Mental Health and Substance Abuse Issues

Background

Recent research shows that mental health and substance abuse needs exist among the juvenile justice population at much higher rates than that of the general population under 18 years of age. Furthermore, a portion of those in juvenile detention are not facing any delinquency charges and remain in this setting only as they await community mental health services.

Considerable questions remain with regard to the intersection of juvenile justice and mental health and substance abuse. At the same time, key facts and findings that reform efforts must address include the following:

  • Sixty-six percent of males and 74 percent of females detained in the juvenile justice system meet the criteria for at least one mental or behavioral health diagnosis

  • Forty-six percent of males and 57 percent of females detained in the juvenile justice system meet the criteria for two or more such diagnoses

  • Youth experiencing serious emotional disturbance make-up approximately 15-20 percent of the population in juvenile justice facilities, a rate up to 10 times higher than their representation in the community

  • The tragedy persists of parents relinquishing legal and physical custody of their children to child welfare and juvenile justice agencies for the sole purpose of securing for their children otherwise unavailable mental health services. Data for 2001 from 19 states and 30 counties showed that nearly 9,000 children and adolescents were sent to the juvenile justice system for this reason

  • A 2004 report to Congress revealed that young people are being held in secure detention facilities, some with no charges pending against them, while they await community mental health services. More than 15,000 children and youth over a six-month period in 2003 were held in this manner, some of them as young as seven.

Finding Solutions

For justice-involved youth, a mental health or substance abuse need represents an additional vulnerability; the potential exists for those held in secure detention settings to experience abuse, trauma, and the worsening of existing mental health conditions. As a result, reauthorization of the Juvenile Justice and Delinquency Prevention Act (JJDPA), must meet two seemingly conflicting goals: helping to remove incentives to drive youth deeper into juvenile justice systems to access mental health and substance abuse care, while still fostering and ensuring an appropriate range of critical services.

As a matter of principle, States ultimately must meet the goal of never housing a young person in secure detention facilities, when no charges are pending. Additional supports within public health and mental health systems are needed to accomplish this, but JJDPA represents an appropriate vehicle to apply pressure in this direction.

Meeting the mental health needs of those facing charges in the juvenile court or who have been adjudicated delinquent poses greater challenges, given limited powers of the court, pre-adjudication, and the need to protect public safety.6 However, as with most justice-involved youth, those with mental health and substance abuse needs usually pose little risk to public safety. Optimally, public mental health agencies should provide services within the community or, if necessary, in in-patient facilities, based on strong partnerships with and referrals from juvenile justice agencies.

At a minimum, juvenile justice agencies should have in place appropriate mechanisms for mental health and substance abuse screening, assessment, and referral to services. When no other option exists, however, juvenile justice agencies should act as service providers.8 This is especially important, given the fact that approximately one-fifth of the population within juvenile justice facilities are experiencing severe emotional disturbance.

Proper implementation within juvenile justice settings of screening, assessment, referral, and treatment services represents a complex task. Furthermore, research shows that certain treatment methods well-suited to addressing certain mental health diagnoses may in-fact exacerbate the symptoms of other disorders.9 These challenges highlight the need for high-impact training and technical assistance on the part of the federal Office of Juvenile Justice and Delinquency Prevention.

Finally, the use of psychotropic medications represents a serious concern for America’s children, especially when the State requests such medications for minors.10 Justice-involved youth should be prescribed psychotropic medications only when ordered as part of a treatment plan, based on a mental health assessment performed by a qualified, licensed mental health professional. Health and mental health professionals in juvenile justice systems must monitor for signs of the serious side effects seen in the use of psychotropic medications.

The research, practice, and policy communities understand much more now about the intersection of mental health, substance abuse, and juvenile justice than during the 2002 reauthorization of the JJDPA. For this reason, the current reauthorization represents a critical opportunity for positive reform and better treatment for justice-involved youth.

References

1 Teplin, L. A., Abram, K. M., McClelland, G. M., Dulcan, M. K., & Mericle, A. A. (2002). Psychiatric Disorders in Youth in Juvenile Detention. Archive of General Psychiatry, 59, 1122-1143.

2 Abram, K. M., Teplin, L. A., McClelland, G. M., & Dulcan, M. K., (2003). Comorbid Psychiatric Disorders in Youth in Juvenile Detention. Archive of General Psychiatry, 60, 1097-1108.

3 Grisso, T. (2008). Adolescent Offenders with Mental Disorders. The Future of Children, 18(2), 143-164.

4 Government Accountability Office (2003). Child Welfare and Juvenile Justice: Federal Agencies Could Play a Stronger Role in Helping States Reduce the Number of Children Placed Solely to Obtain Mental Health Services. Washington, DC: United States Congress, available at http://www.gao.gov/new.items/d03397.pdf.

5 United States Congress (2004). Incarceration of Youth Who are Waiting for Community Mental Health Services in the United States. Washington, DC: United States Congress, available at http://hsgac.senate.gov/public/index.cfm?FuseAction=Files.View&FileStore_id=bdb90292-b3d5-47d4-9ffc-52dcd6e480da.

6 Grisso, T. (2008). Adolescent Offenders with Mental Disorders. The Future of Children, 18(2), 143-164.

7 The National Center for Mental Health and Juvenile Justice (2007). Blueprint for Change: A Comprehensive Model for the Identification and Treatment of Youth with Mental Health Needs in Contact with the Juvenile Justice System. Delmar, NY: Skowyra and Cocozza.

8 Grisso, T. (2008). Adolescent Offenders with Mental Disorders. The Future of Children, 18(2), 143-164.

9 Abram, K.M., Washburn, J. J., Teplin, L. A., Emanuel, K. M., Romero, E. G., & McClelland, G. M. (2007). Posttraumatic Stress Disorder and Psychiatric Comorbidity Among Detained Youths. Psychiatric Services, 58(10), 1311-1316.

10 APA Working Group on Psychoactive Medications for Children and Adolescents (2006). Report of the Working Group on Psychoactive Medications for Children and Adolescents. Psychopharmacological, Psychosocial, and Combined Interventions for Childhood Disorders: Evidence Base, Contextual Factors, and Future Directions. Washington, DC: American Psychological Association.