Final Report Summary - ANTEJUVENILE (Antecedents and Consequences of Mental Health Problems in Juvenile Justice Boys and Girls)
Mental health problems are substantial in juvenile justice youths; almost 65% of convicted and incarcerated juveniles and 60% of detained juveniles (pre-trial) have a psychiatric disorder. These rates are lower in the general population, where adolescent mental health prevalence rates have been shown to be approximately 15%. Thus, mental disorders are highly prevalent in justice-involved youths and therefore constitute a significant concern. Insight into antecedents and consequences of psychiatric disorder in juvenile justice youth could offer a point of departure for improving interventions for juvenile delinquents.
The main aim of this study, Antecedents and Consequences of Mental Health Problems in Juvenile Justice Boys and Girls (AnteJuvenile), was to develop understanding, first, on the impact of mental health problems on reoffending and, second, on explanatory processes of mental disorders of juveniles involved in the justice system. We used data of youths in U.S. juvenile justice facilities, which have been collected by the Center for the Promotion of Mental Health in Juvenile Justice of Columbia University. At baseline, when youths entered a juvenile justice facility, youths completed a psychiatric assessment soon after intake into either their county’s probation, detention or secure care system. Probation officers completed a Mental Health Tracking Form for each youth, recording demographics and recommendations for mental health/substance use services. A little over a year after the close of data collection, the Administrative Office of the Courts matched individual youths’ assessment data to their cumulative juvenile justice and adult criminal records and the de-identified data was used for our investigation.
In the first three studies, we focused on the influence of mental health disorders on re-offending. In contrast to earlier studies, we focused on increasing severity, or worsening course, rather than using a dichotomous or frequency-based measure of offending, as earlier studies have done. By using this new measure we found that youths with substance use disorder with or without co-occurring disorders not only committed more re-offenses, but also more severe re-offenses; those with substance use disorder, with or without co-occurring disorders, were at greater risk for escalations in offense seriousness during adolescence. Next, we compared youths who were referred by probation officers to mental health services with those who did not receive a referral. Those with disruptive behaviour disorder (such as ADHD or conduct disorder) or substance offenses were most likely to receive referrals to mental health or substance abuse services. Those with one or internalizing disorder (such as depression or anxiety) were most likely to remain unidentified and consequently, the least likely to access mental health services. Further, substance use disordered youths with service referrals had lower recidivism risk during adolescence compared to counterparts without service recommendations; referral lowered the recidivism odds to approximately that for youths without a substance use disorder. Providing juvenile justice youths with systematic mental health assessment and linking those with substance use disorder to mental health and substance use services likely reduces recidivism risk. Finally, we examined adolescent psychiatric disorder in relation to adult offending. We found that youths with co-occurring internalizing and disruptive behaviour disorder had a sixfold increased risk for young adult recidivism compared with non-disordered counterparts. Comorbid internalizing disorder likely is a marker for the severity of a youth’s disruptive behaviour disorder; similarly, offending that continues into adulthood likely betokens a more serious course of offending behaviour. The severity underlying both disorder and offending behaviour may be the common link between them.
In the next three studies we examined explanatory factors of mental health problems, such as exposure to traumatic events and childhood maltreatment. First, we compared youths with co-occurring internalizing and disruptive behaviour disorder with those with either one of these disorder types, on demographics, traumatic exposure, suicide attempt, and offending characteristics. Further, in a Dutch male juvenile justice group we examined differences between childhood-onset and adolescent-onset offenders in mental health and substance use problems, and a history of child abuse and neglect. In the final study we examined whether mental health problems explain the link between maltreatment and aggression. These studies are under review or in preparation.
Overall, our findings indicate that rates of psychiatric disorder in juvenile justice youths are high and that mental health problems increase the risk of criminal recidivism. Juvenile offenders with substance use disorder, with or without other co-occurring disorders, are at risk for offense escalation and are more likely to commit more severe re-offenses than are juveniles without disorder. Unlike most youths who “grow out” of offending by young adulthood, those with comorbid internalizing and disruptive behavior disorder show a more persistent course with offending that continues at least into young adulthood. Most likely, this reflects the increased impairment in those with this pattern of comorbid disorders. Taken together, findings suggest that mental health screening can not only contribute to the identification of treatment needs but also identify those most likely to engage in a future escalating course of offending.
Juvenile justice agencies should be keen to screen youths for the presence of internalizing disorder. Those with one or another internalizing disorder were most likely to remain unidentified and consequently, the least likely to access services. Although youths with anxiety or mood disorders do not have elevated recidivism risk, their service needs should nonetheless be addressed. The prevalence of internalizing disorders in youths in juvenile justice settings is considerable (e.g. 23.2 % at system intake and 36.0 % in detention). Moreover, earlier studies have found that their elevated rates of mood disorder place juvenile system youths at increased suicide risk. In addition, youths with comorbid internalizing and disruptive behavior disorder are at increased risk for persistent offending into adulthood.
Information from scientifically sound mental health and substance abuse screening can contribute to the identification of those juveniles most likely to engage in a future course of offending. Identifying substance disordered youths and referring them to appropriate services decreases their recidivism risk. The present findings underscore the importance of universal comprehensive screening for mental health and substance use problems, (i.e. youths should all receive the same assessment, that can identify need across a range of conditions), adequate referral to mental health and substance use services and access to effective treatment for justice system youths.
Machteld Hoeve Ph.D.
University of Amsterdam
Research Institute Child Development and Education
P.O. Box 94208
1090 GE Amsterdam
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