Although estimates of the percentage of youth with mental disorders in the juvenile justice system vary from study to study, a consistent picture is beginning to emerge. Despite differences in methodology and instrumentation, researchers from across the country are documenting high rates of mental disorder, including substance abuse disorders and multiple co-occurring diagnoses, among children incarcerated in juvenile facilities.

Although much of this research was initially conducted for local planning purposes, findings are now appearing in professional academic journals, reflecting an increasing interest in this under-served population. The data, including the studies reviewed below, suggest that youth in the justice system are comparable to those being treated in community-based mental health programs. Children in the juvenile justice system should be screened for mental health problems and provided with comprehensive evaluation and treatment services to address their mental health needs while in custody-as well as to increase the likelihood of their successful transition back into community.

A Summary of Prevalence Findings

• Based on data obtained from site visits to a nationally representative sample of 95 public and private juvenile facilities, researchers found that 73% of the children in these facilities reported mental health problems during screening (Abt Associates, 1994). In addition, 57% of youth reported that they have previously received treatment for mental health problems.

• In Maryland, data obtained from a representative, random sample of youth from all 15 juvenile facilities indicated that 57% have a history of mental illness; 53% have at least one current mental disorder diagnosis (based on structured diagnostic interviews) (Shelton, 1998).

• In Virginia, a census of 17 secure detention homes revealed that 8% to 10% of the youth need immediate mental health treatment (e.g. medication or inpatient treatment) for depression, anxiety, or psychotic symptoms. The clinicians conducting this study estimated that 77% of the youth would meet diagnostic criteria for a mental disorder. Finally, 55% of the youth in these detention homes had previously received treatment for mental health problems (Policy Design Team, 1994).

• Research conducted in Georgia using a random sample of youth admitted to the Regional Youth Detention Centers indicated that 61% of these youth had mental disorders, including substance abuse disorders (based on structured diagnostic interviews) (Marsteller et al., 1997).

• Among a random sample of youth from South Carolina Department of Juvenile Justice facilities, 72% met full criteria for at least one mental disorder diagnosis (Atkins et al., in press).

• Researchers in Canada (Toronto) used a structured diagnostic interview to evaluate adolescents in two secure facilities and found that 63% had two or more mental disorders, with an additional 22% meeting diagnostic criteria for one mental disorder (Ulzen & Hamilton, 1998).

What is the Prevalence of Specific Disorders?

• Anxiety Disorders: Estimates of the prevalence of Anxiety Disorders among youth in the juvenile justice system range from 30% in Georgia, to 33% in South Carolina, to 58% in the Maryland sample. Steiner and his colleagues (Steiner, Garcia, & Matthews, 1997; Cauffman et al., 1998) found that 32% of males incarcerated by the California Youth Authority and 49% of females met full diagnostic criteria for Posttraumatic Stress Disorder (PTSD).

• Mood Disorders: The prevalence of depression and other Mood Disorders ranged from 17% in the Virginia and Maryland samples, to 19% in Georgia, and 24% in South Carolina. In Maryland, 19% of incarcerated youth reported suicidal thoughts, and 13% of the youth in Virginia's secure detention homes were on suicide watch. In their review of the literature on the prevalence of mental disorder among incarcerated youth, Otto and his colleagues (Otto et al., 1992) noted that studies employing clinical interviews with youth found rates of mood disorder as high as 78%.

• Schizophrenia and other Psychotic Disorders: 45% of the incarcerated youth in South Carolina had psychotic symptoms, and, in Maryland, as many as 32% may have had psychotic disorders. Although Otto et al. (1992) report much lower rates (1% to 6%), they note that this is substantially higher than the rate among the general population and significant because of the severity of these disorders.

• Disruptive Behavior Disorders: The prevalence of Disruptive Disorders-including Attention Deficit Hyperactivity Disorder (ADHD) and Conduct Disorder (CD)-ranged from 35% in the Georgia sample, to 40% in Maryland, 43% in South Carolina, and 52% in Virginia.

• Substance Use Disorders: 20% of the youth in South Carolina, 30% in Georgia, and 37% in Maryland were diagnosed with substance abuse disorders. Other evidence suggests that a high percentage of youth (up to 65%) test positive for drugs at the time of their arrest (ADAM Program, 1998) and may underreport their levels of drug use when in juvenile justice settings.

