Copyright @ 2008 American Academy of Child and Adolescent Psychiatry. Unauthorized reproduction of this article is prohibited.

The Challenge of Mental Health Researchin Juvenile Justice

CHRISTOPHER R. THOMAS, M.D.

The origin of child and adolescent psychiatry in theUnited States can be traced through the child guidancemovement to the establishment of the first juvenile courtin Chicago in 1899, emphasizing rehabilitation insteadof punishment in the handling of young offenders. Thisdirectly led in 1909 to the creation of the JuvenilePsychopathic Institute, later renamed the Institute forJuvenile Research, under the direction ofWilliamHealy.Healy argued that interventions with delinquents mustbe based on a scientific understanding of the causes andcontext of antisocial behaviors.1 After a century of effort,it is fitting that the Journal brings together three researchreports covering the spectrum of mental health issues injuvenile justice that help us reflect on how far we havecome and how far we have yet to go.The first paper, by Gina Vincent and colleagues,2

present the findings from a national study of sex andrace differences in symptoms of mental disorder amongjuvenile justice youths. Using the Massachusetts YouthScreening Instrument-Version 2, the authors appliedmeta-analytic techniques in their investigation ofsymptom scores for 70,423 youths from 283 juvenilejustice probation, detention, and correction programsacross the country. The analysis confirmed previousreports on smaller samples and more limited settingsshowing that girls are more likely than boys to reporthigher levels of mental health symptoms. In addition,the authors of this study found age-related differencesfor sex, with the rates of substance use disproportio-

nately higher in younger girls than boys, but notdifferent between older girls and boys. Given thestrength of theses findings, higher rates of mental healthproblems should be anticipated by those working withgirls in the juvenile justice system. Although some racialdifferences were noted, such as whites being more likelyto have elevated symptom scores than Hispanics orblacks, these differences varied greatly across both sitesand states. The strength of the careful analysis in thisstudy of a national sample across various juvenile justicesettings reinforces the importance of mental healthscreening in this at-risk population.The following two articles, by Karen Abram and

colleagues,3,4 report studies on suicidal ideation andbehaviors and on perceived barriers to mental healthservices among youths in detention. These investiga-tions were fittingly conducted in the Cook CountyJuvenile Justice System in Chicago, the first of its kindin the nation and the very site of Healy`s groundbreak-ing research a century ago. The first study reveals thatmore than one third of the 1,829 juvenile detaineessurveyed felt hopeless or had thoughts of death, and 1 in10 had considered suicide in the 6 months beforedetention. Girls and juveniles with major depression oranxiety disorder were more likely to have attemptedsuicide. Most alarming was that less than half of alldetainees who thought of suicide had told anyone aboutit. The second study with the same population surveyeddetainees` thoughts about their need and access tomental health services. Among those youths with mentaldisorders, 85% reported at least one obstacle toobtaining mental health care. Most often this was thebelief that problems of the mental disorder wouldresolve on their own and without intervention. Inter-estingly, detainees who had previously received orbeen referred for mental health services were morelikely to report this belief. Beyond the problems inperception of need for service among youths was

Accepted October 17, 2007.Dr. Thomas is with the Department of Psychiatry and Behavioral Sciences, the

University of Texas Medical Branch at Galveston.Correspondence to Dr. Christopher R. Thomas, 301 University Boulevard,

Galveston, TX 77555-0193; e-mail: crthomas@utmb.edu.0890-8567/08/4703-0236�2008 by the American Academy of Child and

Adolescent PsychiatryDOI: 10.1097/CHI.0b013e3181635e27

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Copyright @ 2008 American Academy of Child and Adolescent Psychiatry. Unauthorized reproduction of this article is prohibited.

their uncertainty as to where or how to obtain mentalhealth care even among those who had received aprevious referral. Clearly, the lack of perceived need formental health care hampers efforts at referral andassistance, even when juvenile detainees are appropri-ately screened and identified as needing furtherevaluation and treatment.

