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A single instance of incarceration in a young person’s life increases the risk of future imprisonment, at a cost to taxpayers of $240.99 per day. Living in jail worsens the mental, emotional, and behavioral problems with which these children and adolescents must struggle. And mental disorders and youth incarceration already share an alarmingly strong link. As James Barrett, a psychologist at the Cambridge Health Alliance and in Harvard Medical School’s Department of Psychiatry, said in an interview with the HPR, a “massive overlap” exists between the two groups. While just 20 percent of all American youth live with one or more mental disorders, that proportion jumps to 70 percent for the juvenile justice population.

Most of these minors’ mental illnesses could have been mitigated through earlier treatment, particularly in schools; however, in-school support is often inadequate or absent. As Alison Barkoff, the Director of Advocacy at the Bazelon Center for Mental Health Law, told the HPR, “The best ways to divert kids with mental health needs from getting into juvenile justice in the first place [are] finding ways to support them in their communities, in their families, [and] in their schools.” For youth at risk of incarceration for mental health-related activities, then, filling that gap is especially vital.

To Face Prison

A small percentage of incarcerated youth are unsurprisingly diagnosed with a conduct disorder, a term that describes a young person who harms or is threateningly aggressive toward others. Yet even excluding conduct disorders, 61 percent of males and 70 percent of females involved in the juvenile justice system struggle with mental disorders at the start of detention, including anxiety disorder, attention deficit hyperactivity disorder (ADHD), bipolar disorder, and major depressive disorder. The rate of psychosis, a severely distressing and debilitating condition, is 10 times that of the general population.

Furthermore, the majority of these youth are not dangerous. