MHW: Family Engagement Key to Justice-Involved Youth; MHANYS Report

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.


Reform goals

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.”