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Legal News
Juvenile Offenders Languish While Awaiting MH Services, Congress Learns
Psychiatric News
Volume 39 Number 16 page 1-39

FIG1Thousands of youth with mental illness are being inappropriately detained in U.S. juvenile detention facilities as they await mental health services in the community that are often scarce, according to a congressional report released at a hearing in Washington, D.C., last month.

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Rep. Henry A. Waxman and Sen. Susan Collins commissioned the report on juveniles in detention facilities. 

According to the report, which was commissioned by House Government Reform Committee ranking minority member Henry A. Waxman (D-Calif.) and Senate Governmental Affairs Committee Chair Susan Collins (R-Maine), two-thirds of juvenile detention facilities in 47 states hold youth who are waiting for mental health services in the community.

"Without access to treatment, some youth with serious mental disorders are placed in detention without any criminal charges pending against them," the report stated. "In other cases, such youth who have been charged with crimes but are able to be released must remain incarcerated for extended periods because no inpatient bed, residential placement, or outpatient appointment is available."

In August 2003, the Special Investigations Division of the U.S. House of Representatives Committee on Government Reform mailed the survey to 698 juvenile detention facilities and received 524 responses.

The survey asked administrators of juvenile detention centers to provide information about youth "waiting for mental health services in the community, including placement in a treatment facility.... [who] leave the detention center as soon as appropriate treatment services become available."

Among the findings:

Detained youth awaiting mental health treatment had a variety of psychiatric illnesses, according to the findings.

For instance, administrators at 315 facilities noted that detainees had depression and substance use disorders.

Other conditions noted by administrators included attention-deficit/hyperactivity disorder (302 facilities), retardation and learning disorders (234 facilities), schizophrenia (137 facilities), and anorexia nervosa, posttraumatic stress disorder, and autism.

The report also highlighted the lack of quality mental health services at juvenile detention centers—95 out of 347 facilities holding youth awaiting mental health services classified their quality of mental health treatment as poor, very poor, or nonexistent.

In addition, the report pointed out, incarcerating youth awaiting community mental health treatment is expensive: according to financial data from the American Correctional Association on 163 facilities, $48.9 million was spent on unnecessary detention for the first six months of 2003, which translates into an annual cost of $98.8 million.

Ken Rogers, M.D., a consulting psychiatrist to the Maryland Department of Juvenile Justice and a member of the American Academy of Child and Adolescent Psychiatry's Committee on Juvenile Justice Reform, spoke at a press briefing following the congressional hearing about the incarceration of youth with mental illness.

"Behavior caused by or related to mental illness often precipitates entry into the juvenile justice system," he said, "and while as many as 65 to 75 percent of youthful offenders have one or more diagnosable psychiatric disorders, most juvenile facilities are not equipped to deal with them."

Rogers identified a number of factors that contribute to the incarceration of youth with mental illness in a subsequent interview with Psychiatric News.

Chief among them, he said, is a critical shortage of child and adolescent psychiatrists and mental health professionals trained to treat adolescents in the community and a lack of coordination and communication among systems of care for children and adolescents.

"Without communication between various agencies, a child who may not have been identified as having problems may in fact have significant problems that are not being addressed because no one is aware of them," he said.

The report concluded that "major improvements in community mental health services are urgently needed" to prevent the unnecessary incarceration of youth in the U.S.

The report, "Incarceration of Youth Who Are Waiting for Community Mental Health Services in the United States," is posted online at<www.reform.house.gov/min>.

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Rep. Henry A. Waxman and Sen. Susan Collins commissioned the report on juveniles in detention facilities. 

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