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Mental illness among juvenile offenders--identification and treatment.

Jeffrey is a 14-year-old mass of movement. Some part of his body appears always in motion. He is quick to smile, quick to anger and rarely quiet. Jeffrey and his sisters have lived with their grandmother since his father was incarcerated for assault and his mother entered court-ordered drug treatment. Jeffrey is enrolled in school as a seventh grader, with records documenting poor attendance due to truancy, expulsions for fighting and frequent illness. He is performing below expected levels in most academic areas. Jeffrey's previous court contacts are for truancy, shoplifting and running away from home. The family is currently being monitored by the state Department of Human Services for prior allegations of neglect and domestic violence. Jeffrey has been diagnosed with attention-deficit hyperactivity disorder, conduct disorder and mild depression, but is currently taking no prescribed medication. His grandmother reports that he has a history of medication noncompliance and she suspects he may have shared his medicine with friends. She is concerned he may be experimenting with marijuana. Jeffrey's case manager reports that his grandmother's efforts to create a stable home for Jeffrey are hampered by her advanced age, limited economic resources and his behavior problems.

Jeffrey's profile includes some risk factors commonly associated with young offenders who present a complex mixture of treatment and custody challenges for the court, probation and corrections personnel who are responsible for supervising them in the community, and juvenile justice placements.


The Office of Juvenile Justice and Delinquency Prevention's (OJJDP) Juvenile Offenders and Victims: 2006 National Report indicates that although the number of juveniles adjudicated for committing violent crimes has decreased, status and drug-related offenses have increased. The report also states that arrests of juvenile female offenders for violent offenses are increasing. The percentage of young offenders diagnosed with mental health and substance abuse disorders is rising, and research has shown a possible correlation between juvenile mental health disorders, offending behavior and recidivism. Studies of juvenile female offenders identify a significant relationship between their reported severe sexual, physical and emotional abuse and their high-risk behaviors (substance abuse, gang activity and truancy) and mental health disorders (post-traumatic stress disorder, major depression, anxiety and eating disorders). (1)

Research suggests that up to 70 percent (2) of the estimated daily average of more than 90,000 (3) adjudicated youths cycling through local and state adult and juvenile justice placements or facilities have a mental health disorder (e.g., conduct disorder, anxiety and depression) with a risk of suicide four times higher than the general juvenile population. More than half have histories of exposure to violence, neglect, abuse and trauma. It is estimated that up to 75 percent of young offenders have a substance abuse disorder, and as many as 20 percent of this group also suffer from a mental health disorder serious enough to impair their daily functioning. (4)

The juvenile justice system is facing the trend experienced by the adult criminal justice system--the criminalization of mental illness. Youth facilities have become substitute mental health "hospitals," while also facing the pressure of economic constraints, difficulties recruiting and retaining qualified staff, and the possible shift in focus from a treatment and rehabilitation model to one of custody and control. Legally, these facilities are obligated to provide adequate medical and mental health services to the offenders in their care. The U.S. Department of Justice, pursuant to the Civil Rights of Institutionalized Persons Act of 1980 and the Violent Crime Control and Law Enforcement Act of 1994, notes that it continues to investigate allegations of systemic abuse and civil rights violations related to the conditions of confinement, including the provision of adequate mental health services and suicide prevention. The spotlight has now turned to the juvenile justice system. Investigations have resulted in federal lawsuits, consent decrees and settlement agreements, which challenge conditions and mandate major program reforms and mental health service improvements at juvenile facilities across the country.

Corrections' Responsibility

Successful community reentry remains a fundamental goal of juvenile correctional systems. Whereas success and failure can be statistically tracked and defined, it is important to remember that those figures are created child by child. A substantial number of juveniles need and are entitled to mental health treatment programs delivered by qualified mental health staff to strengthen their ability to make positive life choices. Although statistical data and the needs of these youths are influenced by multiple factors--including family, gender, developmental level, culture, peers and education--researchers have identified several strategies to assist juveniles affected with mental health and/or substance abuse problems to enhance the probability of their successful reintegration into the community and reduce their risk of re-offending. These strategies include assessment, identification, treatment planning, interventions and community services coordination.

Early identification. All youths must be screened for mental health problems at initial contact with the juvenile justice system and admission to a residential placement or facility as part of the intake process. According to ACA's standards for juvenile detention facilities, the screening should include evaluation for:

* Current risk or history of suicide and self-harm (to include family history);

* Mental health problems;

* Substance abuse;

* Medications;

* Aggressive or violent behavior;

* Psychiatric hospitalization or treatment; and

* Current mental status.

Information should be derived from multiple sources (e.g., courts, family, school, previous providers, direct observation and self-reports). Following the initial assessment, periodic evaluations should be completed for an ongoing assessment of mental health status. Studies have shown that substance abuse treatment has a significantly decreased chance of success if an existing co-occurring mental health disorder remains unidentified and untreated. The screening tool must be designed and approved by a credentialed mental health professional and implemented by adequately trained and qualified staff. All direct care staff must be initially trained and periodically retrained on the signs and symptoms of mental illness, suicide risk behavior, appropriate responses and referral procedures.

