Critical Intervention Point:  Detention

Overview of Intervention Point

During the processing of a case, a youth may be held in a secure detention facility. The organization and administration of juvenile detention varies by state, and even within states, and from community to community depending on state and local practice. In general, juvenile detention is a secure setting intended to safely detain youth who are awaiting adjudication, disposition or placement in a correctional or probation program. Most states use pre-trial detention to hold juveniles awaiting adjudication. However, some states also use juvenile detention for post-adjudication placement or as a temporary disposition while awaiting placement elsewhere.

Typically, after a youth is arrested, they are brought to a juvenile detention facility by law enforcement. Juvenile probation officers or detention intake workers review the case and decide if the youth should be held in detention pending a hearing by a juvenile court judge. In all states, a detention hearing must be held within a time period specified by statute, generally within 24 to 72 hours. At the detention hearing, a judge reviews the case and determines if continued detention is warranted or if the youth can be released to the custody of a parent or guardian. Youth are typically placed in secure detention for two main purposes: to ensure that the youth appears for all court hearings and to protect the community from future offending (Austin et al., 2005). In 2000, juveniles were detained in 20 percent of all delinquency cases processed by juvenile courts (OJJDP, 2004).

In 1990, juvenile courts handled 1.3 million delinquency cases; by 1999 this number increased by 27 percent to almost 1.7 million cases (Harms, 2003). The increase in the number of delinquency cases in the juvenile court system resulted in an 11 percent increase in the number of delinquency cases involving juvenile detention (Harms, 2003). In 1999, 33,400 more juvenile delinquency cases were detained than in 1990 (Harms, 2003). While the overall proportion of delinquency cases referred to detention remained relatively stable between 1990 and 1999 (around 20%), the profile of the national juvenile detention population shifted, with more youth charged with person and drug offenses and a greater proportion of adolescent girls detained (Harms, 2003). It is estimated that anywhere from 300,000 to 600,000 youth cycle through secure juvenile detention centers each year, and that on any given day, approximately 27,000 youth are held in some 500 secure juvenile detention facilities across the country. This represents an increase of over 70 percent since the early 1990s (Coalition for Juvenile Justice, 2003).

A youth is detained in pre-trial detention because they are accused of conduct that is subject to the jurisdiction of the juvenile court. The average length of stay in juvenile detention is approximately 15 days (Parent et al., 1994). While the National Juvenile Detention Association recommends that quality health, mental health, and education services be afforded to youth while in detention, there is tremendous variation in the scope and quality of services provided to youth. Further, many of the nation’s juvenile detention facilities are seriously overcrowded—nearly 70 percent of youth in public detention centers are in facilities operating above their official capacity (Smith, 1998). Staffing shortages within detention centers only exacerbate the issues of overcrowding and can result in an extremely chaotic and stressful experience for both detained youth and the staff who are responsible for supervising and managing them.

Mental Health Needs and Issues

Contributing to the concerns about juvenile detention centers is the increasing number of youth entering the system with mental health disorders. Since the release of the 1992 research monograph, Responding to the Mental Health Needs of Youth in the Juvenile Justice System (Cocozza, 1992) the research base on the prevalence of mental health disorder among the juvenile justice population has steadily grown. Interestingly, juvenile detention centers have served as the setting for many of these new studies and therefore provide the clearest picture of the prevalence of disorder within the broader juvenile justice system. For example, Teplin’s study of juvenile detainees in the Cook County, Illinois juvenile detention center found that nearly 66 percent of the males and 73 percent of the females met diagnostic criteria for one or more psychiatric disorders (Teplin et al., 2002).

There have been recent attempts to encourage the development of alternatives to secure juvenile detention. One of the most prominent efforts is the Juvenile Detention Alternatives Initiative (JDAI), which is supported by the Annie E. Casey Foundation. Established in 1992, the JDAI seeks to reduce the number of youth unnecessarily or inappropriately detained; to reduce the number of youth who fail to appear in court or re-offend pending adjudication; to re-direct public funds toward successful reform strategies; and to improve the conditions of confinement for youth who are detained (Casey/JDAI website). The goal is to create new and more effective strategies for youth without compromising public safety, and many communities across the country have made significant progress in developing secure detention alternatives. While successful, the initiative has not placed a priority on reforms that specifically address the mental health treatment needs of these youth.

Juvenile detention can be a traumatic experience for all youth, but the situation can be much worse for youth with serious mental health needs. Feelings of depression, anxiety, and hopelessness are heightened for all youth in juvenile detention, some of whom are experiencing their first separation from parents or caregivers, but can be much worse for youth with mental health needs. The potential for crisis is high. Youth with mental health disorders may also be particularly vulnerable to victimization because of their disorders. Detention can also mean an interruption in both medication and therapeutic services for youth who already receive these things in the community. While suicide among youth in juvenile detention centers is a significant concern (Hayes, 2000), there have been no national studies conducted to date that have compared suicide rates among youth in confinement with those of youth in the general population (Hayes, 2004). The only national survey on the incidence of juvenile suicides in custody contained several flaws (Flaherty, 1980); a reanalysis of suicide rates in that survey found that youth suicide in detention centers was estimated to be more than four times greater than in the general population (Memory, 1998).

