A Public Health Approach to Address the Mental Health Needs of Juvenile Offenders

• Date: 08 August 2005
• DOI: https://doi.org/10.1016/S0196-1152(05)12001-8
• Pages: 3-25
• Published date: 08 August 2005
• Author: Robert A. McMackin,Elliot Pittel

A PUBLIC HEALTH APPROACH TO

ADDRESS THE MENTAL HEALTH

NEEDS OF JUVENILE OFFENDERS

Robert A. McMackin and Elliot Pittel

ABSTRACT

The Lemuel Shattuck Hospital Youth Service Program adopted a public

health approach to address the mental health needs of incarcerated ju-

venile offenders in Massachusetts. The program, which operated for 6

years, provided psychiatric care and neuropsychological assessment to

delinquent youth as well as training for psychiatry residents, neuropsy-

chology fellows and Massachusetts Department of Youth Services’ staff.

The program recognized and attempted to address the health care dis-

parity of limited access to quality mental health services for incarcerated

youth, particularly those from disadvantaged and minority backgrounds.

The program was a collaborative venture among the Massachusetts De-

partments of Public Health and Youth Services, and Tufts-New England

Medical Center. The scope of the problem of mental health care for

incarcerated youth will be first outlined, followed by a history and eval-

uation of the program from a public health and system integration per-

spective.

The Organizational Response to Persons with Mental Illness Involved with the Criminal Justice

System

Research in Social Problems and Public Policy, Volume 12, 3–25

Copyright r2005 by Elsevier Ltd.

All rights of reproduction in any form reserved

ISSN: 0196-1152/doi:10.1016/S0196-1152(05)12001-8

3

THE EPIDEMIOLOGY OF MENTAL ILLNESS

AMONG JUVENILE OFFENDERS

The National Mental Health Association (1999) reported rates of mental

health disorders as high as 60–75% for incarcerated adolescents. A recent

study by Teplin et al. (2002) of 1,829 youth interviewed with the Diagnostic

Interview Schedule for Children (DISC) at the Cook County Detention

Center in Chicago, Illinois, found the prevalence of any mental disorder was

67% for males ðn¼1;172Þand 74% for females ðn¼657Þ:A notable find-

ing in the Teplin study was that, even excluding Conduct Disorder, the

overall prevalence of mental health disorders remained 60% in males and

70% in females. These rates of mental health disorders among criminally

involved youth are two to six times those found in the general population

(Breda, 1996) and hold up across cultures. Vreugdenhil, Doreleijers,

Vermeiren, Wouoters, & Wim Vand Den Brink (2004), also using the

DISC, found a 90% rate of mental health disorders among a population of

incarcerated Dutch male youth, which was over three times the prevalence

found in the normal Dutch adolescent population. Additionally, the co-

morbidity rate among juvenile offenders, particularly of substance abuse

and mental health disorders, has been reported as high as 67% (GAINS,

1999;Vreugdenhil et al., 2004).

Serious emotional disturbance can be defined as an emotional disturbance

that leads to extreme functional impairment. Friedman, Katz-Leavy,

Manderscheid, and Sondheimer (1996) reported the overall community

prevalence for any diagnosable psychiatric disorder among children aged

9–17 is 20% and 5–9% for serious emotional disturbance. Cocozza and

Skowyra (2000) estimated that the prevalence of serious emotional disorders

among youth in the juvenile justice system is at least 20%. Not only is the

prevalence of mental illness among juvenile offenders high, but one in five

juvenile offenders experiences functional impairment such as learning dis-

abilities, social skills deficits, or interpersonal problem-solving difficulties as

a result of serious emotional disturbance or mental illness.

In some respects, this high prevalence of mental health problems among

many youthful offenders is not surprising, considering the toxic environ-

ments in which many have been raised. The lives of many juvenile offenders

are marked by inconsistent parenting, familial substance abuse, physical

and/or sexual abuse, and exposure to community violence (Haapasalo &

Kankkonen, 1997;Malinosky-Rummell & Hansen, 1993;McMackin,

Morrissey, Newman, Erwin, & Daly, 1998;Rivera & Widom, 1990;Weeks

& Widom, 1998;Widom, 1989, 1995).

ROBERT A. MCMACKIN AND ELLIOT PITTEL4