A Preliminary Investigation of the Intersection of Race and Disabilities among Inmates in the U.S. State Prison System

Abstract

The American prison system is overcrowded with minorities in general, and African Americans, in particular. The Department of Justice notes that more than 50% of the prison population have some type of mental disability. In this study, we examine the intersection between race and disabilities in the U.S. State prison system. Using the Rehabilitation Services Administration data set, the study highlights the prevalence and type of disabilities in the prison inmate population. Results demonstrate that African American inmates are overrepresented among inmates with disabilities, are more likely to have mental disabilities relative to physical disabilities, and these results hold for various types of mental disabilities including cognitive, psychosocial, and other mental disabilities. Study limitations and directions for future research are also discussed.

Keywords

race African American Hispanics disabilities corrections mental health physical health

Introduction

U.S. prisons are overrepresented with ethnic minorities. Specifically, African Americans comprise the most overrepresented group in U.S. prisons. Although African Americans only represent 13% of the total U.S. population, approximately 3% of all U.S. African American males were in a federal or state prison in 2013 compared with 0.5% of White males (Carson, 2014). Comparatively, African Americans and Hispanics represent more than 60% of the state and federal prison population (Carson, 2014). Furthermore, Bronson, Maruschak, and Berzofsky (2015) noted that more than one third of all state and federal prisoners and jail inmates had some type of disability related to hearing, vision, cognitive, ambulatory, self-care, or independent living. Daniel (2007) also reported that more than 50% of the prison population had some type of mental disability compared with only 11% of the general population. In addition, McCarthy (2014) illustrated that the U.S. State and County prisons hold 10 times more of those with mental illnesses than State mental hospitals and are becoming the “new asylums.” To this end, individuals with severe mental illnesses were also 2½ times more likely to be violently victimized compared with the general population (Hiday et.al, 1999). For inmates with mental illnesses, they face a number of safety threats in terms of manipulation and abuse from other prisoners. They were also more likely to be hurt in a fight and involved in a physical assault (Schlanger, 2017). In this vein, it is common for the inmates’ mental health issues to become worse as they are continually left untreated in the prisons leading to deteriorated mental conditions and higher rates of reoffending and recidivism (Feist-Price, Lavergne, & Davis, 2014; Reingle Gonzalez, Cannell, Jetelina, & Froehlich-Grobe, 2016).

Prior research has also noted that individuals with mental disabilities were more likely to be involved with the criminal justice system to begin with and report extreme psychological distress relative to inmates without disabilities (Bronson et al., 2015; Davis, 2009; Reingle Gonzalez et al., 2016; Weis, 2013). Moreover, more than 50% of state inmates who reported being homeless also identified as having a mental illness (Marushack & Beck, 1997). Similarly, two in 10 prison inmates were noted to have a cognitive disability, also the most commonly reported disability among prison populations (Bronson et al., 2015). Prins (2014) has argued that while attention has been given to disabilities in the inmate population, only a couple of federal self-report studies are generally cited that provide insight on the prevalence of disabilities in the inmate populations (Jones, 2007; Krienert, Henderson, & Vandiver, 2003). A recent report by the American Civil Liberties Union (2017) noted that while there is no comprehensive data on inmates with physical disabilities, based on a 2003 survey, approximately 26% of inmates reported having a mobility, visual, or hearing disability. In addition, in examining 10 states in the report, the study found 21% of inmates in the Florida Department of Corrections were assigned to some type of assistive device and one in 20 inmates in Pennsylvania identified as having a visual or hearing disability (Morgan, 2017).

Similarly, Schlanger (2017) noted an estimated 7.1% vision and 6.2% hearing disability among inmates in prisons. Furthermore, in a study conducted in 11 California prisons on physical disabilities among geriatric prisoners, Williams et al. (2009) reported that the total number of older prisoners with a disability was significantly higher than those that were officially known to the correctional officers and the California Department of Corrections and Rehabilitation (CDCR). High health risk prisoners were more likely to have memory disabilities with high-level functional disabilities. Barry, Wakefield, Trestman, and Conwell (2017) also indicated that older inmates who had disabilities in activities of daily prison living were at a higher risk of comorbidities including depression and suicide ideation. Similarly, others have noted that inmates with intellectual disabilities often have coexisting physical disabilities such as hearing and vision disabilities as well as other mental health conditions (Dias, Ware, Kinner, & Lennox, 2013; Hellenbach, Karatzias, & Brown, 2017). In one of the more comprehensive studies to date on the inmates with disabilities population, Reingle Gonzalez et al. (2016) analyzed a nationally representative sample of prisoners and reported that 41% of prisoners had disabilities. More specifically, prevalence estimates of certain types of disabilities among the inmates with disabilities were as follows: learning (31%), vision (25%), hearing (17%), mental health (14%), speech (9%), and assistive device (6%). Nevertheless, there is still a dearth of research examining inmates with disabilities in the prison system generally, and a near absent literature examining if there is an overrepresentation of minority inmates with disabilities specifically. For example, the Illinois Department of Corrections does not collect any data on the number or type of disabilities in the inmate population (American Civil Liberties Union, 2017). Therefore, it is important to assess the prevalence and nature of disabilities in state prisons to create effective prison policies and rehabilitation efforts to reduce recidivism.

