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