Key Issue 1: Growing Awareness of Mental Health Disorders Among Youth in the General Population
The Surgeon General's 2002 Report on Children's Mental Health found that:
- Approximately 20% of children and adolescents
in the general youth population are experiencing a
mental disorder;
- Approximately 10% experience mental illness
severe enough to cause impairment at home, in school,
and in the community;
- Yet less than half will receive the treatment that they need.
The release of this report shed light on the fact that mental disorder among youth in the general population was significantly higher than what was previously believed.
Key Issue 2: The prevalence of mental disorder among youth in the juvenile justice system is two to three times higher than among youth in the general population.
While the research base on this issue is very much still developing, existing research suggests that most youth in the juvenile justice system, anywhere from 70 to 100%, have a diagnosable mental disorder. (Otto et al., 1992; Virginia Policy Design Team, 1994; Wierson, Forehand and Frame, 1992)
Approximately one out of five (20%) has a serious mental disorder. (Cocozza and Skowyra, 2000)
Some of the best information on
this issue is coming out of a study being conducted
by Dr. Linda Teplin at the Cook County detention
center in Chicago, Illinois. (Teplin et al.,
2002)
- Dr. Teplin is conducting a large-scale
study using a randomized sample and standardized
instruments (DISC) to collect mental health
and substance use prevalence data among youth
in the detention center.
- Her data suggests
that rates of mental disorder are high
among both boys and girls (66 % to 73% of youth
surveyed).
- These rates remain high even when
you eliminate conduct disorder from the
identified disorders- 60% of boys and 70% of
girls still meet criteria for some other psychiatric
disorder.
- Rates of mental disorder are consistently higher for girls than for boys, especially for affective and anxiety disorders.
Key Issue 3: There is an increasing sense of awareness and crisis surrounding the care and treatment of youth with mental disorders in the juvenile justice system.
This is a population of youth whose mental health needs have been neglected for a long time. Now, attention is being paid in a way that was largely absent ten years ago.
- Growing concern on the part of both
the juvenile justice and mental health systems
over the criminalization of mental illness. This
is a trend that we've seen at the adult level for
some time, and are now beginning to see at the
juvenile level as well.
- Increasing attention by the media,
advocacy organizations (NAMI, NMHA, Federation
of Families), and funding organizations (private
foundations like MacArthur and Casey, as well as
federal agencies such as SAMHSA and OJJDP).
- DOJ investigations into the conditions of confinement of youth in juvenile detention and correctional facilities across the country. These investigations have consistently highlighted the lack of appropriate screening, assessment and treatment available to youth, the inappropriate use of medication, and the inappropriate responses to suicide threats. (DOJ, 2003)
Key Issue 4: There are a number of factors that are contributing to the sense of crisis.
- There appears to be an increasing
number of youth with mental disorders entering
the juvenile justice system. The Texas Youth
Commission reported a 27% increase in the number
of youth with mental disorders entering the state's
juvenile justice system between 1995 and 2001
(TYC, 2002).
- Many of these youth are incarcerated
for minor, non-violent offenses. A review
in Louisiana found that 73% of youth in Louisiana
were incarcerated for non-violent offenses.
A similar review in Texas found 67% (Schwank et
al., 2003).
- There is concern that the juvenile justice system is becoming the system of "last resort" for many youth. A 1999 survey by the National Alliance for the Mentally Ill (NAMI)found that 36% of their respondents reported having to place their children in the juvenile justice system in order to access mental health services that were otherwise unavailable to them (NAMI, 1999). A more recent study conducted by the U.S. General Accounting Office (GAO) found that in 2001, parents placed over 12,700 children into the child welfare or juvenile justice systems in order to access mental health services (GAO, July 2003).
Key Issue 5: Despite this bleak picture, we are seeing signs of improvement with the availability of new and effective tools and services that are demonstrating real promise for youth involved with the juvenile justice system.
- We now have screening and assessment
tools that have been specifically designed for
use with youth in the juvenile justice system.
The development of the MAYSI-2, a 52 item self-report
screening tool, and the V-DISC, a computer operated,
voice-activated diagnostic assessment tool, are
being used in numerous states and juvenile justice
settings across the country. (The MAYSI is being
used in 45 states and in 28 of those states being
used system-wide. The V-DISC is now in 15 states
with plans for expansion).
