Introduction

Youth in the juvenile justice system are at high risk for mental health problems that may have contributed to their criminal behavior and that are likely to interfere with rehabilitation (Loeber et al., 1998; Lynam, 1996). Emotional impairment due to an untreated mental disorder may contribute to an adverse reaction to confinement, which in turn may result in a poor adjustment during incarceration. Poor adjustment can have a negative impact on behavior, discipline, and on a youth’s ability to participate in available program components designed to address mental health, emotional, physical, and academic needs. Together, all of these factors may increase the risk for recidivism.

In a review of 34 studies on mental health needs and services in the juvenile justice system, Otto and colleagues (1992) found that rates of mental disorders were substantially higher among youth involved in the justice system than among youth in the general population. They also found that rates of disorder were higher in studies that assessed youth in person than in those that assessed youth by chart review. These authors suggested that existing studies of the prevalence of mental disorders among youth in the juvenile justice system were limited by the use of instruments with inadequate psychometrics, the failure to consider comorbidity (i.e., co-occurring conditions), problems with identifying sample characteristics, and a lack of information regarding when the assessments were conducted. They note that previous studies often did not define the timeframe for symptoms. However, distinguishing between lifetime and current symptoms is important not only for determining the prevalence of disorders but also in planning for immediate service needs.

Although great advances have been made in reliable mental health assessment of children and adolescents (Jensen et al., 1995; Shaffer et al., 1996), assessment practices in juvenile justice settings remain highly variable and generally have not used evidence-based, scientifically sound instruments (Cocozza and Skowyra, 2000; LeBlanc, 1998; Nicol et al., 2000; Towberman, 1992; Wiebush et al., 1995). A common practice has been to rely on a youth’s history of using mental health services as an indicator of whether the youth currently needs services. However, research suggests that the juvenile justice system cannot rely on other systems to provide information on the previous use of mental health services for all youth at entry. For example, Novins and colleagues (1999) found that only 34 percent of a sample of juvenile detainees with a documented anxiety, affective (mood), or disruptive behavior disorder had previously received services for those disorders. Similarly, the Policy Design Team (1994) found that approximately 50 percent of the juvenile detainees in Virginia showed mental health problems of moderate severity or higher and that 8.5 percent showed “severe” problems, but that only 15 percent of the detainees who exhibited mental health problems were receiving mental health services while in custody. A study of youth in South Carolina found that despite higher rates of disorder, incarcerated youth were significantly less likely to have received outpatient mental health services previously than were youth enrolled in a community mental health service (Pumariega et al., 1999). Other research suggests that minority youth and youth of low socioeconomic status are less likely to have a history of using mental health services (Pumariega et al., 1998).¹

This Bulletin reports the results of a study that used a computerized, self-administered version of the Diagnostic Interview Schedule for Children (DISC) to screen for psychiatric disorders in youth newly admitted to juvenile assessment centers in Illinois and New Jersey. The study assessed rates of psychiatric disorders and tested the feasibility of using this assessment instrument among youth in the juvenile justice system.² Recommendations are also offered for “best practices” for mental health assessment in juvenile justice settings based on a comparison of the rates of psychiatric disorder identified in this study with those found in other studies in which earlier versions of the DISC were used in juvenile justice settings.

Assessing the Mental Health Status of Youth in Juvenile Justice Settings	OJJDP Bulletin • August 2004