I wanted to expand on the NPR piece about prisons becoming the new state mental hospital.Until recently, most of my clients were African-American adolescents and adults. Given that my program focused heavily on cultural issues in psychology, professors emphasized the importance of being able to discern between cultural factors and diagnostic criteria. Working with other trainees whose programs did not focus heavily on cultural factors in psychology showed me how frequently psychologists, particularly White students and psychologists, over-diagnose or misdiagnose African-Americans.
It’s well-known in psychology that the prevalence rate of psychological disorders among inmates far exceeds the prevalence rates in society. But in all the literature on this topic, few seem to wonder if over diagnosis of psychological disorders in African-Americans is paying into these high rates. Earlier this year, a review article by Rich, Wakeman, & Dickman (2011), Medicine and the Epidemic of Incarceration in the United States , discussed the prevalence of mental illness in prisons and jails appeared in the New England Journal of Medicine. You may be wondering what in the world is a “review article.” Well, it’s an article in an academic journal, like the New England Journal of Medicine, that summarizes the current research on a specific topic, and in this case, the rise of psychological disorders in U.S. prisons and jail. According to the article, 22% of state prisoners and 7% of jail inmate are treated for mental health issues while incarcerated. It is a well-known, documented, and maddening fact that racial disparities exist in our prison system, where Latinos and African-Americans are more likely than Whites to be incarcerated. Rich, Wakerman, & Dickman (2011) raised important points about what may be influencing these rates, such as the living conditions, solitary confinement, and substance use and dependence.
Sometimes my profession embarrasses me, and this is one of those moments. Remember Dr. Satoshi Kanazawa? The evoluntionary psychologist who asserted in Psychology Today that Black women were not only less attractive than almost every other ethincity, but also have more testosterone and less intelligence? Well, his “punishment” from the London School of Economics was recently announced in Times Higher Education:
The LSE has now published the findings of an internal investigation into the affair, ruling that Dr Kanazawa had “brought the school into disrepute” and barring him from publishing in non-peer-reviewed outlets for a year.
In addition to the 12-month ban, he will not teach any compulsory courses this academic year.
LSE’s disciplinary actions induce eye rolling. This was not the first, second, third, or fourth time Dr. Kanazawa has used the cloak of his degree and psychology to promote racist and sexist stereotypes or just plain ol’ dumb ideas. Instead of setting a standard of what is valid and objective research, the university preserved his faculty statues and will allow him to publish in peer reviewed journals, which are of higher professional esteem than non-peer reviewed ones. Therefore, he can spend a year in his lab conducting more studies and continue writing in journals (assuming his work is accepted) that reach people inside and outside of the field. Adding to this, he will back in the classroom this time next year, where he can continue to impart his pseudo-scientific beliefs into future researchers.
In an attempt to save what’s left of his face, he penned a letter:
In a letter to Judith Rees, director of the LSE, Dr Kanazawa says he “deeply regrets” the “unintended consequences” of the blog and accepts it was an “error” to publish it.
“In retrospect, I should have been more careful in selecting the title and the language that I used to express my ideas,” he writes.
“Unintended consequences” and being mindful of his language? I’m not buying it given his history of purposefully crafting incendiary titles and conclusions. He put forth “controversial” ideas for attention and to be “edgy” (whatever that means these days). Although his respect and status took a major hit, he maintains his job, continues conducting research, and may soon return to being published in peer reviewed journals. A slap on the wrist indeed.
"It seems to me that we criminalized the mentally ill"- Sheriff Greg Hamilton of Travis County in Austin, Texas
Earlier last week, All Things Considered reported on how jails now serve as hospitals for people with severe mental illness. It briefly touches on why most state psychiatric hospitals were fazed out in the 1980s. Also, the crisis is discussed in how it affects the judicial system in two major cities: Miami and Austin. Lastly, Chris Payne’s book, Asylum: Inside the Closed World of State Mental Hospitals, is profiled, which is collection of photos taken at abandoned and dilapidated state psychiatric hospitals. Selected photos from the book can be found on his website. This is a major issue that is growing rapidly as the development of jails and prisons continues to expand. Yet in discussions about fixing the U.S. health care system, the lack of mental hospitals is ignored.
