Despite the growing concern, there is a paucity of adequate research on the prevalence and types of mental health disorders among youth in the juvenile justice system. A comprehensive review of the research literature (Otto et al., 1992) found the research to be scarce and methodologically flawed. Other reviews have reached similar conclusions (Wierson, Forehand, and Frame, 1992). Methodological problems include inconsistent definitions and measurements of mental illness; use of biased, nonrandom samples; reliance on retrospective case report data; and use of nonstandardized measurement instruments.|
Despite these problems, some general conclusions can be drawn:
Youth in the juvenile justice system experience substantially higher rates of mental health disorders than youth in the general population. This is a major conclusion drawn from a review of 34 studies (Otto et al., 1992) and is also consistent with the finding that mental illness prevalence rates in adult corrections populations are two to four times higher than the rates in the general adult population (Teplin, 1990).
There is a paucity of adequate research on mental health disorders among youth in the juvenile justice system.
A high percentage of youth in the juvenile justice system have a diagnosable mental health disorder. One difficulty in addressing mental health issues in the juvenile justice system centers around the varying uses and definitions of the terms "mental health disorder" and "mental illness." One critical distinction is between youth with a diagnosable mental health disorder and youth with a serious mental health disorder or serious emotional disturbance (SED). Youth with a diagnosable mental health disorder are those that meet the formal criteria for any of the disorders listed in the Diagnostic and Statistical Manual of Mental Disorders: Fourth Edition, DSM-IV (American Psychiatric Association, 1994) such as psychotic, learning, conduct, and substance abuse disorders. The terms "serious mental health disorder" and "SED"defined and measured in a number of different waysare used to identify youth experiencing more severe conditions that substantially interfere with their functioning. The term "serious mental health disorder" often refers to specific diagnostic categories such as schizophrenia, major depression, and bipolar disorder. "SED," a term used for youth, includes those youth with a diagnosable disorder for whom the disorder has resulted in functional impairment affecting family, school, or community activities. With regard to diagnosable mental health disorders in general, research has found that most youth in the juvenile justice system qualify for at least one diagnosis. It is not uncommon for 80 percent or more of the juvenile justice population to be diagnosed with conduct disorder (Otto et al., 1992; Wierson, Forehand, and Frame, 1992; Virginia Policy Design Team, 1994). Given the broad definitional criteria for conduct disorder, Melton and Pagliocca (1992) point out that such a finding is not surprising, although many of these youth qualify for more than one diagnosis (Virginia Policy Design Team, 1994).
It is safe to estimate that at least one out of every five youth in the juvenile justice system has serious mental health problems. Estimates of the prevalence of serious mental health disorders among these youth are particularly unreliable because of the problems with research and, as mentioned above, the varying definitions and measures of serious mental illness. If the prevalence rate of SED for youth in the general population is estimated at 9-13 percent (Friedman et al., 1996) and the prevalence rate of disorders for youth in the juvenile justice system is consistently found to be at least twice as high (Otto et al., 1992), one can reasonably expect the prevalence rate of serious mental health disorders for youth in contact with the juvenile justice system to be at least 20 percent. This estimate is consistent with the findings other researchers have reported (Schultz and Mitchell-Timmons, 1995). A more accurate estimate will require further research. It is clear, however, that while most youth in the juvenile justice system have a diagnosable mental illness and could benefit from some services, there is a sizable group of youth who critically need access to mental health services because they are experiencing serious problems that interfere with their functioning.
Many of the youth in the juvenile justice system with mental illness also have a co-occurring substance abuse disorder. Over the past several years, there has been greater recognition and documentation of the high level of co-occurring substance abuse disorders among individuals with mental health disorders. Kessler et al. (1996) found that 50.9 percent of the general adult population with serious mental health disorders have a co-occurring substance abuse disorder, while Teplin, Abram, and McClelland (1991) found that 73 percent of adult jail detainees with serious mental health disorders had a co-occurring substance abuse disorder. Although research has just begun to focus on youth, Greenbaum, Foster-Johnson, and Petrila (1996:58) found that "approximately half of all adolescents receiving mental health services" in the general population are reported as having a dual diagnosis. Among the juvenile justice system population, the rates may be even higher (Otto et al., 1992; Milin et al., 1991).