Early intervention. Youths identified upon initial screening as at risk for imminent harm must be protected and referred for immediate evaluation by a credentialed mental health professional. Youths found to have had prior mental health issues, a history of substance abuse, and/or present behaviors associated with a current mental health concern must be referred in a timely manner for appropriate follow-up evaluation and individualized treatment planning by a qualified professional. Studies support that early identification of mental health disorders, partnered with integrated, individualized, evidence-based mental health interventions, increase the likelihood of long-term positive outcomes when initiated at an early age (12 or younger). The lack of identification and intervention increases the risk of continued school failure, limited or nonexistent employment opportunities, unstable social and family relationships, and high-risk behaviors, increasing the potential for chronic criminal behavior into adulthood. (5)

Individualized treatment. Interventions and treatment plans must be culturally sensitive, age- and developmental-level-appropriate, and gender-specific. They must also target the individual needs of each youth, based on diagnosis and family dynamic to include planning for continued treatment and support following reentry. Family participation in treatment should be encouraged to facilitate successful family reunification and to increase family competence through counseling, education and support groups. Coordinated care linking community-based providers and economic support services that can assist in accessing necessary services should be initiated as soon as possible to permit an effective continuum of care and transition to the community. Reentry planning should begin during the intake process and include family participation.

Programs Across the Nation

Several juvenile programs across the country at local and state levels have been developed to target assessment, early intervention, integrated treatment and community services follow-up for mental health disorders and co-occurring substance abuse issues. In 2002, the Illinois Department of Human Services initiated and provided funding for the Mental Health Juvenile Justice (MHJJ) Initiative. According to Debra Ferguson, Ph.D., director of juvenile forensics at MHJJ, this program identifies youths throughout the state with severe mental health disorders (affective or psychotic) by referral from such stakeholders as judges, attorneys, probation officers and parents. Liaisons coordinate with the courts, detention centers and community-based providers for wraparound services for the family and the youth, both while in detention or residential placement and following reentry, that address the juvenile's strengths and treatment needs, Ferguson said. She reported that each year, this program serves approximately 1,000 juveniles and their families. A recent study completed by the Department of Human Services shows that participants in the program have a 21.3 percent recidivism rate, compared with the state juvenile offender recidivism rate of 72 percent, according to Ferguson.

Originally developed as a drug court in 1999, Crossroads is a juvenile mental health treatment court that was implemented in Summit County, Ohio, in 2003. Dawn Jones, Crossroads administrator, said youths referred (post-adjudication) to the program have a major affective disorder, severe post-traumatic stress disorder or a psychotic disorder. Youths with co-occurring substance abuse disorders also qualify for this program, which provides integrated, home-based treatment by community-based providers, she said. Successful completion of the 12-month program leads to expungement of the admitting charge and related parole violations from the juvenile's record, Jones said.

The Juvenile Rehabilitation Administration of the Washington State Department of Social and Health Services implemented the Family Integrated Transitions program in 2001. (6) This program was designed to provide evidence-based intensive treatment for juveniles with co-occurring mental illness and chemical dependency. For eligible youths, the program begins two months prior to release from a Juvenile Rehabilitation Administration placement and continues for four to six months while the youth is under parole supervision in the community. The family is integrated into the treatment program as well. A comparison study of felony recidivism for youths successfully completing the program (27 percent 18-month recidivism rate) and nonparticipatory but qualified youths (41 percent 18-month recidivism rate) supports the program's success. While the structure may vary, successful programs have common core components: identification; individualized, integrated evidence-based treatment; community collaboration; family involvement; prerelease planning; continuation of services upon reentry; and evaluation of program outcomes.

There are several resources available that describe programs, research and demographic information regarding the successful identification and treatment of youths with mental illness. OJJDP ( is an excellent starting point, offering a number of publications, statistical data, fact sheets and links to potential public and private funding sources. Juvenile correctional facilities should find out what works effectively for their system and most of all for their youths.


(1) Acoca, L. 1999. Investing in girls: A 21st century strategy. Journal of the Office of Juvenile Justice and Delinquency Prevention, 6(1):3-13.

(2) Snyder, H.N. and M. Sickmund. 2006. Juvenile offenders and victims: 2006 national report. Washington, D.C.: Office of Juvenile Justice and Delinquency Prevention.

(3) American Bar Association, Governmental Affairs Office. 2007. Youth at risk: Juvenile Justice and Delinquency Prevention Act. Washington, D.C.: American Bar Association. Available at

(4) Skowyra, Kathleen and Joseph Cocozza. Blueprint for change: A comprehensive model for the identification and treatment of youth with mental health needs in contact with the juvenile justice system. Washington, D.C.: OJJDP and the National Center for Mental Health and Juvenile Justice.

(5) National Alliance on Mental Illness. 2006. Facts on children's mental health in America. Arlington, Va.: National Alliance on Mental Illness.

(6) The information on this program comes from: Aos, S. 2004. Washington state's family integrated transitions program for juvenile offenders: Outcome evaluation and benefit-cost analysis. Olympia, Wash.: Washington State Institute for Public Policy.


National Mental Health Association. 2004. Mental health treatment for youth in the juvenile justice system: A compendium of promising practices. Alexandria, Va.: National Mental Health Association.

Cocozza, Joseph J. and Kathleen Skowyra. 2000. Youth with mental health disorders: Issues and emerging responses. Juvenile Justice, 7(1):3-13. Washington, D.C.: OJJDP.

Leslee Hunsicker is the administrator of health care programs for the American Correctional Association.
COPYRIGHT 2007 American Correctional Association, Inc.
No portion of this article can be reproduced without the express written permission from the copyright holder.
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Title Annotation:CT FEATURE
Author:Hunsicker, Leslee
Publication:Corrections Today
Geographic Code:1USA
Date:Oct 1, 2007
Previous Article:Serving those serving time.
Next Article:ACA is leading the way in the new generation of health care standards.

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