In recognition of these gaps in the extant research, the current study utilizes the Rehabilitation Services Administration (RSA) 911 data set to determine the prevalence and nature (physical or mental) of disabilities and factors associated with them among the inmates with disabilities population in U.S. State prisons. In addition, we seek to examine if minorities are overrepresented in this specific population and/or presented higher prevalence rates of certain types of disabilities.

Method

Data

The present study relies on data from the RSA 911 case report from 2002 to 2011. These data are provided by state vocational rehabilitation (VR) agencies across all states as mandated by the Department of Education’s State Vocational Rehabilitation Services Program. Specifically, the Rehabilitation Act of 1973 mandated all state agencies to provide employment and VR services to all individuals with disabilities including individuals residing at correctional facilities.¹ Specifically, the data are comprised of case service records from VR agencies across the 50 states that receive RSA funding from the Department of Education. Demographic and agency data are collected by each agency for every individual exiting the VR program through the case service record every fiscal year.² These data are reported centrally to the RSA by each individual agency. As such, eligible inmates can receive VR services based on their disability. In addition, an assessment is conducted by individual VR agencies to determine disability status to be eligible to receive services.

For the purpose of our analysis, only individuals that identified as living at a correctional facility were included in the analysis. The original data are comprised of 35,371 inmates. Inmates that were not diagnosed with any disability were eliminated (n = 977) along with inmates who had missing disability information (n = 1,242). In addition, to permit an examination of mutually exclusive racial/ethnic categories and due to very small percentages of Asians, Pacific Islanders, and Native Americans, the Mixed Race and Other Race (i.e., Asians, Pacific Islanders, and Native Americans) categories were also excluded. Thus, the final analysis sample consisted of 30,269 African American, Hispanic, or White inmates with disabilities.

Dependent Variable

Disabilities

The disabilities are originally represented by a total of 16 physical disabilities and three mental disabilities.³ These 19 categories were subsequently divided into four major categories of disability types: physical, cognitive, psychosocial, and other mental disabilities.⁴ The resulting categorical variable was coded such that 1 = physical disabilities, 2 = cognitive disabilities, 3 = psychosocial disabilities, and 4 = other mental disabilities.

Independent Variable

Race

Race was originally coded as White = 1, Black or African American = 2, American Indian or Alaska Native = 3, Asian = 4, Native Hawaiian or Other Pacific Islander = 5, Hispanic or Latino = 6, and Mixed or Other Race = 7. For reasons described above (small sample sizes and mutual exclusiveness), inmate race was represented by the following three dichotomous and mutually exclusive variables: African American (yes = 1, no = 0), Hispanic (yes = 1, no = 0), or White (yes = 1, no = 0).

Demographic Control Variables

Consistent with prior research utilizing these data and examining the inmates with disabilities population (Baloch & Jennings, 2018), demographic control variables were included representing the education and biological sex of the inmate.⁵ Education was originally coded as: 0 = no formal schooling, 1 = elementary education, 2 = secondary education (Grades 1-8), 3 = secondary education, no high school diploma (Grades 9-12), 4 = high school graduate or equivalency certificate (regular education students), 5 = post-secondary education, no degree, 6 = associate degree or vocational/technical certificate, 7 = bachelor’s degree, and 8 = master’s degree or higher. For analysis purposes, this measure was recoded as 1 = high school diploma or higher and 0 = less than a high school diploma. Comparatively, biological sex was originally coded as 1 = male and 2 = female, and this measure was recoded as male = 1 and female = 0.

Analytic Procedure

In terms of our analytical strategy and statistical techniques employed, the analysis progressed in three key stages. First, we began by examining the prevalence and types of disabilities in the total sample of 30,269 inmates. The second stage of the analysis involved a series of chi-square tests to demonstrate the differences in the prevalence and types of disabilities present among African American, Hispanic, and White inmates. The last step in the analysis included estimating a multinomial logistic regression model to evaluate the association between being an African American or Hispanic inmate and the likelihood of having a certain type of disability (i.e., cognitive, psychosocial, or other mental disabilities relative to physical disabilities) net of demographic control variables.

