Family engagement key to justice-involved youth with MI
Mental Health Weekly
Vol. 23, # 40; Oct. 21, 2013
Family engagement, recovery and wellness strategies, and appropriate mental health screening and evaluation should be built into current juvenile justice reform proposals, according to a new report released this month by the Mental Health Association in New York State (MHANYS).
MHANYS’s “Report on Juvenile Justice, Mental Health & Family Engagement” found that youth within the juvenile justice system are at high risk for psychiatric conditions, and these conditions may have contributed to the risk of offending, or may interfere with rehabilitation.
The most common disorders assessed in major studies of youths’ mental disorders in juvenile justice programs include mood disorders, such as major depression, dysthymia and bipolar disorder. Other disorders include obsessive-compulsive disorder, post-traumatic stress disorder (PTSD), substance-related disorders, anxiety disorders and disruptive behavior disorders, such as oppositional defiant disorder and conduct disorder.
“About 65 to 76 percent of youth in custody have some sort of co-occurring issue,” MHANYS CEO Glenn Liebman told MHW. “We want to bring to light issues around juvenile justice and the impact it has on youth with psychiatric disabilities in our juvenile justice system. Family engagement is so critical and it’s an issue that has not been addressed.”
For more than a century, juvenile justice courts and researchers have recognized the integral role of families in the lives of justice-involved youth, the report stated. Moreover, mounting evidence over the past two decades affirms that family engagement is a key feature for effective delivery of mental health services in the community as well as when youth are housed in correctional facilities.
“When you have a child in custody, you have a family in custody,” Debra Faust, co-author of the report and director of criminal justice and suicide prevention initiatives for MHANYS, told MHW. Families need to be a part of the treatment process, she said. Research points to the onset of mental health disorders in children beginning at about age 14, Faust said.
Families and mental health system providers need to be educated on this issue, she said. “I see family engagement as part of a diversion process if done well,” said Faust.
According to New York state law, families do not have to be notified when a 16-year-old is arrested, causing even more concern, noted Faust. “It’s up to the discretion of the arresting officer,” she said. “Right from the start you have to make sure those families are engaged. It’s critical so that a person can be screened and treated promptly.”
MHANYS is pleased that New York state has initiated some innovative reforms around criminal justice in the last several years, she said. The New York State Office of Children and Family Services is overseeing efforts to try to bring youth close to treatment in communities near their home. Additionally, New York State Chief Judge Jonathan Lippman has spearheaded a new youth court initiative to serve 16- and 17-year-olds, noted Faust.
However, these reforms tend to focus more on the overarching problem of the juvenile justice system and not about family engagement, Faust said. Also, rural communities in the state with fewer resources may not have access to some of those services, she added. “We need to have a cultural shift,” Faust said.
Currently, New York and North Carolina are the only two states where juveniles at the age of 16 are tried as adults, said John Richter, director of public policy for MHANYS. The fact that nearly 75 percent of the youth in the juvenile justice system have a mental health disorder makes the problem even more severe, he said.
“There is a big reform effort going on now to raise the age to 18,” Richter, co-author of the report, told MHW. Absent in that discussion, however, is the issue of youth with mental illness, he said.
According to the report, the goal for mental health policy reforms should be a capacity to (1) identify more precisely and reliably those youth with mental health needs, (2) identify the specific services needed to meet individual needs and (3) deliver services in ways that transcend bureaucratic barriers in order to meet each youth’s needs regardless of setting.
According to MHANYS, some of the recommendations that should be considered as necessary components for future reform proposals include:
• Mental health services should be available to youth with mental illness regardless of whether they are adjudicated through family court or the adult justice system.
• Whenever possible and when public safety allows, youth with mental health needs should be diverted into evidence-based mental health treatment in a community setting.
• If diversion out of the juvenile justice system is not possible, youth should be placed in the least restrictive setting possible, with access to evidence-based treatment.
• Policies are needed that establish appropriate mental health screening and evaluation to facilitate connecting youth who have mental health needs with appropriate, individual treatment plans.
• Provide an evidence-based, scientifically sound mental health screen within the first 24 hours of a youth’s arrival at a facility.
All mental health services afforded to youth should be evidence-based. Examples include Cognitive Behavioral Therapy (CBT), community-based approaches such as Multi-systemic Therapy (MST), Functional Family Therapy (FFT), Assertive Community Treatment (ACT) teams, Transition to Independence (TIP) programs, integrated co-occurring treatment and medication therapy, the report stated.
“We have to continue with public awareness and educate our legislators and policymakers and let them know that very impactful decisions should be made,” Liebman added. “We’re looking at a sea change in the way the system of care currently operates.”