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

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. © 2013 Springer Science+Business Media New York.