Results

As displayed in Table 1, approximately 53% of the inmates with disabilities referred to the VR agencies were African Americans, 46% were White, and 1% was Hispanic. The majority of inmates were males (83%). A little over half of the 30,269 inmates had an education of a high school diploma or higher. In regard to the disabilities present, 92% of the inmates had some type of mental disability compared with 8% who exhibited a physical disability. Among the inmates who had mental disabilities, psychosocial disabilities represented over half of the total mental disabilities at 57% followed by other mental and cognitive disabilities at 31% and 12%, respectively.

Table 1.

Descriptive Statistics (n = 30,269).

Variables	% (n)	SD	Minimum	Maximum
Independent variables
African American	53 (16,043)	—	0.00	1.00
Hispanic	1 (303)	—	0.00	1.00
White	46 (13,924)	—	0.00	1.00
High school diploma or higher	58 (17,556)	—	0.00	1.00
Male	83 (25,123)	—	0.00	1.00
Dependent variable
Physical disability	8 (2,422)	—	0.00	1.00
Mental disability	92 (27,847)	—	0.00	1.00
Type of mental disability
Cognitive disability	12 (3,342)	—	0.00	1.00
Psychosocial disability	57 (15,873)	—	0.00	1.00
Other mental disability	31 (8,632)	—	0.00	1.00

The results of the chi-square tests of the prevalence and types of disabilities present among the three groups of inmates are illustrated in Table 2. Overall, demographic factors (high school and male) were significantly different across the three racial groups with Whites having the highest prevalence of a high school diploma or higher at 68%. African American inmates had the highest prevalence of male inmates at 88%. In terms of disabilities, mental disabilities including cognitive, psychosocial, and other mental disabilities were significantly different across the three racial/ethnic groups. Specifically, African American inmates had the highest prevalence of mental disabilities in general and cognitive disabilities specifically. Whites were also found to have a higher prevalence of psychosocial disabilities while Hispanics had the highest prevalence of other mental disabilities.

Table 2.

Chi-Square Results by Race/Ethnicity.

Variables	High school diploma or higherYes (%)	MaleYes (%)	Mental disabilityYes (%)	Cognitive mental disabilityYes (%)	Psychosocial mental disabilityYes (%)	Other mental disabilityYes (%)
African American	49	88	94	13	52	29
Hispanic	49	85	90	11	40	39
White	68	78	91	09	54	27
χ² statistic	1.1***	490.8***	123.8***	125.5***	36.8***	29.3***

Note. Rounded row percentages reported.

p < .05. **p < .01. ***p < .001.

The results above provide support for the hypothesis that African American inmates may have a higher prevalence of mental disabilities, specifically cognitive disabilities. To test this relationship further, we estimate a multinomial logistic regression model, where the outcome variable, that is, type of disability, comprises four categories (cognitive disability, psychosocial disability, and other mental disability with physical disability serving as the reference category) and four independent variables are included (i.e., African American, Hispanic, inmate education, and inmate biological sex). As reported in Table 3, the results from the multinomial logistic regression model mirror the chi-square results suggesting that being an African American inmate is associated with having a higher likelihood of having a mental disability, specifically cognitive disabilities. Stated differently, being an African American inmate significantly increased the likelihood of having a mental disability in general relative to having a physical disability, with the relative risk ratios ranging from 1.86 (95% confidence interval [CI] = [1.66, 2.07], p < .001) for cognitive disabilities, 1.43 (95% CI = [1.31, 1.57], p < .001) for psychosocial disabilities, and 1.57 (95% CI = [1.42, 1.72], p < .001) for other mental disabilities. Similarly, having an education of a high school diploma or higher significantly decreased the likelihood of having a mental disability across all types relative to having a physical disability. In addition, being male significantly decreased the likelihood of having other mental disabilities in contrast to having a physical disability. No significant effects were observed for the relationship between being Hispanic and the various types of disabilities.

Table 3.

Multinomial Regression Model.

