Health and Justice for Youth

Mental Health Issues

All young people in the justice system have the right to the highest attainable standard of mental health and related services. States’ over-reliance on incarceration as a response to the development and mental health needs of children emphasizes a need for change in policy.

More than half of youth in the juvenile justice system have mental disorders—substantially higher than mental disorders of children in the general population (less than 25%) and comparable (if not exceeding) rates of children in the mental health system (60-86%).

A recent report states that “[w]hile 90% of the juveniles in detention and reception facilities were screened for emergency medical conditions and drug/ alcohol use…fewer than 75% of the juveniles were asked about mental health problems and fewer than 60% were asked about prior mental health treatment or hospitalization.” (Wasserman, 2003)

According to the National Association of Mental Health, the most prevalent disorders experienced by youth in the juvenile justice system are: conduct disorder, oppositional defiant disorder, major depression, dysthymic disorder, bipolar disorder, anxiety disorders, posttraumatic stress disorder, attention deficit hyperactivity disorder, mental retardation, learning disorders, and fetal alcohol syndrome. Mild or undiagnosed developmental disabilities often are mistaken for behavioral problems because of poor impulse control and negative social interaction.

Incarceration itself may even cause mental health problems; in 30% of the cases, the onset of depression occurred after being placed in a secure facility.

These mental health issues are often exacerbated by histories of physical, sexual and emotional abuse, parental drug or alcohol use, poor school performance or truancy, and family conflict. Youth with traumatic and abusive histories need coping and resilience skill building treatment.

Substance Abuse and Co-Occurring Disorders

Two thirds of youth in the justice system have co-occurring disorders, including substance abuse, which compound the challenges in diagnosis and treatment.

• Among adolescents with co-occurring disorders, conduct disorders and depression are the two more frequently reported disorders that co-occur with substance abuse.
• Among incarcerated youth with substance use disorders, nearly one third have a mood or anxiety disorder.
• Delinquents with substance abuse and behaviors disorders such as conduct disorder and ADHD engage in higher rates of crime and exhibit more alcohol and illicit drug use than do youth with mood disorders and are at higher risk for out-of-home placement and other poor outcomes.

Children suffering from dual diagnoses require unique treatment services that address the needs of the whole child. Clinicians or teams must be extensively trained in addressing both of the disorders so that they may provide an integrated treatment rather than relying on the less effective approach of treating disorders separately.

National Mental Health Reform is Desperately Needed

In 2003, the United States House of Representatives’ Committee on Government Reform revealed that a sizable portion of youth held in detention centers have not committed any offense, but are placed there while awaiting community mental health services. Over a six month period, juvenile detention facilities spent over $100 million to house 15,000 youth waiting for mental health treatment in two-thirds of juvenile detention facilities in the nation.

The lack of mental health services in this country have led families to take drastic measures. In 2003, 12,000 families relinquished parental custody of their children to the child welfare system in order to access mental health treatments they could not afford. Parents are then denied authority to make medical, educational and other important decisions about their children’s lives.

While individual efforts by local and statewide organizations have succeeded, reform is needed nationwide.