Mental illness is still a taboo subject in the United States. And while the stigma may be starting to shift a little, a recent survey conducted by the Bureau of Justice Statistics shows just how far the nation has to go — especially when it comes to the connection between race and how psychological disorders are diagnosed and treated, both in the U.S. prison system and out.

There are approximately 1,315,561 lawyers in the U.S. today. Although these attorneys undoubtedly fight to keep their clients out of jail, they’re not always successful. American imprisonment rates have spiked since the 1970s, and in 2017, the Prison Policy Initiative estimated that approximately 2.3 million individuals were incarcerated across the nation.

It’s not surprising that these Americans would be subject to increased emotional and mental issues than the average person living outside prison walls. But the Bureau of Justice Statistics survey shows that federal prisoners and jail inmates are up to five times more likely to have serious psychological distress (SPD) than free citizens.

According to the survey, a typical American has around a 5% chance of meeting the requirements for serious psychological distress. However, among those in federal prison, that percentage increases to 14%; inmates in jail have a 26% chance of having SPD.

Interestingly, white inmates were far more likely to receive any type of diagnosis for their mental disorder. Of all the males surveyed, 33% of those in prison and 41% of those in jail had been informed by a mental health professional they showed signs of a disorder. But the breakdown of those numbers shows a curious disparity: white inmates were far more likely to have been told they had a mental disorder than Hispanic or black inmates. In fact, Hispanic inmates were least likely to receive a diagnosis at 31%, while black inmates had a slightly higher chance, at 36%. Around 57% of white inmates were told they had serious psychological distress.

Of those who did receive a diagnosis from a mental health expert, 24% were told they had major depressive disorder, while 18% were diagnosed with bipolar disorder. Around 13% were diagnosed with either PTSD or personality disorder, and 9% of inmates were diagnosed with schizophrenia or another psychotic disorder.

But just because these inmates have a clear diagnosis doesn’t mean they’ll receive treatment. The DOJ report goes on to say that only one-third of U.S. inmates with diagnosed mental health issues ever receive treatment, and about half of those in federal prisons get the treatment they need.

The problem, according to researchers, is two-fold. Many inmates who enter the system already have a history of mental illness. But because prisons are unable to treat mental health problems in any capacity, the stress of incarceration may exacerbate these problems. The report found that SPD is usually experienced and reported within an inmate’s first month in detention.

Lauren-Brooke Eisen of The Brennan Center for Justice explained to The Daily Beast, “Prisons are very ill-equipped to respond to mental health challenges, and there is almost no programing in jails. In prisons there is more programing than in jails but it’s not enough and the programs that exist are very hard to get into. There are huge waiting lists to get into these programs and they prioritize those reentering society sooner.”

The lack of diagnoses and treatment accessibility extends outside prison walls though, especially when it comes to Hispanic and African American individuals. One study found that only 8.6% of black adults and 7.3% of Hispanic adults, compared to 16.6% of white adults, used mental health services between 2014 and 2015. High costs and lack of insurance were the top reasons cited for the disparity.

Some experts are exploring whether starting early with new kinds of therapy might help vulnerable individuals. Brief behavioral therapy, a streamlined kind of intervention geared towards children who exhibit signs of anxiety and depression, was found to be more effective than other kinds of outpatient treatment. Currently, only about one-third of those suffering from anxiety disorders ever receive treatment, but research has found that 56.8% of youths who receive BBT by their pediatrician experienced improvement in anxiety and depression scores; only 28.2% of those who were referred to mental health care professionals saw improvements in these areas.

Hispanic children were shown to have an even stronger response to this type of therapy than non-Hispanic patients, which researchers say “may be a useful tool in addressing ethnic disparities in care.” Structuring treatment in this type of environment has the potential to improve access for Latinx youth and address mental health problems that otherwise may go unchecked.

While the subject of mental health often gets swept under the rug, it’s clear that treatment is necessary before those with psychological disorders reach adulthood, especially for those who live in vulnerable communities.