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September 2025 (Volume 103)
Quarterly Article
Abhery Das
Michael Esposito
Tim A. Bruckner
Hedwig Lee
Sep 23, 2026
Jun 29, 2026
Jun 12, 2026
Back to The Milbank Quarterly
Policy Points:
Context: The justice system incarcerates nearly 2.3 million individuals in the United States. Black Americans comprise 40% of those incarcerated despite representing less than 15% of the population. Theoretical work posits that mass incarceration can erode social capital by straining social and family networks as well as inducing carceral churn and coercive mobility within Black communities. Scholars report that greater incarceration may influence population-level health, specifically in communities of color. However, previous work does not address whether incarceration, as well as the racial disparity in incarceration, corresponds with psychiatric help seeking in the Black community.
Methods: We examine the relation between incarceration and psychiatric emergency department (ED) visits among Black Americans from 2006 to 2015. As the exposure, we use 1) jail and prison incarceration among Black Americans (per 100,000 population), and 2) the ratio of non-Hispanic Black to non-Hispanic White American incarcerated populations as a measure of racial inequity in the criminal legal system. We examine, as the outcome, annual psychiatric ED visits (per 100,000 population) among Black Americans in 404 counties from ten US states between 2006 and 2015 (2,360 county-years). Linear fixed effects analyses control for time-invariant county factors as well as percentage below the federal poverty line, percentage unemployed, number of hospitals, and arrests for violent crime.
Findings: One additional individual incarcerated (per 100,000 population) corresponds with a 1.4% increase in psychiatric ED visits in Black communities (p < 0.001). An increase in racial inequity in incarceration (non-Hispanic Black to non-Hispanic White American ratio) also coincides with a 2.2% increase in psychiatric emergencies among Black Americans (p < 0.001).
Conclusions: The long arm of incarceration may extend to psychiatric emergencies among Black Americans in the broader community. Researchers and policymakers may consider measures, such as drug reform or other social policies, to reduce the influence of mass incarceration on acute and adverse mental health in the Black community.