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How Prevalent are Substance Abuse and Mental Health Issues in Juvenile Justice? The Answer May Surprise You
by JEFFREY A. BUTTS PH.D.

adolescent-substance-abuse-treatment_criminal-justice-and-behavior-journal-coverGail Wasserman and her colleagues from the Center for the Promotion of Mental Health in Juvenile Justice at Columbia University published an important new study that was released just this week in Criminal Justice and Behavior: "Psychiatric Disorder, Comorbidity, and Suicidal Behavior in Juvenile Justice Youth." It may be the best source of information yet on the prevalence of substance abuse and mental health disorders among youth in the juvenile justice system.

We need accurate information. I've heard many practitioners around the country make the same mistake, claiming that "70 percent" of the youth in "the system" have diagnosable disorders. As I described in a 2008 post on this blog ("Size of Drug Problem in Juvenile Justice Depends on Where You Look"), this common mistake usually starts with a misreading of the 2002 study by Linda Teplin at Northwestern University.

Teplin and her colleagues found high rates of substance abuse and mental disorders among a population of juvenile offenders, but many readers failed to note that the study was about just one large detention center—not exactly a good proxy for the entire juvenile system. The Teplin study did not include data about youth at other stages of the juvenile justice process, such as probation and intake.

Gail Wasserman and her colleagues, on the other hand, used a high-quality and consistent methodology (the DISC) to measure the presence of disorders among nearly 10,000 juveniles in more than 50 jurisdictions and at varying points of juvenile justice contact, including juvenile intake.

adolescent-substance-abuse-treatment_diagram-small-version

When you look at their findings (see chart above - click to enlarge), it is clear that mental health and substance abuse issues are not the main reasons youth come into contact with the justice system, but both problems increase in prevalence as youth are processed more deeply into the system.

In other words, as we look more deeply into the juvenile justice system, from youth at intake to those in detention and those in long-term confinement, we begin to see far more juveniles with prior offenses and more youth with substance abuse and mental health issues.

This is probably because youth with more serious problems tend to accumulate (i.e., they are less likely to be diverted) as delinquency cases are processed by police, courts, and correctional agencies. By the time we are dealing with multiple-offense youth in a secure setting, those with mental health issues/substance use disorders are much more common, even making up the majority of the population.

I wrote to Dr. Wasserman this week and asked her if this was a fair interpretation of her research, and she replied, "Yes. That is it. Healthier kids may not enter [the system], or if they do enter they may take better advantage of opportunities for intervention."

adolescent-substance-abuse-treatment_thumbnail-showing-prevalenceComparing this new study with previous research, we can also see that mental health and substance abuse prevalence rates among youth at juvenile justice intake are indeed higher than among youth in the general population (35% versus 20% for mental health; and 17% versus 8% for substance abuse -- click on the image at left and scan slides 9-26 of my PowerPoint presentation, "Positive Youth Development: From Theory to Practice" for a visual summary of past research), but even this comparison is misleading. If the general population figures were adjusted for socioeconomic status, the differences would likely be smaller.

If researchers measured the rate of substance abuse and mental health problems among only poor and disadvantaged youth, and then compared the rate for poor youth involved in the justice system versus poor youth not involved in the justice system, we would probably find their respective rates to be closer than what we see in conventional studies that compare offenders to all non-offenders, both poor and non-poor.

If such studies existed (and why don't they?) we would probably learn that when newly arrested, first-time offenders show up at the early stages of juvenile justice processing, they are not so different from other youth living in the same poor neighborhoods and from similar families facing the same types of economic and social challenges. When they come back for their second, third, or fourth offense, however, and when they start to qualify for secure detention, they are more likely to be youth with complicated lives and challenging home environments. 

This new study underscores the relevance of mental health and substance issues for juvenile justice interventions, and the relevance is mainly at the deep end of the justice process.

The bottom line: Youth come into the juvenile justice system for a lot of different reasons. Some--perhaps one in three--will show up with mental health and substance abuse problems. For most youth, their offending was probably not "caused" by mental health and substance abuse problems, but by the time a juvenile has committed multiple offenses, and by the time he or she has been detained or incarcerated, mental health and substance abuse are likely to be salient for whatever treatment and intervention plan follows.

  


juvenile-justice-reform_Jeff-ButtsJeffrey A. Butts is Executive Director of the Research Evaluation Center at John Jay College of Criminal Justice, City University of New York.  Since 1991, he has managed more than $10 million of research and evaluation projects focused on youth justice. Before joining John Jay College, Jeff was a Research Fellow with Chapin Hall at the University of Chicago and before that director of the Program on Youth Justice at the Urban Institute in Washington, DC. He began his career as a drug and alcohol counselor for the juvenile court in Eugene, Oregon.

Go here for more information on his current projects, research, and recent presentations.

 

 

Dr. Butts,

Thanks for sharing the research. It is fascinating. Something I'm struggling with that maybe you and others can provide feedback on - Evidence and this article suggest targeting high risk or deep end youth. This research and your referenced presentation seem to indicate or ask the question - As youth enter the system they are on par with the average overall population for substance use and mental health, but the numbers increase significantly as they become more involved with the system. I think your presentation indicates that maybe this is because of the way we handle/treat these youth - putting them deeper into the system because of SA/MH issues. Does that beg for focusing on the deep end, or providing diversion services (Drug Court or Mental Health Court diversion) on the front end?

Greg

Greg,
You'd think there would be a straightforward answer to your straightforward question, but alas, like many issues in our field, things get complicated pretty easily.

As Gail Wasserman has said before, the growing prevalence of SA/MH problems as youth penetrate further and further into the jj system is not evidence of some sort of iatrogenic effect. Arresting, charging, and adjudicating youth doesn't "cause" SA/MH problems, but those processes end up sorting youth, and the youth with SA/MH issues have a higher probability of moving on to the next stage, for various reasons, some good and some bad.

It would also be wrong, however, to conclude that since SA/MH problems are more common in the deep end, that must mean that SA/MH problems are what "causes" youth to offend. In some cases this is probably true, but it would be wrong to see SA/MH treatment as a panacea for crime reduction. Most youth come into the jj system "with" SA/MH issues, not "because" of SA/MH issues.

As I said in my recent post, we know that youth coming into the jj system are more likely to have SA/MH issues, but we have not yet teased out the contribution that socioeconomic and environmental factors play in the difference. It is quite possible that poor youth, school-challenged youth, and youth from chaotic families are more likely to be diagnosed with SA/MH issues, AND more likely to be caught up in the juvenile justice system. But, what we're seeing might be correlation, not causation.

I'm not suggesting that treating SA/MH is unimportant for crime prevention and reducing individual recidivism. It is very important. But, it is just one part of effective intervention.

So, it's important that we look for SA/MH issues at the front door of the system and react effectively, because youth with SA/MH problems are less likely to be diverted. They SHOULD be diverted, of course, if their delinquency charges do not merit more intrusive interventions, but this doesn't mean that we should ignore their SA/MH issues. It means that we need to be more creative in addressing them without dragging the youth deeper into the justice system than is warranted based upon public safety concerns. So, we should divert, but we should also refer and follow-up. Diversion shouldn't be a way to ignore young people.

And, yes, it's important to recognize that once youth end up in the deep end, a lot of them will have SA/MH issues, so good treatment has to be a part of what happens in the deep end.

I know it's annoying when someone asks a question with the form: A or B? ... and the answer given, is both A or B. But, it's the only answer I can offer.