A few weeks ago, my colleague, Jeff Butts, discussed here the implications of our recent study of rates of psychiatric disorder in almost 10,000 young persons at various levels of penetration of the justice system. (Here’s the original study: "Psychiatric Disorder, Comorbidity, and Suicidal Behavior in Juvenile Justice Youth.")
He drew attention to our finding that, when evaluated in a standard way, approximately 35% of young persons at system entry (i.e., entering the juvenile justice system via probation or family court processing) met criteria for a mental health or substance use disorder.
In that work, we relied on a well-validated, computerized, instrument which aggregates a youth’s answers to specific questions about symptoms to generate a set of provisional psychiatric disorders (the DISC-IV). But what happens about identifying mental health problems in settings where such research activities are not in place?
In another study, our goal was to learn how probation officers actually go about determining who needs mental health services and who does not; we reviewed case records for more than 500 youths undergoing probation intake in four NY counties. We found that approximately 40% were identified, broadly, during their probation contact as having a mental health or substance use problem, about a third of whom were already in treatment at case opening. That corresponds well with the rate of need identified in our national sample (35%) at system intake.
We wondered if we could more clearly understand who was being identified. Setting aside those who were already in treatment (and so identified by some other party), youths identified by probation staff were more than twice as likely to be repeat offenders, more likely to have probation officers who knew more about mental health, and more likely to reside in a county with more available mental health services.
As one might expect, without systematic assessment, justice staff were better at identifying conduct and substance use problems than mood problems or suicide risk. It’s easy to see that without systematic procedures to ask all incoming youths about problems like depression, trauma exposure, and suicidal thoughts, justice staff will focus on the more obvious problems that bring a young person to their attention (conduct and substance use, to be specific).
The same is true, by the way, of service providers in other care sectors, and of parents: if there is a conduct problem, other types of worrisome mental health concerns may not be noticed.
Probationers’ mental health problems were more likely to be a focus if staff were more informed about mental health issues, and if local services were more available. But even so, not all identified juvenile probationers actually made it to treatment (see image above — click for larger view). Of those identified, approximately two-thirds received a referral for mental health or substance use services. And only about half of identified youths actually accessed services during the period of chart review.
Juvenile justice, mental health, and substance abuse agencies need to work together to make sure that these young people get the services they need.
Dr. Gail A. Wasserman is a Professor of Clinical Psychology in Child Psychiatry at Columbia University. She directs Columbia’s Center for the Promotion of Mental Health in Juvenile Justice (www.promotementalhealth.org ), a research and policy center offering guidance to juvenile justice agencies on protocols for efficient identification and service referral for those with mental health service needs. She has been conducting research on developmental psychopathology for 35 years. Dr. Wasserman has authored more than 100 papers for academic and practitioner audiences.
Photo at top: colemama.