Variables	Group 2Cognitive mental disability		Group 3Psychosocial mental disability		Group 4Other mental disability
Variables	RRR	95% CI	RRR	95% CI	RRR	95% CI
African American (reference category = White)	1.86***	[1.66, 2.07]	1.43***	[1.31, 1.57]	1.57***	[1.42, 1.72]
Hispanic (reference category = White)	0.93	[0.58, 1.51]	0.69	[0.47, 1.02]	1.32	[0.90, 1.94]
High school diploma or higher (reference category = less than a high school diploma)	0.31***	[0.28, 0.35]	0.74***	[0.67, 0.81]	0.62***	[0.56, 0.69]
Male (reference category = female)	0.88	[0.76, 1.02]	0.91	[0.80, 1.03]	0.73***	[0.64, 0.83]

Note. Group 1 (physical disability) is the omitted reference category. Model χ² = 897.02***; –2 Log Likelihood = −34,045.235; Nagelkerke R² = 0.013; N = 30,269. RRR = relative risk ratio; CI = confidence interval.

p < .05. **p < .01. ***p < .001.

Discussion and Conclusion

The purpose of this study was twofold: (a) to examine the prevalence and nature of disabilities among the inmates with disabilities population; and (b) to determine if minorities were overrepresented in this specific population and/or presented higher prevalence rates of certain types of disabilities. Several key findings emerged from this effort and are highlighted below.

Using the RSA 911 data set, our findings highlight that the majority of inmates referred to vocational services had mental disabilities compared with physical disabilities in the U.S. State prisons. In terms of the nature of disabilities, psychosocial mental disabilities were found to be the most common among inmates with disabilities. These findings are consistent with prior studies identifying an overrepresentation of mental illnesses in the prison populations (Bronson, Stroop, Zimmer, & Berzofsky, 2017; Daniel, 2007). In addition, the results echo other studies that found inmates are at a significantly higher risk of antisocial and other behavioral disorders compared with the general population (Fazel et al., 2002; Fazel & Seewald, 2012; Fazel, Hayes, Bartellas, Clerici, & Trestman, 2016; Whitefield, 2009). For instance, a worldwide study on prisoners conducted by Fazel and Danesh (2002) noted that prison populations were 10 times more likely to have antisocial personality disorder and several times more likely to have psychosis and depression than the general population. Considering that over half of the U.S. prison inmate population have some type of substance abuse/drug dependence disorder that are often accompanied with psychosocial disabilities, our findings were not entirely unanticipated (Bronson et al., 2017). In terms of physical disabilities, our findings revealed that there exists only a small percentage of inmates with physical disabilities who utilized VR services. These findings may provide support for prior research that inmates with physical disabilities are often not identified and/or referred to appropriate programs and services in prisons (Williams et al., 2009). In addition, it may be possible that inmates with mental health conditions accompany physical disabilities as noted in other studies (Barry et al., 2017; Dias et al., 2013; Hellenbach et al., 2017). However, the data in the current study do not account for coexisting disabilities; hence, we were unable to identify inmates with both types of disabilities.

Furthermore, to address our second research question, our findings showed approximately half of the inmates who utilized VR services were African American, whereas only 1% of the inmates who utilized these services were Hispanics. This representation is fairly reflective of the prevalence of African American inmates in the U.S. State prisons in general, but Hispanics are underrepresented relative to their representation in the state inmate population overall (see Bronson et al., 2017). Comparatively, African American inmates had a higher prevalence of cognitive disabilities compared with White and Hispanic inmates. Cognitive disabilities generally include specific intellectual conditions ranging from learning, reading, and difficulty concentrating. Not to our surprise, these findings mirror the disabilities and minority youth contact with the criminal justice system literature where there is an overrepresentation of African American children overall and in specific intellectual disabilities and mental retardation categories specifically (Baglivio, Wolff, Piquero, Greenwald, & Epps, 2017; Losen & Welner, 2001; Piquero, 2008; Raines, Dever, Kamphaus, & Roach, 2012; Togut, 2012).

The findings from this research bring important implications by providing insight on the prevalence and nature of disabilities in state prisons. To this end, our research highlights a need for offender treatment and rehabilitation efforts based on the characteristics of the prison populations, specifically for inmates with disabilities. This is particularly important given that inmates with disabilities are at a much higher risk of recidivating versus inmates without disabilities due to a lack of treatment, social support networks, and other challenges (Reingle Gonzalez et al., 2016; Stevenson, 2014). In addition, they are more likely to have higher criminogenic factors and belong to disadvantaged backgrounds compared with other inmate populations (Reingle Gonzalez et al., 2016). Furthermore, they are often marginalized and mistreated due to the state prisons generally lacking a structure and ability to accommodate and provide services based on the needs of their disabilities (Harley, 1996; Krienert et al., 2003; Morton & Anderson, 1996; Williams et al., 2009).

