Lorio Forensics

Achieving Mental Healthcare Equity For The Incarcerated

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 be 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.”

Click here to purchase and view this full article.


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

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Dr. Vinson Recently Featured on NPR

Dr. Vinson was recently featured on NPR. She’s featured in a new Ken Burns documentary on youth mental health entitled ‘Hiding in Plain Sight’. Listen