Black Americans receiving mental health services are disproportionately diagnosed with disruptive, defiant and psychotic disorders, and are nearly twice as likely to be physically, mechanically, or chemically restrained in mental health facilities, restrained for a longer time, and more likely to die in restraints.

African Americans and other Black Americans are more likely than other racial and ethnic groups to receive mental health diagnoses of psychiatric disorders related to disruptive, defiant and psychotic behavior, according to an updated government report on Americans’ use of mental health services. 

In mental health programs operated or funded by state mental health agencies, psychiatrists, psychologists, and other mental health providers disproportionately diagnosed Black people with attention-deficit hyperactivity disorder (ADHD), schizophrenia, conduct disorder, and oppositional defiant disorder (ODD), the 2026 annual report from the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) indicates.  The report is based on data collected in 2024.

Black people comprised 19.6% of those utilizing state mental health services, but accounted for 32.7% of individuals diagnosed with schizophrenia or other psychotic disorders – significantly higher than their proportion in the population serviced. 

Black young adults aged 18 to 24 years, comprising 19.7% of young adults serviced, accounted for an even more disproportionate 35.4% of young adults diagnosed with schizophrenia or other psychotic disorders.

Black children aged 0 to 17 years comprised 18.7% of all children receiving mental health services from state agencies, but received a disproportionate 26.2% of diagnoses of oppositional defiant disorder and 27.3% of diagnoses of conduct disorder.

An exceptionally large proportion of Black children – one in three (36.2%) – were diagnosed with ADHD, the most frequent mental health diagnosis for these children. 

The typical treatment is ADHD drugs, many of them stimulants, often prescribed before changes in behavior management  are even tried.  Research has found, however, that any initial benefit from stimulants decreases over time, with little if any long-term benefit.

Patients continue to be exposed to stimulants’ side effects, including loss of appetite, difficulty sleeping, anxiety, headaches, nausea and vomiting, tremors, and increased heart rate and blood pressure.  Stimulants have also been linked to delayed growth in children.  

Additionally, the U.S. Food and Drug Administration (FDA) requires the prescribing information for prescription stimulants to warn of  the potential of misuse, abuse, addiction, and overdose of the drugs.   

People receiving a diagnosis of schizophrenia or other psychotic condition are typically prescribed powerful antipsychotic drugs.  Data from recent research indicated that any benefit from antipsychotics compared to placebo (dummy pill) may be so small that it might not be noticeable by the patient.  Users are exposed to antipsychotics’ risks of harmful side effects that include weight gain, heart and cardiovascular problems, metabolic disorders, stroke and death.

Black people are more likely to have worse side effects and are more likely to be overdrugged on antipsychotics.  Studies have suggested that 33% of African Americans are slow metabolizers, meaning that toxic levels of antipsychotics build up more readily, potentially resulting in an overdrugged effect.

Black people are also more likely to experience cardiac and metabolic problems, with one study finding that nearly half of cases of new-onset diabetes from antipsychotics occurred in African Americans.

Longer-term use of antipsychotics can lead to tardive dyskinesia, an involuntary movement disorder that is characterized by tics, spasms or other jerky or uncontrolled movements of the body.  The condition can be disabling and permanent.

More fundamentally, psychiatric diagnoses, including the ADHD, schizophrenia, conduct disorder, and ODD diagnoses disproportionately given to Black people, lack scientific validity, as they are based on subjective assessments of behavior.  The psychotropic drugs that are prescribed are meant to alter or “rebalance” brain chemicals, but there is no scientific basis or proof for the theory that an imbalance of brain chemicals causes behavioral conditions. 

Still more evidence of ongoing racism in the mental health system is found in recent research revealing that Black patients are nearly twice as likely as their White counterparts to be physically, mechanically, or chemically restrained in mental health facilities and to remain restrained for a longer time.

Tragically, one study found that an exceptionally large 38% of 229 deaths from prone restraint in mental health facilities were African American.  The World Health Organization (WHO) has long called for an end to the use of restraints and other coercive mental health practices because they can be traumatizing, re-traumatizing, and even deadly to patients.

Psychiatric diagnoses and drugs that are the standard of care in today’s mental health system have failed to improve mental health conditions in the U.S.  Prescriptions for psychiatric drugs do not address the underlying causes of people’s emotional and behavioral problems, while the drugs’ harmful side effects may make handling those problems even more difficult.  Black people continue to bear a disproportionately large share of the harm in the mental health system. 

What is needed is replacing psychiatric diagnoses, drugs and coercive treatment with consensual, patient-centered solutions to the underlying causes of emotional and behavioral conditions, delivered with empathy and respect.  In this way, human rights and dignity may be ensured in the field of mental health.

The content on this site is for informational purposes only and is not intended to substitute for personal medical advice given by a physician or other qualified healthcare provider.

Anyone wishing to discontinue or change the dose of a psychiatric drug is cautioned to do so only under the supervision of a physician because of potentially dangerous withdrawal symptoms or other complications.