Delinquent behavior: Criminalized rather than diagnosed
A large number of youth in detention centers need psychological treatment rather than an introduction to the juvenile justice system, new research suggests.
“Many of these kids could be effectively treated in their communities, and not detained,” says Dr. Linda Teplin, professor and vice chair of research in the department of psychiatry and behavioral sciences at Northwestern, author of the new findings. This is especially true for minority youth whose behavior is often seen as criminal rather than psychological, she says.
In 2003, she found that two-thirds of the boys and three-fourths of the girls in Chicago’s Cook County Juvenile Temporary Detention Center suffered from one or more types of psychiatric illness. And, many of these youth continue to suffer with the illnesses five years after being released, she reports in new data published in Archives of General Psychiatry.
The rates of mental illness in juvenile detention centers are not unique to Cook County. Statistics from Louisiana, Texas and Washington show the same.
It is well reported that African-American youth are overrepresented in juvenile detention centers, also with a high proportion of mental health disorders. But, experts agree that the same delinquent behavior leading white youth to psychiatric treatment leads nonwhite youth to the legal system.
“There are two very different consequences for the same set of behaviors,” says Dr. Alfiee Breland-Noble, assistant professor of psychiatry at Georgetown Medical Center. “My own experiences as a clinical and [child mental health disparities] researcher — consulting with schools, churches and community centers, as well as treating patients myself — support this idea.”
Dr. Jacqueline Smith, child and adolescent psychiatrist at University of North Carolina Hospitals has had similar experiences.
“Minority children are overly represented in the juvenile justice system, meaning their behaviors are more likely to be seen as criminal, not the result of mental illness or family problems,” she says. “It seems as though, rather than getting appropriate treatment and services, minority youth are shunted to the juvenile justice system.”
Smith says that inadequate public funding for mental health services, legislation, policies and stigmas are factors. But, class also plays a role.
“Think about what happens,” Teplin explains. “It’s often poor kids. They live in areas more densely trafficked by police, and poor people are less likely to get a family attorney. There’s a class bias for who gets into detention.”
The other kids are instead treated for mental illnesses, she says, simply because the parents have the resources to put them into treatment.
Sadly, one study pointed out, for some children, entering the juvenile justice system is the only way they can receive a psychiatric diagnosis and treatment. However, some centers face the same budgetary limitations and staffing shortages that schools and outpatient mental health resources do.
The most common diagnoses among youth in detention centers are disruptive disorders such as conduct disorder, according to the National Center for Mental Health and Juvenile Justice.
Conduct disorder is defined as long-term defiance, impulsive behavior, drug use or criminal activity in childhood. However, even after removing conduct disorder from the analysis, 66 percent of youth still met the criteria for a psychiatric disorder.
This raises the question of whether these behaviors in certain children are innately psychiatric, a result of difficult household and traumatic experiences, or both.
“Behavior is multi-determined,” says Dr. Carl Bell, acting director of the Institute for Juvenile Research and professor in the Department of Psychiatry at the University of Illinois at Chicago. “You can go from cultural issues, acquired issues like [exposure to alcohol as a fetus] and family-based issues.”
Bell adds to that list the fragility of childhood and adolescent brains that are still developing.
“Brain development of judgment, wisdom and logic doesn’t finish until 26 years of age, meaning that teenagers are all gas, no breaks, no steering wheel,” he says.
“Yet,” Bell adds, “a fabric that monitors children, provides safety for children, teaches children how to turn trauma into learned help and makes sure that children are within a village with significant adult relationships that they can be connected to — that’s what gives them brakes and steering wheels.”
Bell feels there should be a focus on teaching how to parent, and on prevention in dysfunctional families where depression and a risk of substance abuse exist. And he’s shown it works. He used this type of a prevention program in Illinois where the number of children being placed into child protective services decreased from four out of 1,000 children to 1.8 statewide and 0.8 in Cook County.
“The kids we see in the juvenile justice system are byproducts of the worst kind of parenting,” says Penter Holmes III, managing partner of a firm that handles criminal cases. “As in, when the parent ignores the kid until the parent can no longer avoid it because the kid makes a scene or gets into too much trouble.”
“And then, when the parent pays attention to the kid, it’s usually out of anger, and they employ corporal punishment… leading to a kid who believes that violence is an acceptable form of ‘correction,’ but who is unmonitored,” Holmes continues.
Breland-Noble, too, stands behind the concept of the importance of preventive care.
“It can be helpful to seek support for youth mental health problems prior to them being necessitated by a severe incident,” she says, while admitting that financial limitations and access to timely community resources are challenges.
There are also stark observations according to gender as shown by Teplin’s data. Girls in juvenile detention centers are found to be at higher risk for mental health disorders than the boys. Similarly, another study found that 80 percent of the girls met the criteria for a psychiatric disorder compared to 67 percent of the boys.
While males are more represented in juvenile detention centers, the proportion of female offenders is rising.
The National Center for Mental Health and Juvenile Justice reports that this difference is due to girls’ tendency to have internalizing disorders such as anxiety, depression and bipolar disorder. Boys, on the other hand, are more likely to develop disruptive and substance use disorders.
A history of trauma further complicates these disorders for many of the girls studied.
“Children exposed to trauma are at risk for antisocial behaviors, learning disabilities, psychiatric disorders, depression and anxiety,” Bell says. “It is clear.”
Bell says these issues are not just limited to the justice system and preventive services should also become focused on children in foster care and special education.
“What you do is, rather than demonize, diagnose, or medicate [the children], is you strengthen them,” he says. “If you’re in child protective services and you need medication, without it you’re not able to function, there needs to be a systematic review by someone who is an expert before a child is placed on medication.”
Teplin’s most recent study highlights the fact that those in detention have special psychological needs moving forward. While her research only looked at detainees five years after release, other statistics show that those with psychiatric illnesses continue to have them until adulthood.
“[And] the responsibility for their care doesn’t end when they leave detention. They need services to address their needs,” she says.
Dr. Tyeese Gaines is a physician-journalist with over 10 years of print and broadcast experience, now serving as health editor for theGrio.com. Dr. Ty is also a practicing emergency medicine physician in New Jersey. Follow her on twitter at @doctorty or on Facebook.