Mental Health in Youth Facilities

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Author: Kira Pyne is CJJ's Communications Assistant. 

May is Mental Health Awareness Month. Now more than ever, as we reflect on this month, and the trauma of the moment that we are in, it is crucial that we do not forget about young people in the justice system. Youth involved in the justice system have mental health disorders at a disproportionate rate compared to the general population. A 2006 study from the National Center for Mental Health and Juvenile Justice estimated that roughly 70% of youth in juvenile detention facilities meet the criteria for at least one mental health disorder (Shufelt & Cocozza, 2006). The most common disorders are conduct disorders, substance disorders, anxiety disorders, and mood disorders (Shufelt & Cocozza, 2006). Eighty-one percent of all females in juvenile detention facilities meet the criteria for a mental health disorder, as do 66.8% of males (Shufelt & Cocozza, 2006). Emotionally difficult periods such as the one in which we now find ourselves can exacerbate mental health challenges. 

The National Commission on Correctional Health Care (NCCHC) has released guidelines - updated yearly - that youth detention facilities must adhere to. Although the NCCHC states that all youth must be screened for both physical and mental health concerns upon entering a facility, only 61% of youth reported receiving mental health screening while 97% reported receiving screening for physical medical problems (Desai et al., 2006). Seventy-seven percent of young people in youth facilities reported having access to “informal” mental counseling, but no other service such as family counseling, or suicide risk reduction had reported access ratings of above 50% (Desai et al., 2006). When the JJDPA was reauthorized in 2018, it required states to begin to increase the availability of mental health screening and individualized treatment options. States must update a three-year plan on an annual basis. These requirements may increase the number of youth who receive successful treatment while in a youth facility as states continue to implement changes. During this moment, young people, including both those behind the walls and those who are released to home, must continue to have access to therapy and mental health services. 

In light of COVID-19, the mental well-being of youth who are incarcerated needs to be a higher priority than ever before. It is crucial that solitary confinement is not used as a means of implementing social distancing measures. Isolation can cause extreme psychological distress for those who experience it; studies have shown that solitary confinement can be just as psychologically damaging as torture (Reyes, 2007) (Basoglu, Livanou, and Crnobaric, 2007). Solitary confinement can lead youth to experience higher rates of anxiety, depression, or cause them to be more likely to commit suicide (Juvenile Law Center). Youth who are in solitary confinement are locked in their cells for 23 hours a day; they do not get to interact with other inmates and they usually do not have access to books, television, education services, or other mental stimuli (Juvenile Law Center). Solitary confinement should not be used as a method for enforcing social distancing measures. The main strategy for keeping youth safe during COVID-19 should be releasing them home to be with their families.

In addition to all youth being in need of more mental health treatment options, there are also racial and socioeconomic inequalities that may lead to higher rates of mental illness.  Black and Hispanic youth in the United States experience disproportionate rates of harassment, discrimination, and marginalization in comparison to their white peers, all of which can lead to negative mental health outcomes (Kuper, Coleman, & Mustanski, 2013). Black and Hispanic youth will experience daily life stressors such as daily racist micro-stressors, racism-related life events, and collective life experiences (Harrell, 2000). Additionally, Black and Hispanic youth are more likely to experience certain traumas that could lead to depression, anxiety, PTSD, or another mental illness. For example, in 2016, Black and Hispanic youth accounted for 63% of youth who were killed by police (National Juvenile Justice Network, 2017). Witnessing or hearing about incidents of brutality triggers stressors and negative emotions, especially since such incidents occur on multiple occasions (Alang, McAlphine, McCreedy, & Hardeman, 2017).

A youth’s socioeconomic status can also cause them to be more prone to mental illnesses for a variety of reasons. A 2005 study done in Massachusetts analyzed the correlation between mental illness and socioeconomic status and found that there is a “…consistent negative correlation between socioeconomic conditions and mental illness, one that supports the role of social causation in mental illness and cannot be accounted for by geographic or economic downward mobility,” (Hudson, 2005, p. 16). Those lower on the socioeconomic scale are more likely to have a diagnosable mental illness and are also more likely to experience psychiatric hospitalization (Hudson, 2005). In addition, one study looking at mental health in areas of low socioeconomic status found that 80% of youth in need of mental health services had not received any in the previous year (Kataoka, Zhang, & Wells, 2002).