While the average length of stay in detention is about two weeks, youth who stay longer in detention (often more than 30 days) are usually those with complicated placement needs rather than those charged with more serious offenses (Woolard, Gross, Mulvey, & Reppucci, 1992; Butts & Adams, 2001). As a result, youth with mental health problems are particularly susceptible to extended detention stays. The public health crisis that exists generally around children’s mental health is only exacerbated by placing youth in juvenile justice settings, such as detention, where staff often do not have the knowledge, training, or expertise to appropriately deal with these youth.

A report issued by Congress in July 2004 further documents the inappropriate use of detention for youth with mental health problems. A survey, commissioned by Representative Henry Waxman and Senator Susan Collins, was conducted to look specifically at the issue of youth with mental health needs who are unnecessarily incarcerated in juvenile detention facilities awaiting mental health services in the community (United States House of Representatives, 2004). In a study of 698 detention centers across the country, the authors concluded that the nation’s juvenile detention centers have become “warehouses” for mentally ill youth, many of whom have not committed any crimes. Among the study’s findings:

• Two-thirds of juvenile detention facilities surveyed reported holding youth who are waiting for community mental health treatment.
• Over a 6-month period, nearly 15,000 incarcerated youth waited for community mental health services.
• One quarter of the facilities reported providing poor or no mental health treatment to juvenile detainees, and over 50 percent reported inadequate levels of staff training.
• Juvenile detention facilities spend an estimated $100 million each year to house youth who are awaiting community services.

One solution might be to create an extensive mental health system within the juvenile detention system to respond to youth with mental health needs. However, given the short-term nature of most juvenile detention placements and concerns over net-widening, the better approach for ensuring that youth have access to mental health treatment is to establish linkages with community-based mental health providers to provide treatment to youth while they are in detention. Several communities have created programs that illustrate this approach. The Bernalillo County Juvenile Detention Center (BCJDC) developed an intake process that identifies youth with mental health needs and diverts these youth to a community mental health clinic, the Children’s Community Mental Health Clinic (CCMHC), which is located 200 yards away from the detention facility and is fully funded by Medicaid. The CCMHC serves all youth in Bernalillo County who would benefit from the services provided by a mental health treatment team. Referrals to the clinic can be made by the juvenile detention center, care providers, parents or patients, thereby reducing any incentive to refer youth to the detention center simply in order to access mental health services. Youth brought to the detention center undergo a comprehensive intake screening to identify any mental health needs. Youth identified through the screening as needing immediate mental health services are walked from the detention center to the mental health clinic. Clinical services, which are available to youth in detention as well as youth in the community, include evaluation and assessment, individual and group therapy, medication management, substance abuse treatment, case management, and crisis management.

The Illinois Department of Human Services (DHS) created the Mental Health Juvenile Justice (MHJJ) Initiative in 2000 to identify youth in detention centers with severe mental illness. DHS provides funding to support mental health juvenile justice service liaisons who work with detention centers, juvenile courts, and others to coordinate community-based services for youth in detention who have a major affective disorder or a psychotic disorder. Youth with disruptive behavior disorders are excluded unless these disorders co-occur with a psychotic or affective disorder. The program targets youth with the most serious of disorders who are in juvenile detention, and funds are provided to the local community mental health agency to pay for the services of a system liaison who works to link youth in detention with local services and care. Once a youth is referred to MHJJ, eligibility assessments are conducted and a care plan is developed for the youth and family. The liaison informs the court that a youth with severe mental illness has been identified in the detention center with specific needs that can be treated in the community. The judge can then release the youth to the community and the liaison assists the family by linking them to services for a period of 6 months. Once the plan is in place, services are provided based on the wraparound model—individualized services that address the youth’s needs and strengths. (Lyons, Griffin, Quintenz, Jenuwine, & Shasha, 2003).

The Prime Time Project is a collaborative between the King County, Washington, Department of Youth Services and a community-based mental health clinic. It is a comprehensive intervention model for youth who are in detention, who are between the age of 12 and 17, who have at least two prior admissions to detention, who are in detention for a relatively serious offense, and who have a diagnosable mental health disorder. The program aims to decrease delinquent behavior, increase pro-social behavior, and stabilize psychiatric symptoms. Services, provided by the community mental health clinic, begin in detention and follow youth as they return to the community; interventions take place over a year-long period with the intensity of services tapering over the course of treatment. Based largely on Multi-Systemic Therapy, the program attempts to address the ecological factors that contribute to a youth’s delinquent behavior through evidence-based psychotherapeutic interventions.