• Multiple, co-occurring diagnoses: Two-thirds of those with any mental health diagnosis in Maryland had dual disorders (more than one mental or substance use disorder diagnosis). Similarly, 44% of the youth interviewed in Georgia had two or more diagnoses, and youth in the South Carolina sample had an average of 2.4 mental disorder diagnoses. In their review of the literature, Otto et al. (1992) report that more than 50% of youth with Conduct Disorder have at least one other mental disorder.

Comparison with Children in the General Population

• Otto et al. (1992) note that the prevalence of mental disorders among youth in the general population is estimated to be under 25%, and they conclude that the prevalence rate for youth in the juvenile justice system is "considerably higher."

• Rates of disorder among youth in South Carolina Department of Juvenile Justice facilities fall between the rate among youth served by community mental health centers (60% meet criteria for a mental disorder) and the rate among hospitalized youth (86% meet criteria for a mental disorder).

• Researchers in Georgia compared rates of disorder observed among their detained youth with rates reported from the National Institute of Mental Health's MECA study (see Shaffer et al., 1996). Rates among the detained youth were signficantly higher than among the NIMH multi-site community sample. Detained youth had higher rates of any disorder (61% versus 22%), anxiety disorders (30% versus 11%), and depression (13% versus 4%), for example.

Conclusions

• The prevalence of mental disorders among youth in juvenile justice facilities ranges from 50% to 75% in multiple, well designed studies which used structured diagnostic interviewing techniques to determine children's diagnoses.

• From one quarter to one third of the youth had Anxiety Disorder or Mood Disorder diagnoses, with some researchers finding that nearly half of incarcerated girls meet criteria for PTSD and up to 19% of youth may be suicidal.

• Children involved with the juvenile justice system frequently have more than one co-occurring mental and/or substance use disorder, making their diagnosis and treatment needs more complex.

• Children involved with the juvenile justice system have substantially higher rates of mental disorder than children in the general population, and they may have rates of disorder comparable to (or even exceeding) those among youth being treated in the mental health system.

References

Abt Associates, Inc. (1994). Conditions of confinement: Juvenile detention and corrections facilities. Office of Juvenile Justice and Delinquency Prevention: Washington, DC.

ADAM Arrestee Drug Abuse Monitoring Program. (1998). 1997 Annual report on adult and juvenile arrestees. National Institute of Justice: Washington, DC.

Atkins, D., Pumariega, A., Montgomery, L., et al. (in press). Psychopathology in incarcerated youth: An epidemiological study. Journal of Child and Family Studies.

Cauffman, E., Feldman, S., Waterman, J., & Steiner, H. (1998). Posttraumatic Stress disorder among female juvenile offenders. Journal of the American Academy of Child and Adolescent Psychiatry, 37(11), 1209-1216.

Marsteller, F., Brogan, D., Smith, I., et al. (1997). The prevalence of substance use disorders among juveniles admitted to regional youth detention centers operated by the Georgia Department of Children and Youth Services. CSAT Final Report.

Otto, R., Greenstein, J., Johnson, M., & Friedman, R. (1992). Prevalence of mental disorders among youth in the juvenile justice system. In J. Cocozza (Ed.), Responding to the mental health needs of youth in the juvenile justice system. The National Coalition for the Mentally Ill in the Criminal Justice System: Seattle, WA. (pp. 7-48).

Policy Design Team. (1994). Mental health needs of youth in Virginia's juvenile detention centers. Department of Criminal Justice Services: Richmond, VA.

Shaffer, D., Fisher, P., Dulcan, M., et al. (1996). The NIMH Diagnostic Interview Schedule for Children Version 2.3 (DISC 2.3): Description, acceptability, prevalence rates, and performance in the MECA study. Journal of the American Academy of Child and Adolescent Psychiatry, 35(7), 865-877.

Shelton, D. (1998). Estimates of emotional disorder in detained and committed youth in the Maryland Juvenile Justice System. Report to the Maryland Juvenile Justice Advisory Council.

Steiner, H., Garcia, I., & Matthews, Z. (1997). Posttraumatic Stress disorder in incarcerated juvenile delinquents. Journal of the American Academy of Child and Adolescent Psychiatry, 36(3), 357-365.

Ulzen, T., & Hamilton, H. (1998). The nature and characteristics of psychiatric comorbidity in incarcerated adolescents. Canadian Journal of Psychiatry, 43(1), 57-63.