Prison or treatment? Gender, racial, and ethnic inequities in mental health care utilization and criminal justice history among incarcerated persons with borderline and antisocial personality disorders.

Abstract

Objective: Borderline and antisocial personality disorders are characterized by pervasive psychosocial impairment, disproportionate criminal justice involvement, and high mental health care utilization. Although some evidence suggests that systemic bias may contribute to demographic inequities in criminal justice and mental health care among persons experiencing these mental health conditions, no research to date has explicitly examined such differences. Hypotheses: Women and White persons would be more likely to endorse internalizing symptoms and have a more extensive history of mental health service utilization, whereas men, persons from minoritized racial groups, and persons identifying as Hispanic/Latino would be more likely to endorse externalizing symptoms and have more extensive histories of involvement with the criminal justice system. Method: This study examined gender, racial, and ethnic differences in symptom presentation, criminal justice history, and mental health care utilization in a sample of 314 adults with comorbid borderline and antisocial personality disorders enrolled in prison-based substance use treatment programs in the United States. Results: Results suggested that men with these personality disorders were more likely to have early extensive criminal justice involvement, whereas women and White people had more and subset of variables relevant to these analyses are also available via the Open Science Framework (https://osf.io/yue9r).Emily R. Edwards played a lead role in conceptualization, formal analysis, and writing-original draft and an equal role in writing-review and editing. Gabriella Epshteyn played a lead role in writing-review and editing and a supporting role in conceptualization, formal analysis, and writing-original draft. Caroline K. Diehl played a supporting role in conceptualization, writingoriginal draft, and writing-review and editing. Danny Ruiz played a supporting role in conceptualization, writing-original draft, and writing-review and editing. Brettland Coolidge played a supporting role in writing-original draft and writing-review and editing. Nicole H. Weiss played a supporting role in supervision and writing-review and editing. Lynda Stein played a supporting role in writing-review and editing.