Last Updated 2/18/03

Introduction

The responsibility for children’s mental health is dispersed across multiple systems: schools, primary care, the juvenile justice system, child welfare and substance abuse treatment (U.S. Department of Health and Human Services, 1999).  

There is a high prevalence of mental health needs among juvenile offenders.  Unfortunately, an increasing number of youth with mental health disorders continue to enter and remain involved in the juvenile justice system.  

Background

It is estimated that 50 to 75 percent of incarcerated young offenders nationwide have a diagnosable mental health disorder.  Moreover, while there are highly successful treatment methods which can rebuild families and provide intensive mental health services to young offenders with mental health problems, their availability is rare (Coalition for Juvenile Justice, 2000).  

Estimates provided by both state and local juvenile justice facilities suggest that juvenile offenders have significant mental health treatment needs.  A study by the Virginia Department of Juvenile Justice (DJJ) showed that more than 40 percent of males and almost 60 percent of females in detention homes were in need of mental health services; more than 7 percent of males and more than 15 percent of females had urgent mental health treatment needs (Joint Commission for Behavioral Health Care, Virginia State Crime Commission and Virginia Commission on Youth, 2002).  

Data compiled from multiple national studies reveal that that the rate of particular mental health disorders is, on average, higher among youth in the juvenile justice population than in the general population, as illustrated in Table 1.  The descriptions of the most common psychiatric disorders seen among juvenile offenders are listed in Table 2.

Juveniles are commonly sent to juvenile justice with complex mental health and behavioral health needs.  According to a national report released by the National Alliance for the Mentally Ill (NAMI), 36 percent of respondents to a nationwide survey of families who have children with severe mental illnesses said that their children were in the juvenile justice system because of the unavailability of mental health care services (NAMI, 1999).

Table 1
Prevalence of Mental Disorders
in the Juvenile Population and General Populations
 American Psychiatric Association, 2000, as cited by Boesky, L. M., 2002  

Table 2
Most Common Psychiatric Disorders
Seen Among Juvenile Offenders
Boesky, L. M. (2002)

Findings from Studies

The findings of a study by the Research & Training Center on Family Support and Children’s Mental Health (2001) compare mental health needs and demographics among a sample of youth.  These are based on data gathered on youth that were both involved in the system but not confined; youth incarcerated for their crimes as well as youth adjudicated to residential treatment.  It appears from the study results that children at an increased risk for institutional placement will be placed roughly according to the type of primary dysfunction they evidence, with behaviorally disordered children becoming incarcerated and emotionally disordered children being placed into the state mental health system.  Other factors relating to later institutional placement included chronic school truancy, prior outpatient substance abuse or mental health treatment and prior use or a firearm.  

Youth within the juvenile justice system are at high risk for psychiatric conditions that may have contributed to the risk of offending, or may interfere with rehabilitation (Columbia University, 2002).  The findings also indicate a high need for mental health services and a lack of systematic assessment (Research & Training Center on Family Support and Children’s Mental Health, 2001).  Additional studies have shown that juvenile courts have positive mental health orientation and provide a foundation to build a stronger system of care collaboration and the establishment evidence-based practices in the juvenile justice system (Columbia University).  

Promising Approaches

There are promising approaches in providing mental health services in the juvenile justice system. Heightened awareness of mental health disorders has led to increased research and new treatment practices. Among delinquent juveniles who receive structured, meaningful and sensitive treatment, recidivism rates are 25 percent lower than those in untreated, control groups.  Highly successful programs reduce rates of reoffense by as much as 80 percent (Coalition for Juvenile Justice, 2000).  

The National Center for Mental Health and Juvenile Justice (2002) has compiled information on best practices for treatment of juvenile offenders.  These interventions incorporate several treatment components and are discussed in the following paragraphs.  Although several of these treatment approaches may be applied and utilized in the institutional setting, the following discussion refers to the application of these approaches in the community setting.  

Wraparound

The wraparound approach focus is on treating children with serious emotional problems including the development of individualized, child-centered, family-focused, community-based, and culturally competent services ( National Center for Mental Health and Juvenile Justice, 2002).  The design is enhanced to promote programs that provide integrated service systems for youth with serious emotional problems operating across the mental health, juvenile justice, child welfare and education systems (Kamradt, as cited by the National Center for Mental Health and Juvenile Justice).  Wraparound improves public safety while keeping youth in their family systems, close to home and community ( Research & Training Center on Family Support and Children’s Mental Health, 2001).  

Integrated Systems of Care

Integrated Systems of Care typically involve collaboration across a number of agencies such as juvenile justice and mental health, with the goal of developing coordinated plans for family-centered services, building upon youth and family strengths.  Wraparound is such a system of care (NMHA, as cited by the National Center for Mental Health and Juvenile Justice, 2002).  

Multisystemic Therapy

Multisystemic Therapy provides an integrative, cost effective, family-based treatment with focus on improving psychosocial functioning for youth and families so that the need for out-of-home placements is reduced or eliminated.  Multisystemic therapy (MST) is an intensive family-and-community based treatment that addresses the numerous factors of serious antisocial behavior in juvenile delinquency.  MST interventions focus on the individual child and their family, peers, school and neighborhood/community support (Henggeler, as cited by the National Center for Mental Health and Juvenile Justice, 2002).

The underlying premise of multisystemic therapy is that the behavioral problems of children and adolescents are maintained through problematic interactions within or between one or more of these systems.

