Meeting the Mental Health Needs of Youth in Juvenile Justice

One fifth or 20 % of all children and adolescents in America experience a diagnosable mental health disorder before the age of 21. One in ten children suffers from disease severe enough to impair dailylife, but fewer than 20 % who need mental health treatment receive services (U.S. Department of Health and Human Services, 1999). The lack of adequate, appropriate and accessible mental health services for youth and families is a national crisis. Because of this lack of care, adolescent behaviors normally associated with mental illness are moreoften identified as delinquent with subsequent admission of mentally ill youth to the juvenile justice system. The number of adolescents with undiagnosed mental health disorders committed to the juvenile justice system has exploded. Estimates are that between 50% and 75 % of the youth who are committed to juvenile justice have diagnosable mental health problems.
Diagnosable mental health problems that are discovered after a youth is admitted to the juvenile justice system suggest several gaps in the mental health care delivery system. An initial gap is that the mental illness has never been diagnosed and treated in the youth’s community. Second, for those youth who have received some kind of psychiatric care, the mental health system has failed them. Finally, because of the longstanding stigma surrounding mental illness, psychiatric illnesses of many youth remain undiagnosed and untreated. Youth with mental health disorders should be served in community settings yet inadequate funding of community mental health systems results in limited capacity and fragmented services. Thus, often due to a lack of psychiatric care in the community and inadequate insurance funding for particular segments of our society, youth with mental health disorders are being committed to the juvenile justice system, a system that was never designed to provide psychiatric care.


Youth in Juvenile Justice: a vulnerable population receiving inadequate services

Congressional inquiries and media reports as well as the opinions of mental health professionals, correctional authorities and parents all converge on the sad reality that the juvenile justice system has become the avenue of last resort for youth with mental health disorders. These groups also acknowledge that the juvenile justice system is not designed to address the needs of this vulnerable population. The juvenile justice system is fraught with inconsistencies in screening and diagnosis along with a limited capacity for mental health services. Further, the primary mission of the juvenile justice system has been the provision of public safety and therefore the system is ill-equipped to be the nation’s primary provider of child and adolescent mental health care. Unfortunately, without appropriate diagnosis and treatment as juveniles, youth in the juvenile justice system continue to demonstrate dysfunctional behavior. However, juvenile justice officials note that entrance into adult penal systems is the typical trajectory for these youth. In one of the 3 only research studies tracking this, Copeland and others (2007) retrospectively followed a group of children into young adulthood and found that 51.4% of male young adult offenders and 43.6% of female offenders had a child psychiatric history. Early age detention, as well as how detained youth view treatment within the detention center, contribute to lifelong criminality. Sensitivity to both normal growth and development issues of youth and their criminal trajectories have implications when planning primary, secondary, and tertiary levels of psychiatric mental health (PMH) care to those at risk for involvement or who are already involved in the juvenile justice system.


Screening and assessment issues

The first step in responding to the needs of youth in the juvenile justice system is the provision of screening and assessment. Screening is identification of problems in individuals through procedures that can be applied quickly and inexpensively. Assessment is development of comprehensive pictures of individuals which yield specific diagnoses with recommendations for diagnosis and treatment. Clear recommendations for screening and assessment of juvenile justice
youth exist. Penn et al.’srecommendations include:
• all youth should receive screening at the earliest point of contact with the juvenile justice system
• youth who require further evaluation should receive thorough assessments
• care should be taken to identify the most appropriate instruments for screening and assessment
• risk assessment results and needs assessment results should be combined to reflect both the level of risk youth present and youth’s need for treatment and services
• There is no one preferred method to provide mental health screening and assessment for juvenile justice youth.