Addressing The High Rates of Mental Illness among Detained Youth

February 22, 2021

By Sara Jaffee, PhD., Field Center Faculty Director, Professor and Director of Graduate Studies, Department of Psychology

In recent years, highly publicized suicides in detention centers like Riker’s Island in New York have focused a spotlight on mental illness in adult prison populations. A meta-analysis published in the February 2021 issue of the Journal of the American Academy of Child and Adolescent Psychiatry (Beaudry et al., 2021) highlights this problem among adolescents in the juvenile justice system. Aggregating data from 47 studies across 19 countries, the authors report that rates of current disorder (meaning that symptoms exceeded diagnostic thresholds in the past six months) were substantially elevated among young people between the ages of 10 and 19 years in the juvenile justice system compared to young people in the general population. Incarcerated youth were diagnosed with major depressive disorder at 2 to 2.5 times the rate in the general population and with psychotic illness at approximately 10 times the rate in the general population. Rates of post-traumatic stress disorder were three to four times higher among detained youth than among youth in the general population. 

There is substantial overlap between youth in the juvenile justice and child welfare systems, with child welfare-involved youth comprising 30% to 40% of juvenile justice populations (Herz et al., 2010). Rates of mental health problems are likely to be particularly high among these “cross-over” youth, who are known to both the child welfare and juvenile justice systems. There is a large literature documenting links between childhood maltreatment and poor mental health (Jaffee, 2017). Moreover, maltreated youth are disproportionately likely to experience other forms of violence in their communities and families that are also risk factors for poor mental health (Finkelhor et al., 2007).

These realities have at least three implications. First, juvenile justice facilities need to provide better access to mental health services and these services need to be trauma-focused, with a recognition that incarceration itself may be a trauma. African Americans and other youth of color are over-represented in “cross-over” populations, underscoring a need for mental health treatments that are effective across diverse groups and mental health professionals who are culturally competent to provide therapy. Second, more intellectual and financial resources should be directed towards juvenile justice reform efforts that expand partnerships between schools, courts, law enforcement, and other community-serving professionals. Such partnerships have the potential to foster academic success, reduce rates of delinquency, and divert young people from the juvenile justice system into programs with a more rehabilitative focus (see, for example, Georgetown University’s Center for Juvenile Justice Reform). Third, the Beaudry et al. meta-analysis found that two-thirds of young people in the juvenile justice system had a lifetime history of conduct disorder – approximately six times the rate in the general population. Effective treatments for conduct disorder are available, including parenting interventions like the Incredible Years program that could be subsidized by funds from the Family First Prevention Services Act as well as programs targeted at youth in foster care like Multidimensional Treatment Foster Care. The prevention of clinically-significant levels of conduct problems as part of efforts to keep youth out of foster care and the treatment of conduct disorder among youth in foster care is likely to prevent cross over from the child welfare to the juvenile justice system.

References

Beaudry, G., Yu, R., Långström, N., & Fazel, S. (2021). An updated systematic review and meta-regression analysis: Mental disorders among adolescents in juvenile detention and correctional facilities. Journal of the American Academy of Child & Adolescent Psychiatry, 60(1), 46–60. https://doi.org/10.1016/j.jaac.2020.01.015

Finkelhor, D., Ormrod, R. K., & Turner, H. A. (2007). Polyvictimization and trauma in a national longitudinal cohort. Development and Psychopathology, 19(1), 149–166.

Herz, D. C., Ryan, J. P., & Bilchik, S. (2010). Challenges facing crossover youth: An examination of juvenile justice decision-making and recidivism. Family Court Review, 48(2), 305–321.

Jaffee, S. R. (2017). Child maltreatment and risk for psychopathology in childhood and adulthood. Annual Review of Clinical Psychology, 13, 525–551.

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