MH Courts for Youth Show Promise but Need Study

Mental health courts aren’t just for grown-ups anymore. At least 41 juvenile mental health courts now operate across the United States, providing similar diversion opportunities for younger defendants, but a national survey of those courts suggests a need for better data collection and for understanding the different needs of young people involved in the criminal justice system.

Perhaps two-thirds of young people in that system have a mental disorder, wrote Lisa Callahan, Ph.D., and colleagues in the February Psychiatric Services. Callahan and her coauthors are affiliated with the National Center for Mental Health and Juvenile Justice at Policy Research Associates Inc. in Delmar, N.Y.

The first juvenile mental health court began operation in York County, Pa., in 1998. Only 15 states have such courts, led by Ohio (nine) and California (eight), said Callahan. Many young people end up in the court systems simply because community-based programs to deal with their behavioral problems don’t exist.

The intersection of the courts and young people accused of crimes has a long and varied history, commented Thomas Grisso, Ph.D., a professor of psychiatry and director of the Law and Psychiatry Program at the University of Massachusetts Medical School.

For the first half of the 20th century, these youngsters were seen in special juvenile courts said to be operating in the “best interests of the child,” said Grisso in an interview. Those courts were staffed by a judge and child-welfare workers. There were no prosecutors and no defense attorneys, and no oversight with due process.

“The problem was, they often abused their discretion, and kids could be sent away for minor offenses,” he said.

The situation changed in the 1960s when the U.S. Supreme Court required due process, including the right to an attorney.

In the late 1980s and early 1990s, a wave of juvenile violence caused another shift, as more young people were transferred to adult courts and faced harsher penalties.

Then a reaction to that swing of the pendulum set in 10 or 15 years ago, and the period since has seen the rise of mental health courts, in some ways coming back to the original idea of the juvenile court, said Grisso.

The juvenile mental health courts are a return to that perspective but not to that system, he emphasized.

“The court itself is acting on therapeutic principles to shape children’s behavior,” he said. “Today, we should be focused on rehabilitation because kids are still malleable.”

For their study, Callahan and colleagues collected data from 35 of the 41 juvenile mental health courts around the United States. About half (51 percent) operate under juvenile court systems, while others function in combination with probation departments or other entities. The courts also work closely with local or state mental health agencies, substance abuse treatment agencies, detention facilities, and law enforcement authorities.

Callahan’s survey found that 70 percent of courts dealt with young people charged with felonies and 91 percent with misdemeanors. Those charged with sex offenses were generally excluded.

The most common psychiatric diagnosis reported was bipolar disorder, followed by depression and attention-deficit/hyperactivity disorder.

Courts most commonly directed defendants to individual outpatient treatment, family therapy, or case management. The average length of time in the court-supervised programs was one year.

More data on outcomes and on the effectiveness of incentives would provide more insight into the strengths and weaknesses of juvenile mental health courts, said both Callahan and Grisso.

Also, whether the requirements of mental health courts in general are coercive is an ongoing debate, but the issue assumes a greater importance when juveniles are involved.

However, with sufficient guidance, structure, and information, children are capable of doing more than if left on their own, said Grisso. If they are well advised by an attorney, many youth are capable of grasping what they need to know for a fair trial.

“But many children with mental illnesses are severely disabled and so need added protections,” Grisso noted.

Finally, only 40 percent of courts reported dismissing charges, a fact that concerned Callahan and colleagues.

“[A] conviction or adjudication record can follow a youth and complicate his or her life in unanticipated ways, such as by limiting access to federal student loans, employment, and military service,” they wrote. “A guilty plea may result in a felony conviction, which can also restrict access to public housing and other public entitlement programs.”

“A National Survey of U.S. Juvenile Mental Health Courts” is posted at http://ps.psychiatryonline.org/article.aspx?articleid=432947 .

Country’s First MH Youth Court Had 50% Completion Rate

According to Lisa Callahan, Ph.D., of the National Center for Mental Health and Juvenile Justice, the first juvenile mental health court in the United States was established in York County, Pa., in 1998.

As often happens with mental health courts, the idea had a powerful champion nudging it into being.

“It became pretty obvious to me that a significant number of youth appearing in juvenile court had psychiatric diagnoses,” recalled Judge John Uhler in an interview with Psychiatric News. “But there were very few community mental health resources available to the court.”

So for his court Uhler adapted a California initiative based in the probationary system that oversaw mental health issues in adolescents.

By 2002, the program had evolved so that Uhler was directly involved from the bench with the youngsters, their families, and a treatment team, overseeing biweekly meetings. Participants attended individual, group, and family therapy sessions. A probation officer, district attorney, and public defender were involved. Everything was coordinated by a master’s-level social worker.

There were two tracks to the program. One placed the youth in treatment before adjudication. The second offered the same services but followed a finding by the judge of “delinquent activity.”

Although these tracks were often the “last-ditch effort” before residential placement, about half the young people completed them successfully.

Uhler stepped down from his position two years ago and is now a senior judge in the county, but he recalled his experience in the juvenile mental health courtroom with pride.

“It was tremendously rewarding, particularly for the kids,” he said. “For those involved with the programming, it gives you the self-satisfaction that indeed we do accomplish something.”