In addition, given that an overwhelming proportion of the inmate population have some type of mental illness (Daniel, 2007; Reingle Gonzalez et al., 2016) with a large number of inmates with psychosocial disabilities and substance abuse problems, in-prison programs for drug rehabilitation should be introduced or expanded. Specifically, given that the risk of recidivism may be highest among offenders with substance abuse disorders, concentrated attention should be directed at rehabilitating these offenders (El Sayed et al., 2016) as inmates with substance abuse disorders often present co-occurring mental health conditions. Furthermore, in a number of cases such as nonviolent drug offenses and low risk offenders, alternatives to imprisonment and “risk-and-needs” assessments can be offered for offenders with disabilities. In addition, extensive mental health evaluations may be helpful at the initial stage of arrest or adjudication to direct appropriate action to avoid the huge costs associated with the criminal justice system process and incarceration. One such effort is represented in the state of Texas where specialty courts have been introduced that range from mental health to commercially sexually exploited persons (CSEP) courts which have had some success in decreasing recidivism (Malcolm, 2016; Thielo, Cullen, Cohen, & Cecilia, 2016). A recent report by The Pew Charitable Trusts (2016), examining a number of states from 2010 to 2015 that introduced significant criminal justice reform with increased rehabilitation, observed declines in the crime rates in those states. In addition, other states that introduced similar efforts including drug, veterans, and prostitution courts also experienced notable declines in their crime rates. Although many states are shifting toward criminal justice policy reform and the results have been promising (Malcolm, 2016), specialized efforts need to be directed at offenders with disabilities given that they are one of the most underresearched and marginalized populations in the criminal justice (and prison) system.

More importantly, there is a general scarcity of data on inmates with disabilities in the prison system. A dire need for data collection on inmates with disabilities is required to introduce rehabilitation and treatment efforts accordingly. Overall, there is a lack of best practices across the criminal justice system including the police, courts, and corrections in terms of managing persons with disabilities. Training programs and efforts for the police aimed at handling individuals with disabilities should be supported to avoid additional costs to the system and society. These efforts can be pointed toward directing these individuals to appropriate rehabilitation services and prevent them from further entry into the criminal justice system to begin with. Other rehabilitation services such as VR can be especially beneficial in securing employment for inmates with disabilities (Baloch & Jennings, 2018).

The National Alliance on Mental Illness (2018) noted that approximately 18.5% of U.S. adults face a mental illness every year with 4% or 9.8 million experiencing a serious mental illness. In general, states are shifting toward improving mental health care and providing increased services to individuals with disabilities. With the adoption of the expansion of the Affordable Care Act in 2014, states that adopted the expansion can provide continuous medical and psychological services to the inmates through subsidized Medicaid (The Pew Charitable Trusts, 2015). In addition, a large proportion of individuals who exited prisons that were not covered previously (nondisabled inmates without dependent children) have access to health care under the expansion of the Affordable Care Act. Considering these major milestones in health care pertaining to prison and other vulnerable populations, it may be easier to rehabilitate inmates with disabilities and rehabilitation efforts may be more successful.

Despite these important results derived from the current study, this research has some limitations that need to be acknowledged. First, the data are derived from the state VR agencies and do not provide any offense data on the inmates. Therefore, we are unable to examine the relationship between inmate disability and the type of offense committed or subsequent recidivism. It would be useful to identify if there is an association between a certain type of disability (cognitive vs. psychosocial) and specific crimes (property vs. violent crimes), and if inmates with certain types of disabilities have a differential risk for recidivism. Second, the data lack other confounders including employment prior to incarceration and the need for vocational training that may provide additional insight to the nature of disabilities. Third, the data only contain individuals that were actually identified as having a disability and referred to the state vocational agencies. Given the poor state of attention given to mental health in the state prison systems, the data used in the study may not account for individuals that were never diagnosed. Fourth, it is not possible to identify inmates with co-occurring disabilities (mental and physical), which may very well be the case for a number of inmates (Baloch & Jennings, 2018). Fifth, although this is beyond the scope of our study, it would be highly useful for future research to incorporate measures of discrimination into their analysis when data permit as research has consistently demonstrated that experiencing racial/ethnic discrimination is associated with a number of adverse outcomes, and these experiences are both shared and uniquely experienced across racial/ethnic groups (Jennings, Piquero, Gover, & Pérez, 2009; Pérez, Jennings, & Gover 2008; Peck, Childs, Brady, & Jennings, 2018; Piquero, 2008). Ultimately, it is clear that inmates with disabilities in general and minority (African American) inmates with disabilities in particular are a “high needs” population that should be the focus of future empirical research and criminal justice policy and programming going forward.

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

Notes

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