Vinson Sarah Y, Dennis Andrea L
Department of Psychiatry and Behavioral Sciences, Morehouse School of Medicine, and Lorio Forensics, Atlanta (Vinson); University of Georgia School of Law, Athens (Dennis).
Psychiatr Serv. 2021 Dec 1;72(12):1428-1433. doi: 10.1176/appi.ps.202000735. Epub 2021 May 12.
The current configuration and function of U.S. societal structures drives the overrepresentation of people with serious mental illness in the criminal legal system. Although the causes are multifactorial, the mental health system poorly serves those at highest risk of criminal legal system involvement. The growth of the mental health evidence base regarding the social determinants of mental health has ushered in greater understanding of their central role in the promotion and maintenance of mental illness and health. These academic strides, however, have failed to translate into widespread care and payment policy changes. Additionally, as is the case in the criminal legal system, structural racism shapes people's experiences in the mental health care system, contributing to inequitable mental health outcomes for persons with severe mental illness from racial and ethnic minority groups. This is a critical consideration for the population involved in the criminal legal system: Black and Brown people make up more than half of those incarcerated in the United States (despite comprising just 32% of the total population). In the absence of an intersectional, antiracist, structurally informed approach, any attempt by the mental health care system to stem the overrepresentation of people with serious mental illness in the criminal legal system will fail. This article provides an overview of the current mental health care system's shortcomings in serving this population. It proposes concrete steps to address these shortcomings, with a special focus on race and social determinants of health.
美国社会结构的当前配置和功能导致严重精神疾病患者在刑事法律系统中占比过高。尽管原因是多方面的，但心理健康系统对那些最有可能卷入刑事法律系统的人服务不佳。关于心理健康社会决定因素的心理健康证据基础的增长，使人们对其在精神疾病的促发和维持以及健康方面的核心作用有了更深入的理解。然而，这些学术进展未能转化为广泛的护理和支付政策变革。此外，正如在刑事法律系统中一样，结构性种族主义塑造了人们在心理健康护理系统中的经历，导致来自种族和族裔少数群体的严重精神疾病患者出现不公平的心理健康结果。对于涉及刑事法律系统的人群来说，这是一个关键考量因素：黑人和棕色人种占美国被监禁人数的一半以上（尽管仅占总人口的32%）。如果缺乏一种交叉性的、反种族主义的、基于结构认知的方法，心理健康护理系统为阻止严重精神疾病患者在刑事法律系统中占比过高所做的任何努力都将失败。本文概述了当前心理健康护理系统在为这一人群服务方面的不足。它提出了具体措施来解决这些不足，特别关注种族和健康的社会决定因素。
