Idaho Screening for Mental Health, Substance Abuse Problems in Juvenile Justice System
As many in the juvenile justice community sadly know, a focus on diagnosing and treating mental health and substance abuse problems in detained juveniles developed relatively late nationally. This is particularly true in the State of Idaho, which did not have systematic, routine mental health and substance abuse screening occurring in its 12 juvenile detention centers (JDCs) until 2008. Since the inception of the Clinical Services Program (CSP), a collaborative effort funded by the Idaho Department of Juvenile Corrections and the Idaho Department of Health and Welfare, Idaho has made dramatic strides in screening for mental health and substance abuse problems in juveniles entering its JDCs, and recommending and (and sometimes coordinating) treatment for these juveniles upon their return to their communities.
Starting in 2008, my colleagues and I at Boise State University’s Center for Health Policy have performed annual, multimodal assessments of the CSP. One of the main components of our evaluation has involved documenting the prevalence of mental health and substance abuse problems. What we’ve found is that juveniles entering Idaho’s JDCs should be considered to have at least one of these types of problems unless demonstrated otherwise; in other words, having a mental health or substance abuse problem, or both types of problems, is the rule rather than the exception to it.
Aggregating results across four years of CSP evaluations, we have found that 62% (range 59-68%) of juveniles entering Idaho’s JDCs meet screening criteria for a mental health problem, 47% (range 43-54%) meet screening criteria for a substance abuse problem, and 33% meet the screening criteria for both types of problems. Seventy-six percent of the juveniles meet the criteria for having at least one type of problem, meaning fewer than one in four detained juveniles in Idaho appears free from either a mental health or substance abuse problem. These percentages are alarming, and are higher than what is often reported in the literature (e.g., most studies of mental health and substance abuse disorders report that between 50-70% of detained juveniles have a mental health problem, a substance abuse problem, or both types of problems). Sadly, we’ve found that nearly two-thirds of these juveniles were diagnosed with one or more of the these problems prior to detention, leading us to conclude that Idaho’s JDCs have become a de facto repository for youth with mental health and or substance abuse problems.
Fortunately, the CSP is not only about screening for and diagnosing problems in the JDCs. Over the past five years, thousands of juveniles released from detention in Idaho have accessed community-based services, most often including psychological counseling and substance abuse treatment. Members of key stakeholder groups such as judges and chief probation officers report relying on information from JDC clinicians in decisions they make about juvenile offenders. Furthermore, the presence of clinicians in the JDCs seems to have improved life within the facilities. JDC administrators credit the program with improving communication between juveniles and staff, informing decision making, and helping line staff better understand how to work effectively with troubled youth. In the three years after the CSP was implemented, use of restraints and suicide attempts in Idaho’s JDCs were reduced 13% and 32%, respectively.
Overall, the CSP has performed a vital function in Idaho through the identification and facilitation of treatment of mental health and substance abuse problems in thousands of juvenile offenders. It continues to evolve to offer better services to juveniles with mental health and substance abuse problems in the hope that these efforts will reduce recidivism and the impacts and costs of juvenile delinquency on counties and the state.
Tedd McDonald, PhD, is a Senior Researcher at the Center for Health Policy, Director of the Master of Health Science Program and a Professor in the Department of Community and Environmental Health in the College of Health Sciences at Boise State University. He is a community psychologist with interests in studying access to and delivery of health care services, particularly in the context of mental health. He earned his Ph.D. in Psychology from the University of Wisconsin-Milwaukee in 1998. Most of his research focuses on mental health, substance abuse, and quality of life issues among members of vulnerable populations, including the homeless, refugees from war-torn countries, at-risk youth, Native Americans, senior citizens, and residents of isolated rural communities.
*Photo at top by Flickr user bronwynlewis