These studies highlight the need for mental healthresearch focusing on the juvenile justice population. Asnoted in the third article, 2.2 million youths are arrestedyearly in the United States, and nearly 100,000 are injuvenile justice facilities on any given day.5 Previousreports supported by these studies show that a majorityof those youths suffer with mental disorders even whenconduct disorder is excluded.6 These three articles alsoreveal the unique challenges of pursuing such investiga-tions. It is not easy to conduct research in juvenilejustice because the usual ethical and technical difficultiesfor any study involving youths with mental disorders arefurther complicated by the justice systemVthe pro-blems of conducting research with prisoners or withthose facing legal charges. The permissions needed forcarrying out such studies are complicated, as noted byAbram and colleagues in the difficult, often impossible,task of obtaining parental consent. Protecting theprivacy of participant data from law enforcement isalso a challenge that requires careful planning, as with aFederal Certificate of Confidentiality.

Another problem for studies involving juvenile justiceis that the various placements and stages in handlingyoung offenders can create selection bias and requirecareful attention to sampling and analysis. The firststudy made innovative use of meta-analytic techniquesin handling the challenge of combining differing sitesand samples to provide a more representative under-standing of potential sex and racial differences. Anadditional interesting challenge for researchers is the lackof awareness or appreciation of mental health problemsin juvenile justice populations and the interrelationshipof these problems with delinquency. Although suchobstacles are not unique to juvenile justice settings, they

can be formidable in them, and for this, the authorsdeserve praise for their skill and perseverance.Taken together, these three articles, along with other

recent efforts toward reintegration and rehabilitation7

add to our knowledge base, informing us of unmetneeds of youths in the juvenile justice system andpointing the way to necessary interventions as well as tofurther study. Findings from juvenile justice researchhave resulted in the American Academy of Child andAdolescent Psychiatry`s issuing calls for reform,8 as wellas guidelines for mental health service.9 The challengeof mental health research in juvenile justice is not justthe difficulties and obstacles to conducting investiga-tions with these youths, but also the demand forresponse to the findings of those studies in order toaddress the mental health needs of young offenders andto fulfill the promise of rehabilitation envisioned duringthe past century.

Disclosure: The author reports no conflicts of interest.

REFERENCES

1. Healy W. The Individual Delinquent. Boston:Little, Brown & Co.; 1917.2. Vincent G, Grisso T, Terry A, Banks S. Sex and race differences in mental

health symptoms in juvenile justice: the MAYSI-2 National Meta-Analysis. J Am Acad Child Adolesc Psychiatry. 2008;47:282Y290.

3. Abram KM, Choe JY, Washburn JJ, Teplin LA, King DC, Dulcan MK.Suicidal ideation and behaviors among youths in juvenile detention. J AmAcad Child Adolesc Psychiatry. 2008;47:291Y300.

4. Abram KM, Paskar LD, Washburn JJ, Teplin LA. Perceived barriers tomental health services among youths in detention. J Am Acad Child AdolescPsychiatry. 2008;47:301Y308.

5. Snyder HN, Sickmund M. Juvenile Offenders and Victims: 2006 NationalReport. Washington, DC:U.S. Department of Justice, Office of JusticePrograms, Office of Juvenile Justice and Delinquency Prevention; 2006.

6. Teplin LA, Abram KM, McClelland GM, Dulcan MK, Mericle AA.Psychiatric disorders in youth in juvenile detention. Arch Gen Psychiatry.2002;59:1133Y1143.

7. Kessler CL, Kraus LJ, eds. The Mental Health Needs of Young Offenders:Forging Paths Toward Reintegration and Rehabilitation. Cambridge, UK:Cambridge University Press; 2007.

8. Kraus LK, Arroyo WM, eds. Recommendations for Juvenile Justice Reform.2nd ed. Washington, DC: American Academy of Child and AdolescentPsychiatry; 2005.

9. Penn J, Thomas C. Practice parameter for the assessment and treatment ofyouth in juvenile detention and correctional facilities. J Am Acad ChildAdolesc Psychiatry. 2005;44:1085Y1098.

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