Serious Juvenile Offenders: Do Mental Health Problems Elevate Risk?

NOTE: Two of the co-authors of this post, Carol A. Schubert M.P.H., and Edward P. Mulvey, Ph.D., will be presenting on other aspects of their research on youth in the juvenile justice system at the Office of Juvenile Justice and Delinquency Prevention (OJJDP) juvenile justice conference next week.

The general adolescent population is estimated to have a rate of 9% to 21% in occurrence of diagnosable psychiatric disorders. In comparison, researchers have established that the juvenile offender population has a disproportionately high rate of mental health problems, with estimates suggesting it is as high as 50% to 70%. Additionally, a majority of the diagnosable youth in the juvenile system have a co-occurring substance-use disorder.
Many initiatives dealing with mental health problems in juvenile offenders have treated them as a criminogenic risk factor; positing that, if these problems are addressed, youth’s risk for repeat offenses will decrease and their involvement in pro-social activity will increase. It is important that mental health problems be addressed for these youth,  but we require a better understanding of the role mental health problems play for offending to better inform program development.
Demonstrations that youth with mental health problems have an increased risk for criminal involvement proves an association, but not a definite cause or explanation about the means by which mental disorders elevate criminal risk. It is possible that there is a deeper root cause in the relationship between the two and that having a better understanding of this association can help determine the most effective treatment options.
There is not much data regarding whether and/or how mental health problems relate to continued offending or adjustment problems in adolescent offenders. The purpose of this study is to investigate the relationship among certain mental health problems (affective, anxiety, ADHD, and substance use disorders), criminogenic risk, and outcomes (such as re-arrest) in a sample of serious adolescent offenders.
This investigation used data from a longitudinal study of serious adolescent offenders (The Pathways to Desistance Study). The sample of serious adolescent offenders included 949 individuals (84% male; 78% minority) with a mean age sixteen. 57.7% of the sample met the criteria for at least one of the assessed MPHs. The study investigated three questions:

1. What is the association of mental health problems with three distinct outcomes (re-arrest, self-reported antisocial activity, and gainful activity)?
2. Does having a mental health problem contribute any unique explanatory power regarding these outcomes over and above the criminogenic risk markers?
3. Do mental health problems moderate the relationship between risk markers and outcomes?

Data for the study are primarily youth self-report over a 7-year period with parent collaterals reporting on ADHD and official records as the source for re-arrest information.
Some important findings emerged from these analyses (presented in detail in Schubert, Mulvey & Glasheen, 2011).    

• If you look just at the relationship between mental health problems and outcomes, without considering criminogenic risk factors at all, having a mental health problem other than a substance use disorder (affective, ADHD or anxiety disorder) was not significantly associated with any of the three outcomes. The adolescents with mental health problems (excluding substance use) had the same type of outcomes as the adolescent offenders without these disorders.
• The presence of a substance use disorder, however, does matter. Adolescents with substance use disorders had higher rates of rearrest, more self-reported antisocial activity, and less time spent in gainful activity than the adolescent offenders without substance use disorders.
• Criminogenic risk was related to certain disorders. In other words, adolescent offenders with certain disorders also had markedly higher levels of other risk factors related to future offending. Adolescents with ADHD had the lowest levels of risk factors related to future offending; adolescents with affective disorders, substance use disorders, and anxiety disorders had high levels of risk factors for reoffending.
• After controlling for demographic variables and risk factors, having an indicator of a mental health problem was not associated with the negative outcomes (rate of re-arrest and self-reported antisocial activity). With the background variables and the risk factors taken into account, the adolescent offenders with mental health problems were at no increased risk of re-arrest or engaging in antisocial activities than the adolescent offenders without these problems.
• Substance use showed a different pattern. When substance use disorders were part of the clinical picture, there were significant relations with some outcomes. Substance use disorders, distinct from other mental health problems, contributed to poorer outcomes and they also magnified the effect of certain risk markers (e.g., antisocial history of the adolescent).   

The overall message here is that criminogenic risk factors are appreciably higher in groups of adolescent offenders with certain mental health problems (affective disorders, substance use disorders, and anxiety problems), but the presence of these mental health problems is not highly related to positive or negative outcomes. The only clear exception to this latter observation is substance use problems. The presence of substance use problems is associated with poorer outcomes.  
In conclusion, the heart of this issue seems to be the future challenge that lies in disentangling the relationship of mental health problems and the increased risk of involvement in criminal activity. For this reason, current juvenile justice policies that focus treatment efforts on both criminogenic and mental health factors (with particular emphasis on treating substance use disorders) appear well founded. It is unlikely that focusing solely on treating mental health problems in serious offenders will have a distinct impact on later outcomes.

This post was adapted from the following research article: Schubert, CA, Mulvey, EP, Glasheen, C. (2011). The influence of mental health and substance use problems and criminogenic risk on outcomes in serious juvenile offenders. The Journal of the American Academy of Child and Adolescent Psychiatry, 50(9), 925-937.

Click to learn more about the Pathways to Desistance study here and its generous underwriters.
Carol A. Schubert, M.P.H., is the Pathways Study Coordinator and the Research Program Administrator for the Law and Psychiatry Program at the Western Psychiatric Institute and Clinic of the University of Pittsburgh School of Medicine.
Edward P. Mulvey, Ph.D., is Principal Investigator for the Pathways Study and a Professor of Psychiatry at the Western Psychiatric Institute and Clinic of the University of Pittsburgh School of Medicine. 
Amanda Alderfer is a student at the University of Pittsburgh.
 
Photo at top: Victor Bezrukov, under Creative Commons license.