The reauthorization of the JJDPA calls for states to address the mental health needs of youth who are involved in the justice system. It also brings more mental health experts into the field of youth justice. There is little comprehensive data on the effectiveness of different treatments in facilities, and the data that has been collected is not recent. Society’s idea and acceptance of mental illnesses have been changing significantly; more people are seeking help and learning about their mental health. This could mean that the data currently being studied is inaccurate and does not give the full picture of the number of youths in facilities dealing with or at risk of mental illnesses. The provisions in the JJDPA will help to resolve this lack of data and begin the expansion of evidence-based methods for the youth justice system.

The ideal response to youth who have a mental illness is to not incarcerate them, or any child, for that matter. In the meantime, it is crucial to continue providing services to youth that will not only allow them to receive treatment for mental illness but will also allow them to thrive once they exit the justice system. Now more than ever, we can not overlook the mental health needs of our young people, particularly vulnerable youth under the care of our justice system. 

Sources: 

Alang, S., Mcalpine, D., Mccreedy, E., & Hardeman, R. (2017). Police Brutality and Black Health: Setting the Agenda for Public Health Scholars. American Journal of Public Health, 107(5), 662–665. doi: 10.2105/ajph.2017.303691

Creating Meaningful Police and Youth of Color Relationships (Publication). (2017, October). Retrieved May 11, 2020, from National Juvenile Justice Network website: http://www.njjn.org/our-work/creating-meaningful-police-and-youth-of-color-relationships---njjn-policy-platform---oct--2017

Desai, R. A., Goulet, J. L., Robbins, J., Chapman, J. F., Migdole, S. J., & Hoge, M. A. (2006). Mental Health Care in Juvenile Detention Facilities: A Review. Journal of the American Academy of Psychiatry and the Law Online, 34(2), 204–214. Retrieved from http://jaapl.org/content/34/2/204#ref-31

Edwards, F., Lee, H., & Esposito, M. H. (2019). Risk of being killed by police use of force in the United States by age, race–ethnicity, and sex. Proceedings of the National Academy of Sciences, 116(34), 16793–16798. doi: 10.31235/osf.io/kw9cu

Harrell, S. P. (2000). A multidimensional conceptualization of racism-related stress: Implications for the well-being of people of color. American Journal of Orthopsychiatry, 70(1), 42–57. doi: 10.1037/h0087722

Hudson, C. G. (2005). Socioeconomic Status and Mental Illness: Tests of the Social Causation and Selection Hypotheses. American Journal of Orthopsychiatry, 75(1), 3–18. Doi: 10.1037/0002-9432.75.1.3

Kataoka, S. H., Zhang, L., & Wells, K. B. (2002). Unmet Need for Mental Health Care Among U.S. Children: Variation by Ethnicity and Insurance Status. American Journal of Psychiatry, 159(9), 1548–1555. doi: 10.1176/appi.ajp.159.9.1548

Kuper, L. E., Coleman, B. R., & Mustanski, B. S. (2013). Coping With LGBT and Racial-Ethnic-Related Stressors: A Mixed-Methods Study of LGBT Youth of Color. Journal of Research on Adolescence, 24(4), 703–719. doi: 10.1111/jora.12079

Shufelt, J. L., & Cocozza, J. J. (2006). Youth with Mental Health Disorders in the Juvenile Justice System: Results from a Multi-State Prevalence Study. Washington, DC: National Center for Mental Health and Juvenile Justice.

Solitary Confinement & Harsh Conditions. (n.d.). Retrieved May 13, 2020, from https://jlc.org/issues/solitary-confinement-other-conditions

Reyes H: The worst scars are in the mind: psychological torture. Int Rev Red Cross 89:591–617, 2007