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A Paradox of Bias: Racial Differences in Forensic Psychiatric Diagnosis and Determinations of Criminal Responsibility

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Abstract

Although there is substantial evidence that African Americans receive unequal treatment in both the healthcare and criminal justice systems, less research has investigated the role of race when these two systems converge. Here, we examine the influence of race on patterns of forensic psychiatric diagnosis and determinations of criminal responsibility in pre-trial correctional facilities (e.g., forensic psychiatric hospitals). Data are from a medical chart review of 129 randomly selected competency evaluations that occurred in a pre-trial correctional psychiatric facility. Consistent with previous research, findings indicate that African Americans are disproportionately diagnosed with highly stigmatized psychotic spectrum disorders relative to whites. In addition, they unexpectedly indicate that African Americans are significantly more likely than whites to be found not criminally responsible by the court-appointed evaluating mental health professional, controlling for sociodemographic characteristics, number of violent and non-violent charges, and other potential confounding variables. Mediation analysis reveals the important and previously undocumented finding that the effect of race on criminal responsibility determinations is fully mediated by differential diagnosis. This suggests that patterns of racial inequality and potential bias in the diagnostic process may confer medical resources and other benefits for African Americans in the context of the criminal justice system.

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Notes

  1. According to statistics from the Kentucky Justice and Public Safety Cabinet (2007), 23 % of all individuals arrested in Kentucky between 2003 and 2007 were African American. This figure is very similar to the distribution of African Americans in our randomly selected sample (22 %). However, this figure is substantially higher than the overall percentage of the Kentucky population that is African American (8 %). This suggests that African Americans are disproportionately likely to be arrested in Kentucky, but once arrested, they are probably not disproportionately likely to be sent to a psychiatric correctional facility for evaluation prior to standing trial.

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Acknowledgments

The authors extend special thanks to Ms. Jennifer Haynes for support and feedback related to this project, and to Tyler Jones, MD, who helped initiate the chart review and data collection. The first and second authors contributed equally in this research. Address correspondence to Brea Perry, Department of Sociology, University of Kentucky, 1515 Patterson Office Tower, Lexington, KY 40506 (email: breaperry@uky.edu).

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  1. Department of Sociology, University of Kentucky, Lexington, KY, USA

    Brea L. Perry

  2. University Health Service, University of Kentucky, Lexington, KY, USA

    Matthew Neltner

  3. Department of Psychiatry, University of Kentucky, Lexington, KY, USA

    Timothy Allen

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  1. Brea L. Perry
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Correspondence to Brea L. Perry.

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Perry, B.L., Neltner, M. & Allen, T. A Paradox of Bias: Racial Differences in Forensic Psychiatric Diagnosis and Determinations of Criminal Responsibility. Race Soc Probl 5, 239–249 (2013). https://doi.org/10.1007/s12552-013-9100-3

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