Put aside what we don’t know and support justice-involved youth with mental health needs
By Micah Haskell-Hoehl, Legislative and Federal Affairs Officer at the American Psychological Association
We need to be careful about the language we use to discuss mental health and juvenile justice—and even more careful about how we meet the mental health needs of justice-involved youth.
By the numbers, the link may seem straightforward. Up to 70 percent of youth detained in the juvenile justice system—three to four times the rate among their peers in the community—have diagnosable symptoms of a mental health disorder. Depending on the individual diagnosis, the disparity can be even greater, and, particularly alarming, justice-involved youth experience severe emotional disturbance at two and a half times the rate in the community.
Yet, the association between justice-involvement and mental illness during childhood and adolescence is anything but direct. Mental illness is not the same, research has shown, as risk for delinquency and recidivism. Similarly, the evidence-based practices for treating childhood mental health disorders and treating needs related to risk for delinquency are not one and the same. Because of this, we must avoid reducing juvenile delinquency to mental illness and making statements that stigmatize mental illness and delinquency by framing the former as a cause of the latter.
As cloudy as this picture may seem, though, it should not dissuade juvenile courts, juvenile justice systems, and public mental health agencies from jumping in with both feet to help these young people. We know a tremendous amount about how to address mental health needs among justice-involved youth effectively. Indeed, a wealth of resources exist to help policymakers enact reforms and help agencies build capacity and improve practices. Below is a quick—nowhere near exhaustive—list of a few key dos and don’ts.
DO use evidence-based methods. Provide a mental health screening for every young person detained and, when indicated, follow up with assessment, treatment planning, and treatment by a licensed or certified mental health practitioner with expertise in childhood mental health disorders.
DO divert youth, whenever public safety imperatives allow it, to home- and community-based services. The overwhelming majority of justice-involved youth will respond better—including reducing their risk of recidivism—to treatment in their homes and communities. Furthermore, Medicaid and Children’s Health Insurance Program funds will cover these services, unlike those provided within secure facilities. In situations of mental crisis, law enforcement can divert individuals—even prior to arrest—into mental health services, as is practiced in models such as Crisis Intervention Teams.
DO ensure that evidence-based care delivered by a licensed or certified mental health professional practicing in their area of expertise is provided, when, as a last resort, it is absolutely necessary to hold a young person in a detention or corrections facility. Adequate staffing is critical to providing effective services.
DO adopt a trauma-informed lens. Research has found a strong association between trauma, especially polyvictimization, with risk for delinquency. Both internalizing symptoms (e.g., depression, anxiety) and externalizing behaviors (e.g., aggression, vandalism) can be manifestations of traumatic stress, though also mistaken for symptoms of other mental health problems. If traumatic stress is the primary driver of symptoms, this should inform treatment decisions and goals. Traumatic stress requires specific types of intervention and also makes the treatment of comorbid mental health needs more complicated. However, professionals need training in trauma-informed policy and practice to address these needs effectively.
DO account for the differences between boys and girls. Research shows that certain types of trauma and abuse, such as sexual victimization at the hands of family and community members and traffickers, are more prevalent among girls. This means that girls frequently have pathways into justice-involvement that are different from boys and need treatment that addresses their gender-specific background, experiences, and needs.
DON’T address mental health problems and delinquency problems as one and the same. Despite the high prevalence of mental health disorders among justice-involved youth, mental illness is not the same as criminogenic risk. While critical that these young people receive needed mental health services, they alone are unlikely to reduce risk of recidivism, which should be treated in an integrated fashion with mental health problems.
DON’T give psychotropic medications, unless they’re part of a treatment plan based on a mental health assessment developed by a licensed or certified mental health practitioner with expertise in childhood disorders. Psychotropic medications carry risks that must be weighed against their potential benefits, and clinical trials have not been performed to establish their safety and efficacy in children and adolescents. They should never be prescribed to a young person exhibiting behavioral problems for the convenience of facility staff.
DON’T exacerbate traumatic stress or symptoms of mental illness by holding youth unnecessarily in secure detention or correctional facilities. These settings can expose already vulnerable youth to chaos, victimization at the hands of staff and other young people, violence, and other potentially harmful situations, and evidence indicates that the use of secure confinement tends not to bring about desired outcomes, such as reduced risk of recidivism.
Again, this brief list is far from exhaustive and hits some of the high-points. For additional resources on evidence-based and promising best practices, program development and improvement, and funding, please visit the websites of our colleagues at the National Center for Mental Health and Juvenile Justice, Models for Change initiative, and Juvenile Delinquency Alternatives Initiative. Additionally, the federal Office of Juvenile Justice and Delinquency Prevention provides grants, training, technical assistance, and other resources for agencies and policymakers looking to improve treatment for this group of young people.
Micah A. Haskell-Hoehl is the Legislative and Federal Affairs Officer at the American Psychological Association. He co-manages the APA Congressional Fellowship, and is responsible for issues related to children, youth, and families and criminal and juvenile justice.