Advocate Strives to Improve MH Care For Girls in Juvenile Justice System

Many adolescent girls who enter the juvenile justice system have been physically and sexually abused. As a result, they have complex mental health needs, according to one mental health researcher who added a unique personal understanding to a discussion of those needs.

Laura Prescott is president and founder of Sister Witness International Inc., an organization of formerly institutionalized women and girls based in Sarasota, Fla. Prescott appeared with Joseph Cocozza, Ph.D., at the Center for Mental Health Services (CMHS) Insights Speakers Series in Washington D.C., last October (see story) to talk about improving services for girls and young women who are in the juvenile justice system and have co-occurring disorders.

Prescott is the author of the 1998 report “Improving Policy and Practice for Adolescent Girls With Co-Occurring Disorders in the Juvenile Justice System” and a survivor of physical and sexual abuse by her grandfather. She has also spent time in juvenile justice and psychiatric facilities.

“The effect of violence from the age of 3 into my 20s shattered my life,” Prescott said. “I created internal witnesses in the form of voices that screamed when I couldn’t.”

She said that when she first entered the mental health and substance abuse systems 18 years ago, she was “looking for a place to fit. . .to articulate the truth of my life and stop hiding.” She spent time in a halfway house for women with substance abuse disorders. “Half of them are no longer living,” she said.

Prescott said that during the years when she was in and out of mental health and substance abuse treatment centers, homeless shelters, and juvenile justice facilities, she was “trying to erase the truth I knew, . . .and for girls today in the juvenile justice system, there is a use of substances to erase what they know.”

The numbers support Prescott’s statement. According to her report, 84 percent of female adolescents who come into contact with the juvenile justice system have mental health problems. Studies have found that anywhere from 60 percent to 87 percent are in need of substance abuse treatment.

All too often, however, adolescent girls with both mental health and substance abuse problems cannot find help in one place, Prescott said. When she was an adolescent, she faced this very problem. “In mental health settings, I was told that my substance abuse problems were secondary to the voices I was hearing. In substance abuse, when I heard voices or was self-injured, I was told to get help in a psychiatric setting. In homeless shelters, I couldn’t be hearing voices or using substances or I didn’t qualify [to stay there].”

Another problem Prescott has identified is that adolescent girls with abuse histories may be given a label by schools or mental health systems that turns out to be a self-fulfilling prophecy.

“A part of my giving up was that I lived up to my conduct-disorder label,” Prescott said.

She described days during her fifth and sixth grade school years when she would “wake up from a night of being with my grandfather, a night of abusing substances, and walk into the classroom with a learning disability. People asked me why I wasn’t paying attention.” She said the context of her life was not taken into consideration, and “it made sense to me to live up to what I was told I was—conduct disorder.”

Another problem that can occur in the mental health system is that adolescent girls with substance abuse disorders substitute the substance they were abusing with the anti-anxiety medications prescribed to them.

Prescott said that steps need to be taken to divert adolescent girls away from the juvenile justice system and into comprehensive treatment programs or peer programs.

At the very least, she said, institutions should adopt policies to avoid retraumatization of adolescent girls with abuse histories. Such policies enforce “the regulation of women during vulnerable procedures such as disrobing, showering, and intrusive medical exams,” Prescott said.

“I don’t want to wait until girls violently act out before we hear what they are trying to tell us, which is that they are in trouble.” ▪