The relationship between mental health and juvenile justice is complicated. According to the National Alliance on Mental Illness (NAMI) approximately 2 million youths are arrested in the United States every year and up to 70% of these youths have an identifiable mental health and/or substance use disorder. This is a much higher percentage compared to the average youth population with a prevalence of mental illness of 9-22%.
Unfortunately due to the difficulty of integrating mental health treatment into correctional settings, it is not uncommon for mentally ill youths to wait in custody before receiving mental health treatment they need. This is due to the interplay between ethics, legality, and logistical difficulty of treating youths in a jail or prison setting.
Correctional facilities are not hospitals, thus facilities are staffed primarily by people with experience in law enforcement, and most have little to no training in mental health. The setting of a correctional facility is also not ideal for youths with mental illness given that the facility can be loud, different staff work at different times and other juvenile offenders are coming and going which means there is very little consistency, and it is difficult to sleep in a correctional setting. They can also be antagonized by other offenders, are more likely to spend time in isolation, and are more likely to get write-ups or disciplinary action if they cannot understand or do what is expected of them. The correctional setting is also challenging because mentally ill youth have limited access to familiar faces like family and close friends which can cause additional stress.
Racial and ethnic disparities are clear when it comes to the diagnosis and treatment of mental health conditions in the juvenile justice system but also in the community at large. Youths of color are less likely to receive mental health or substance use treatment, are more likely to be referred to the juvenile justice system, and receive fewer services in the foster care and child welfare populations compared to white youths. Even in the juvenile justice system, youths of color are still less likely to be treated for mental health disorders than white youths even after researchers controlled for age, gender, and detention center location.
Gender also appears to play a role with regard to treatment. Some studies indicate that females are more likely than males to receive mental health placements as opposed to being incarcerated. Girls in the juvenile justice or foster care system are also more likely to be referred for treatment. The explanation for these trends is not clear, but is likely multifactorial.
It also appears that younger youths, typically under 15 are more likely to be referred for mental health placements as opposed to being incarcerated. This suggests that the older the youth, the more punitive the approach as opposed to younger youths where the approach is more rehabilitative.
Mental Health and Violence
A common misconception is that people with mental illness are more likely to be violent. When in fact most people with mental illness are not violent, and are much more likely to be a victim of violence as opposed to a perpetrator. It is difficult for the public to accept that most violent crimes are committed by people without mental illness. This is likely because it leaves us devoid of an explanation as to why sane people still commit violent crimes.
Given that people with mental illness are often portrayed negatively in the media, it is that much more important to discuss relevant data on the matter. Researchers have found that the prevalence of violence among people with a treated mental health condition, was the same when compared to the general population (people not affected by a substance or mental health disorder). This means that people with treated mental health conditions are no more or less likely to engage in violence compared to non-mentally ill, non-substance abusing controls.
This is why early intervention and treatment for youths with mental health and substance use disorders is so important. If these conditions can be identified and treated early, two of the greatest risk factors for incarceration are now eliminated. Early intervention programs have the potential to drastically alter the trajectory of a youth’s life, and is a more effective, healthier, and much less costly alternative to incarceration.
Reintroduction into Society
Upon release from incarceration, individuals with mental and behavioral health issues face many barriers to successful reentry into the community. A few examples are lack of health care, limited job skills and/or education, inability to find stable housing, and poor connection with community behavioral health providers. All of which may jeopardize their recovery and increase their probability of relapse and re-arrest. Individuals leaving correctional facilities often have lengthy waiting periods before attaining medical and mental health services in the community which puts them at high risk for re-incarceration.
What can be done?
The best first step is to identify high risk individuals and screen for mental health and substance use disorders before a crime is committed. This would allow for early intervention, treatment, and additional support. The idea being that with these systems in place, incarceration may be avoided altogether.
If the youth has already entered the juvenile justice system, they should still be screened and assessed for underlying substance or mental health disorders. This is to ensure both recognition of their condition, treatment, and connection with services prior to release from incarceration. This method of practice is much less costly, and is also more effective than providing treatment solely when the youth is incarcerated.
Mental health training for professions that are likely to come into contact with the mentally ill is also important. These professions include but are not limited to law enforcement, probation, juvenile and family court judges, teachers, and other first responders. If mental illness can be identified early, the process of linkage to community services can be achieved much earlier in the course of illness and significantly increases chance of recovery.
What types of treatment have been successful?
Cognitive–behavioral therapy (CBT) has shown positive results. The premise of CBT is helping youths understand that their thoughts play a very big role in their behaviors. The goal is to help them to modify their thinking and behaviors as they relate to delinquency and crime. There is some evidence that this treatment modality can be effective in decreasing recidivism rates.
Functional Family Therapy (FFT) is a family-based program. The focus is on decreasing risk factors for high risk behaviors, and increasing protective factors. The setting of FFT often depends on the severity of the behaviors. Outpatient therapy is common, however if there is a lot of conflict in the home, services can often be provided in the home. There is some evidence that when families engaged and adhered to the FFT model, there was a significant reduction in felony crimes and violent crimes.
Multisystemic Therapy (MST) is also a family based therapy and is designed for youths who have very serious problems such as substance use and severe criminal behavior. The level of intervention is more intense compared to the other two modalities discussed above. MST usually involves multiple therapist–family contacts each week. The goal of this modality of treatment is to increase prosocial behavior while decreasing problem behavior. Due to the severity of the behaviors the youth is engaging in MST generally uses a home-based model. Research suggests that MST has an impact on decreasing re-arrest rates in the youth population.
Provides information and assistance with obtaining health insurance after release from incarceration
National Alliance on Mental Illness (NAMI)
SAMHSA’s GAINS Center
GAINS stands for “Gather, Assess, Integrate, Network, and Stimulate.” This organization supports people who work in behavioral health and criminal justice, helps communities facilitate the integration of mental health and substance use services, and information about funded grand programs.
The National Reentry Resource Center
Provides information on reentry resources including family engagement, housing, substance use treatment, mental health and many other topics.
*Originally published on the Inpathy Bulletin