Health disparities are my thing, my niche. Understanding the gaps between economic class, sex, gender, race, and ethnicity captivate me. Coming across a new study investigating the impact of race and ethnicity on receiving a RO1 research grant from the National Institutes of Health (NIH) obviously gained my full attention during my early morning at internship. Now, grant classification and their respective importance is really only known and understood by those in the scientific industry. In an attempt to explain, a RO1 grant is one of the oldest and most prestigious sources of funding given by NIH for studying health. The success rate for RO1 applications varies by year and division of NIH due to fiscal funding, but it typically ranges from 20-30%. Applicants from a variety of organizations – small businesses, non-profit organizations, hospitals, universities, faith-based, etc. – are eligible for receiving this highly coveted award as it can provide more than $250,000 for research endeavors. Award money is allocated to help researcher(s) cover expenses needed to run a study or studies. Expenditures such as an applicant’s salary, tuition for graduate student, laptops, and office supplies can purchased with the grant. More importantly, an RO1 is instrumental for professors vying for tenure because universities want to know that their faculty has the skill set to bring in money a.k.a. grants, particularly MAJOR ones. Without an RO1 grant under one’s belt, their chances of gaining tenure decreases, and their job security at the university becomes uncertain. A RO1 grant plays a large role in deciding who achieves university faculty status and in determining which scientific issues are addressed.
Back to the study, Ginther et al. (2011) investigated over 83,000 RO1 applications and approximately 40,000 Ph.D. applicants to see if a race and ethnicity influence the likelihood of receiving the grant. Color me unsurprised (although Ginther was), findings show that race does factor into the likelihood of receiving a RO1 grant. Black scientists were less likely to receive the grant, not only in comparison to Whites, but also in comparison Asian and Hispanic scientists. The difference seen in Asian researchers disappeared when accounting for Asians who are not U.S. citizens, yet the gap remained when controlling for non-U.S. citizen Black applicants.
Figure S3 shows that 87% of Asian, 45% of black, 56% of Hispanic, and 25% of white applications were from non-U.S.-citizen investigators. When the analysis sample was restricted to include only those applicants who were U.S. citizens at the time of Ph.D. receipt, the difference in a R01 award probability for Asian applications was cut in half and was no longer statistically significant (table S8). However, the 10 percentage point difference in award probability for blacks did not change (–0.107, P < 0.001) after including all covariates.
Throwing in other potential factors, such as training post-graduation, number of citations, previous research awards, and type of origin, had no effect on the chances of Black applicants obtaining a RO1.
Compared with R01 applications from white U.S. citizens or permanent resident investigators with previous NIH training experience, applications from black investigators were 13.5 percentage points less likely to be funded (P < .001). For all applicants who received F or T training, blacks were 27.4 percentage points (P < .001), Asians were 6.9 percentage points (P < .01), and Hispanics were 9.5 percentage points (P < .01) less likely to ever receive an R01 award compared with whites. A closer investigation of the impact of training by race/ethnicity may provide insight into differences in R01 award probability and perhaps provide a policy lever for diversifying the scientific workforce.
As we try to straddle this recession, even though it is “over” and we are in “recovery,” federal funding for social programs is being slashed. This of course trickles down to state funded programs taking a hit. In particular, money allocated to states for Medicaid is not providing enough coverage, prompting some states, such as Maine, to move enrollees into managed care. Many question whether there would be any benefits for providing healthcare to the uninsured.
The National Bureau of Economic Research tackled this question and found that the poor and uninsured had better health outcomes and used more healthcare services than those who were not under Medicaid. In an unintended research design, the state of Oregon implemented a lottery system to select people at random to be enrolled in Medicaid, which comprised the treatment group). Those not selected compose the control group. The importance of the lottery lies in its ability to assign people randomly to a treatment or control group, which helps eliminate other factors that might influence the outcome of this study. Random assignment assumes that those receiving Medicaid (treatment group) and the uninsured (control group) share similar characteristics. Therefore, the results of the study can be linked to being insured, not the attributes of individual people in the treatment and control group. Furthermore, ethical violations would occur if the researchers randomly choose people to have insured while allowing others to go without it. Scientific research cannot prohibit people from getting available treatment, and in this case, it would be healthcare. Overall, the lottery provided the perfect opportunity since Oregon’s policy inadvertently allowed for random assignment.
At the outset of the study, people were in poor heath with 18% living with diabetes, 28% with asthma, 40% having high blood pressure, and 56% screening positive for depression. What emerged from this study was that having healthcare matters for low-income people. Sounds like a common sense conclusion, but many people think otherwise. People with Medicaid showed a 15% increase in their use of prescription medication and a 55% increase in outpatient visits. Even more, preventive measures increased among Medicaid users. Those with insurance had a 20% increase in blood cholesterol tests, 15% increase in being tested for diabetes or high blood sugar, 60% increase in women having a mammogram, and 45% change in women having a pap test. The insured also reported a 25% increase in describing their health as good or excellent and 40% less likely to say their heath increased within the last year.