retarded” as unconstitutional. For most states as well as within the federal justice system, the designation of mental retardation is tied to intelligence testing. The scholars who authored the article Ethnic Adjustment Abuses in Forensic Assessment of Intellectual Abilities discussed the practice of ethnic adjustment, a practice of psychologists raising IQ scores of ethnic minorities upward by an arbitrary number to compensate for suppression based solely on clinical judgment.

Though the practice has been deemed to be unconstitutional by scholars and law professors, ethnic adjustment is widely used with at least 8 states within the federal circuit admitting testimony with this approach. Though explanations differ by the professionals using ethnic adjustments in intellectual assessment, broad social and cultural factors within ethnic minority groups have elicited such modifications. Specifically, professionals have argued that traditional intelligence testing does not properly account for factors such as poverty, interpersonal functioning, exposure to violence, substance use, and the differing culture of ethnic minority groups. Though ethnic adjustment has been used several times, it is not accepted in the practice of psychology as there is no documented evidence of any empirical support of the validity of ethnic adjustments. Likewise, the United States Supreme Court has previously ruled that ethnic minorities could not have IQ scores adjusted upwards to make them eligible for certain kinds of employment.

Every construct measured by psychological assessments is influenced by culture, including intelligence. Though it is impossible to assert that the construct of intelligence manifests identically across individuals, it is clear that clinical judgment without any use of empirical support will inherently contain bias. Individual bias and the lack of fairness in applying adjustments exclusively to ethnic minorities makes ethnic adjustment in intellectual testing especially harmful in forensic practice. To improve intellectual assessments with minority populations, more examination is needed of whether test properties are equivalent across members of a culturally diverse population. Additionally, more recognition of the heterogeneity in ethnic minority populations to guide research is warranted along with strict guidelines against the use of ethnic adjustment without empirical support.

In the forensic setting, the practice of ethnic adjustment can have dangerous consequences in death penalty cases. As a result, the authors highlight important implications for the justice system when engaging with clinicians and experts performing intelligence testing. The implications for forensic practice include:

Emphasizing the necessity of sound empirical processes and statistical procedures over clinical judgment in IQ scores,
Associating the violations of ethical standards with lack of competence,
Being clear in identifying and asserting limitations of intelligence testing protocols in report writing and testimony, and
Basing conclusions on established scientific and professional literature.

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Sources:

Shapiro, D. L., Ferguson, S., Hernandez, K., Kennedy, T., & Black, R. (2019). Ethnic adjustment abuses in forensic assessment of intellectual abilities. Practice Innovations, 4(4), 265–281.

BLACK PSYCHIATRY - Special Back-to-School Town Hall

September 22, 2020 Sarah Y. Vinson

In a special back-to-school edition of the Black Psychiatry Town Hall, the panel discusses what it’s like to care for children who are returning to school this fall during the COVID-19 pandemic. The featured experts, psychiatrists, teachers, and social workers, discussed how to help our children who are returning to unique settings.

To watch the full video, click the image below or follow this link.

The pandemic paused the US school-to-prison pipeline: potential lessons learned

September 21, 2020 Sarah Y. Vinson

The shift to virtual schooling placed adolescents in the USA out of the reach of harsh school disciplinary procedures, contributing to a drastic reduction in juvenile court referrals nationally - functionally pausing the school-to-prison pipeline. Characterized by school disciplinary approaches placing adolescents on a trajectory to juvenile and then adult criminal legal systems, this pipeline is most pronounced for Black and Latinx students, students with disabilities, and in schools serving impoverished communities.

Against the backdrop of a society in crisis, the return to in-person schooling might be a perfect storm: the anxiety, demoralization, fear, and frustration of stressed and academically behind adolescents manifesting in externalizing behaviors. A resurgence of the school-to-prison pipeline is a foreseeable outcome, one that would place vulnerable adolescents into a juvenile justice system that is not only ill-equipped to address their current mental or physical health needs, but is also associated with poor adult trajectories. Proactively taking steps to mitigate a resurgence of the pipeline is a matter of population health. These steps might help turn the pause in the pipeline into a permanent cessation, contributing to life trajectories that are overall healthier for vulnerable adolescents.

In her article for The Lancet: Child & Adolescent Health, Dr. Sarah Vinson further discusses this matter. To read the full text of her article, click here.