Functional Family Therapy

Functional Family Therapy is a family-based prevention and intervention program that combines and integrates established clinical therapy, empirically supported principles, and extensive clinical experience.  This model allows for intervention in complex problems through clinical practice that is flexibly structured, culturally sensitive and accountable to families (Sexton and Alexander, as cited by the National Center for Mental Health and Juvenile Justice, 2002).

Cognitive Behavioral Therapy

Cognitive Behavioral Therapy is based on the idea that thoughts, beliefs and attitudes determine emotion and behavior.  It is an excessively instructive approach that involves teaching youth about the thought-behavior link and working with them to modify their thinking patterns in a way that will lead to more adaptive behavior in challenging situations.  This approach is especially beneficial for youth in the juvenile justice system because it is very structured and focuses on the triggers for disruptive or aggressive behavior (NMHA, as cited by the National Center for Mental Health and Juvenile Justice, 2002).

Multidimensional Treatment Foster Care

Multidimensional Treatment Foster Care recruits, trains and supervises foster families to provide youth with close supervision, fair and consistent limits and consequences and a supportive relationship with an adult (National Center for Mental Health and Juvenile Justice, 2002). It can be an alternative to corrections and places juvenile offenders who require residential treatment with foster families who are carefully trained to provide supervision, limits consequences and a supportive relationship.  It promotes both rehabilitation and public safety (Chamberlain, 1998).

Components of Effective Treatment for Youth in the Juvenile Justice System

According to the Coalition for Juvenile Justice (2000), there are nine components of effective treatment for juvenile offenders:

• Highly structured, intensive programs focusing on changing specific behaviors;
• Development of basic social skills;
• Individual counseling that directly addresses behavior, attitudes and perceptions;
• Sensitivity to a youth’s race, culture, gender and sexual orientation;
• Family member involvement in the treatment and rehabilitation of children;
• Community-based rather than institution-based treatment;
• Services, support and supervision that “wrap around” a child and family in an individualized way;
• Recognition that youth think and feel differently than adults, especially under streets; and
• Strong Aftercare Treatment.

Incarcerated Juveniles

The juvenile justice system has long been used as a security setting for juveniles with a variety of mental health issues and disorders.  Youth with severe emotional problems often continue to get in trouble and end up being incarcerated for their own or society’s protection.  According to Dennis Waite, Ph.D., Director of Psychological Services, Virginia Department of Juvenile Justice (Personal Communication, October 29, 2002), these juveniles quite often must receive treatment in an institutional setting when their treatment needs were not addressed earlier Approximately, three to four percent of all juveniles that come before the court for criminal behavior will be incarcerated due to the seriousness of their crime or the chronic nature of their behavior (Personal Communication, Dennis Waite, Ph.D.).

The juvenile justice system is the “last stop” for juveniles with mental health disorder, especially when they are seen as untreatable or if appropriate mental health services have not been available or accessed (Boesky, 2002).  The institutional setting offers effective mental health interventions based on the treatment needs for the child.  It is important to note that many juvenile justice facilities have managed their youth with mental health disorders so well that they need not rely upon community based mental health agencies (Boesky).

Conclusion

It is important to note that the juvenile justice system can neither select its service population nor refuse to accept a child based on his mental health diagnosis (Boesky, 2002).  Accordingly, the juvenile justice system has become the “unofficial placement” for children with mental health disorders who are unable to access appropriate psychological and psychiatric treatment in the community (Boesky).  Although juvenile offenders with mental health disorders are a challenging population, promising intervention strategies do exist.  However, it is important to remember that, although the juvenile justice system should respond to the mental health needs of children in its care, the juvenile justice system cannot supplant the mental health system (Boesky).

Sources

Boesky, L. M. (2002).  Juvenile Offenders with Mental Health Disorders:  Who Are They and What Do We Do With Them? (p. 4). American Correctional Association.

Chamberlain, P. (1998).  Office of Juvenile Justice and Delinquency Prevention. (1998). Treatment Foster Care.  

Coalition for Juvenile Justice. (2000). 2000 Annual Report, Handle with Care: Serving the Mental Health Needs of Young Offenders Coalition for Juvenile Justice.  

Columbia University, Division of Child Psychiatry Center for the Promotion of Mental Health in Juvenile Justice. (2002).  Assessments.  [Online] Available:  http://www.promotementalhealth.org/AssessmentGuidelines/assessments.htm#stats. [October 2002].  

Joint Commission for Behavioral Health Care, Virginia State Crime Commission and Virginia Commission on Youth. (2002). Studying Treatment Options for Offenders who have Mental Illness or Substance Abuse Disorders. (Senate Document 25).  

National Alliance for the Mentally Ill. (July 1999).  Families on the Brink: The Impact of Ignoring Children With Serious Mental Illness, Results of a National Survey of Parents and Caregivers.

National Center for Mental Health and Juvenile Justice. (2002). Best Practice Interventions.

Research & Training Center on Family Support and Children’s Mental Health. (2001). Data Trends, Summaries of Research on Mental Health Services for Children and Adolescents and their Families, Juvenile Justice and Mental Health.

U.S. Department of Health and Human Services. (1999). Mental Health: A Report of the Surgeon General. Rockville, MD.

U.S. Department of Health and Human Services. (2001). Report of the Surgeon General’s Conference on Children’s Mental Health: A National Action Agenda. Washington, D.C.

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