Examining the Impact of Mental Health, Substance Use, and Co-Occurring Disorders on Juvenile Court Outcomes

• Author: D’Andre Walker,Arynn A. Infante,Deja Knight
• DOI: http://doi.org/10.1177/00224278221084981
• Published date: 01 November 2022
• Date: 01 November 2022
• Subject Matter: Original Research Articles

Examining the

Impact of Mental

Health, Substance

Use, and

Co-Occurring

Disorders on Juvenile

Court Outcomes

D’Andre Walker

1

,

Arynn A. Infante

2

,

and Deja Knight

3

Abstract

Objectives: This study isolates the effects of mental health, substance use,

and co-occurring disorders on three distinct dispositional outcomes: incar-

ceration (i.e., jail/detention), non-incarcerative residential placement

(i.e., treatment facility), and community sanctions (i.e., f‌ines/restitution or

probation). Methods: Using a sample of juvenile offenders from the

Pathways to Desistance study (N =617), a series of logistic regression mod-

els were estimated to test the joint and independent effects of mental

health, substance use, and co-occurring disorders on the likelihood of

1

Department of Criminal Justice and Legal Studies, University of Mississippi, University, MS,

USA

2

Department of Criminology and Criminal Justice, Portland State University, Portland, OR,

USA

3

Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA

Corresponding Author:

D’Andre Walker, Department of Criminal Justice and Legal Studies, University of Mississippi,

303 Hedleston Hall University, MS 38677, USA.

Email: dlwalke1@olemiss.edu

Original Research Article

Journal of Research in Crime and

Delinquency

2022, Vol. 59(6) 820–853

© The Author(s) 2022

Article reuse guidelines:

sagepub.com/journals-permissions

DOI: 10.1177/00224278221084981

journals.sagepub.com/home/jrc

detention versus non-incarcerative sanctions. A series of multinomial logis-

tic regression models were estimated to assess whether these disorders

increase the likelihood of out-of-home placement (i.e., non-incarcerative

residential placement and incarceration) relative to community sanctions.

Results: While having any disorder was associated with out-of-home

placement, youth with substance use disorders had the greatest likelihood

of receiving an out-of-home placement, including detention. Youth with co-

occurring disorders were more likely to receive a non-incarcerative resi-

dential placement, whereas mental health disorders did not demonstrate

a signif‌icant effect on adjudication. Conclusions: Youth with mental health,

substance use, and co-occurring disorders are treated differently in juvenile

court. Using a composite disorder measure and/or not considering various

sanction types could mask the effects of such disorders on court outcomes.

Keywords

juvenile justice, mental health, substance use, adjudication, incarceration

Introduction

In 2018, there were nearly 730,000 arrests of persons under the age of 18 in

the United States (Puzzanchera 2020), with approximately 744,500 cases pro-

cessed through juvenile courts (Hockenberry and Puzzanchera 2020). These

statistics highlight the number of youth entering the U.S. juvenile justice

system each year. Much of this juvenile justice involvement, however, has

been attributed to the prevalence of youth psychiatric disorders (Cauffman

2004; McCabe et al. 2002; Teplin et al. 2002). Empirical evidence suggests

that nearly two-thirds of males and one-third of females under some form

of juvenile conf‌inement suffer from at least one psychiatric disorder (Teplin

et al. 2002; Wasserman et al. 2002; Wasserman et al. 2005). Furthermore,

nearly 61% of system-involved youth havebeen diagnosed with co-occurring

mental health and substance use disorders (Shufeltand Cocozza 2006). While

research has documented the prevalence of co-occurring disorders among

juvenile offenders (Abrantes, Hoffmann, and Anton 2005; Shufelt and

Cocozza 2006; Turner et al. 2004), there is a lack of research focusing on

how youth with a dual diagnosis are processed in the system.

Studies investigating the effects of mental health and substance use dis-

orders on juvenile adjudication have produced mixed f‌indings (Campbell

and Schmidt 2000; Cauffman et al. 2007; Espinosa et al. 2013; Gebo

2007). Some research has linked mental health (Espinosa et al. 2013;

Walker et al. 821

Gebo 2007) and substance use disorders (Campbell and Schmidt 2000;

Cauffman et al. 2007) to increased sentence severity; while others f‌ind mar-

ginal to null effects of mental health (Campbell and Schmidt 2000;

Cauffman et al. 2007) and substance use (Gebo 2007) on case disposition.

Scholars have argued that methodological differences across studies can par-

tially account for the body of mixed f‌indings (O’Donnell and Lurigio 2008).

Against this backdrop, three methodological limitations are worth men-

tioning. First, existing research often categorizes substance use disorder as

an indicator of poor mental health, precluding the opportunity to study the

independent effects of each disorder on case disposition (e.g., Espinosa

et al. 2013). Consequently, it has been diff‌icult to distinguish the unique

effects of mental health and substance use disorders on various adjudication

outcomes to assess whether these youth fare differently in the juvenile

justice system. Second, prior research has rarely accounted for the presence

of a dual diagnosis of both mental health and substance use disorders to

assess how youth with co-occurring disorders are treated in the

juvenile justice system (e.g., Tolou-Shams et al. 2014). This is problematic

given that a majority of justice involved youth experience both mental health

and substance use disorders concurrently (Shufelt and Cocozza 2006).

Third, much of this research has focused solely on in-out decisions (i.e., like-

lihood of conf‌inement vs. nonconf‌inement), often grouping residential treat-

ment and incarceration in a detention facility as a single indicator of

conf‌inement (e.g., Cauffman et al. 2007; Gebo 2007). Youth with mental

health disorders, however, may be more likely to receive treatment in a

less punitive environment, such as placement in a non-incarcerative residen-

tial placement, like a rehabilitation or treatment facility (Espinosa et al.

2013). Therefore, categorizing residential placement as an indicator of con-

f‌inement potentially masks the unique effects of mental health and substance

use disorders on non-incarcerative, treatment-related outcomes.

Furthermore, examining how youth with mental health, substance use,

and co-occurring disorders are processed in the juvenile justice system is

important in light of research documenting the disparate treatment of

youth based on a set of focal concerns. Studies have shown that court

actors may link offender attributes, such as race, gender, and age with per-

ceptions of blameworthiness, dangerousness, and practical constraints

during sentencing (Steffensmeier et al. 1998; Steffensmeier and Demuth

2000; Steffensmeier and Demuth 2001). In accordance with the focal con-

cerns perspective, it is likely that mental health and substance use disorders

will function similarly to these offender characteristics during juvenile adju-

dication. Court off‌icials may perceive youth with mental health disorders as

822 Journal of Research in Crime and Delinquency 59(6)