Sexual Orientation, Mental Illness, and Substance Use Disorders Among Criminal Legal System–Involved Individuals

Objective:The purpose of this study was to examine the prevalence of mental illness, substance use disorders, and access to treatment among individuals from sexual minority groups who have been involved with the criminal legal system.Methods:This study used data from 195,239 heterosexual adults and 14,995 sexual minority adults ages ≥18 years surveyed in the 2015–2019 National Survey on Drug Use and Health. The authors compared mental illness, substance use disorders, and access to treatment between sexual minority and heterosexual adults by using multivariable logistic regression models and controlling for sociodemographic characteristics.Results:Approximately 9% of legal system–involved adults identified as belonging to a sexual minority group. Among legally involved individuals, sexual minority individuals were more likely than heterosexual individuals to have a serious mental illness, suicidal ideation, or depressive thoughts and to use inhalants, hallucinogens, alcohol, marijuana, or cocaine. Legally involved sexual minority individuals were also more likely than their heterosexual counterparts to receive treatment for mental illness or substance use disorders. The increased probability of receiving treatment for mental illness and substance use among sexual minority individuals was also observed when comparing sexual minority and heterosexual adults not involved with the criminal legal system.Conclusions:This study adds new population-based research to a limited body of evidence on the health disparities and mental health needs of legally involved sexual minority populations. More research and programmatic and policy interventions are needed to better support legally involved sexual minority groups in order to achieve mental health equity for this vulnerable population.