Justice System Ill Equipped To Treat Mentally Ill Youth
Record numbers of youth with mental health problems, including substance abuse, are landing in the juvenile justice system without having their mental health needs addressed. Recent attention to evidence-based interventions and collaboration between service systems, experts say, can stem the growing crisis.
This was the message delivered to attendees at the latest Center for Mental Health Services (CMHS) Insights Speakers Series, “Young People With Mental Health and/or Substance Abuse Disorders in the Juvenile Justice System,” held last month in Washington, D.C.
PRA is a firm that conducts research, policy analysis, and evaluation studies with a primary focus on mental health service issues at the federal, state, and local levels. The center was established last year to promote awareness of the mental health needs of youth in the juvenile justice system and assist in developing policies to help those youth. The center receives funding from the John D. and Catherine T. MacArthur Foundation and the federal Office of Juvenile Justice and Delinquency Prevention.
Scale of Problem
Cocozza cowrote the article “Youth With Mental Health Disorders: Issues and Emerging Responses,” which provides an extensive review of research on mental health issues among youth in the juvenile justice system.
In his review, he found that anywhere from 75 percent to 100 percent of youth in the juvenile justice system meet DSM-IV criteria for mental illness, including substance abuse. As of 1999, there were more than 108,000 adolescents housed in juvenile or detention facilities across the U.S.
“These aren’t necessarily mild cases,” Cocozza said, adding that at least 20 percent of these young people have serious mental illnesses such as bipolar disorder and schizophrenia. While some studies measured the severity of illness in terms of diagnosis, others used measures of functioning or need.
Cocozza cited a study by researchers at the Florida Mental Health Institute estimating that about half of all youth with a mental disorder in the general population also have a substance abuse disorder. Noting that there were few sound studies to measure this finding in adolescents who have come into contact with the juvenile justice system, Cocozza estimated that for this population, the proportion with substance abuse issues would likely be higher than 50 percent.
Furthermore, the number of young people with any mental disorder in the nation’s juvenile correctional facilities seems to be on the rise, Cocozza noted.
He cited data from the Texas Youth Commission, showing that of 2,123 youth entering juvenile justice facilities in Texas in 1995, 27 percent were categorized as having a severe emotional disturbance, and 47 percent had a substance use disorder. Six years later, in 2001, of 2,406 youth entering these facilities in Texas, 48 percent had a severe emotional disturbance, and 54 percent had a substance use disorder.
However, the commission also found that of the youth with serious mental illness, 67 percent were there for nonviolent offenses. “Most of these young people we could divert out of the justice system if we had something in place to bring them to,” Cocozza said.
System Becoming Dumping Ground
“Adding to the growing sense of crisis is the concern that the juvenile justice system is becoming a dumping ground for these kids [with mental disorders],” Cocozza said.
According to a 1999 study commissioned by the National Alliance for the Mentally Ill, 903 families with a mentally ill child responded to a survey about seeking mental health services for that child. Thirty-six percent of parents surveyed said their child was in the juvenile justice system because that was the only setting in which services could be obtained.
“More and more of these kids are entering the juvenile justice system—[whose personnel lack] the training to deal with them,” Cocozza explained.
For instance, the Civil Rights Division of the U.S. Department of Justice undertook a series of investigations that documented the inadequacy of mental health care services in juvenile correctional facilities in a number of states, Cocozza said. The investigations found poor or nonexistent screening practices, insufficient clinical services, and inappropriate use of medications, among other problems.
Solutions Proposed
Over the past decade, increased attention by national mental health organizations, the research community, and family and advocacy groups has helped to improve assessment and treatment of youth who come into contact with the juvenile justice system, Cocozza said.
In the last couple of years, juvenile justice facilities in several states have begun to use the Massachusetts Youth Screening Instrument, Version Two (MAYSI-2), a standardized, scientifically proven screening instrument that can be administered by nonclinical staff in under 10 minutes. The instrument identifies mental health problems in youth entering the juvenile justice system.
In addition, researchers have identified successful evidence-based treatments such as multisystemic therapy, functional family therapy, and multidimensional-treatment foster care. These treatments, researchers have found, not only decrease re-arrest rates and decrease psychiatric symptoms, they also save taxpayers money.
A number of interagency programs have sprung up to treat juvenile offenders, Cocozza noted. Mobile mental health treatment teams, for instance, consist of mental health professionals in the community who travel to the juvenile justice facilities to assess and treat young people.
Other collaborative programs prepare juvenile offenders for release into the community and ensure that after release young people have an array of social services at their disposal.
Cocozza emphasized that collaboration between myriad systems, including mental health and substance abuse, education, and social welfare, will help to keep juvenile offenders with mental health problems out of the juvenile justice system.
“We can’t do this tomorrow,” Cocozza said, adding that with the “tools we have, support, and political will,” mental health problems of young people in the juvenile justice system can be alleviated.
More information about the National Center for Mental Health and Juvenile Justice can be found on the Web at www.ncmhjj.com. ▪
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Published online: 6 December 2002
Published in print: December 6, 2002
Notes
The vast majority of youth entering the juvenile justice system meet criteria for a mental disorder, yet the juvenile justice system is not able to handle their mental health needs.
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