- We now have improved psychosocial approaches,
such as cognitive behavioral therapy and dialectical
behavior therapy which are both showing tremendous
promise.
- Increasing use of evidence-based practices,
such as MST, FFT and OTFC, which are family and
community based interventions. Numerous reviews
(Elliott, 1998) have consistently found positive
outcomes associated with their use with youth in
the jj system:
- Reduced long-term rates of re-arrest
- Improved family functioning and school performance
- Decreased substance use and psychiatric symptoms
- Reduced rates of out of home placement
- Significant Cost Savings (Aos et
al., 2001)
- While not "evidence-based," we have
seen the development of promising interagency collaborative
models involving the mental health and juvenile
justice systems including:
- System of Care models that target youth
in the juvenile justice system such
as WrapAround Milwaukee and Project Hope,
RI.
- Diversion collaboratives such as NYS's
PINS Diversion program and Texas ' Special
Needs Diversionary Program
- Partnerships with universities such as the Prime Time program in Seattle involving the University of Washington and King County.
- System of Care models that target youth
in the juvenile justice system such
as WrapAround Milwaukee and Project Hope,
RI.
Key Issue 6: There is certainly much activity underway but more needs to happen.
- Need to make sure that policy makers
recognize how critical an issue this is.
- Many of the youth involved with
the jj system are in for relatively minor
offenses. Diversion programs need to be developed
and we need to push for more community-based treatment
options that will provide treatment to
these youth in their communities- the research
suggests that this is the most effective approach.
- While we're doing a better job
at screening and assessment, we need to
push for universal screening for all youth entering
the jj system, and further evaluations,
when necessary.
- Treatment services need to be improved
for those youth who are placed in secure
facilities.
- Re-entry programs for youth transitioning out of residential placement need to be strengthened.
References
Aos, S., Phipps, P., Barnoski, E., Leib, R. (2001) The Comparative Costs and Benefits of Programs to Reduce Crime. Olympia , WA : Washington State Institute for Public Policy.
Cocozza, J., Skowyra, K. (2000) Youth with Mental Health Disorders: Issues and Emerging Responses. Office of Juvenile Justice and Delinquency Prevention Journal, 7(1).
Department of Justice. (2003) Press Release dated January 17, 2003 . Retrieved February 28, 2003 from www.usdoj.gov .
Elliott, D. (Ed.) (1998-2002) Blueprints for Violence Prevention Series (Vols. 1-12). Boulder , CO : Center for the Study and Prevention of Violence.
National Alliance for the Mentally Ill. (2001) Families on the Brink: The Impact of Ignoring Children with Serious Mental Illness. Arlington , VA : National Alliance for the Mentally Ill.
Otto, R., Greenstein, J., Johnson, M., Friedman, R. (1992) Prevalence of Mental Disorders Among Youth in the Juvenile Justice System. In Cocozza, J. (Ed.) Responding to the Mental Health Needs of Youth in the Juvenile Justice System. Seattle , WA : National Coalition for the Mentally Ill in the Criminal Justice System.
Reyes, L., Brantley, D. (2002) Council of Juvenile Justice Correctional Administrators Best Practices Committee: Texas Youth Commission Mental Health Presentation , January 2002.
Schwank, J., Espinosa, E., Tolbert, V. (2003) Mental Health and Juvenile Justice in Texas . Austin , TX : Texas Juvenile Probation Commission.
Teplin, L., Abram, K., McClelland, G., Dulcan, M., Mericle, A. (2002) Psychiatric Disorders in Youth in Juvenile Detention. Archives of General Psychiatry, 59(12).
United States Department of Health and Human Services. (2002) Report of the Surgeon General's Conference on Children's Mental Health: A National Action Agenda. Washington , DC : Department of Health and Human Services.
United States General Accounting Office. (2003) Child Welfare and Juvenile Justice. Washington , DC : United States General Accounting Office.
Virginia Policy Design Team. (1994) Mental Health Needs of Youth in Virginia 's Juvenile Detention Centers. Richmond , VA : Virginia Policy Design Team.
Wierson, M., Forehand, R., Frame, C. (1992) Epidemiology and Treatment of Mental Health Problems in Juvenile Delinquents. Advances in Behavior Research and Therapy, 14.
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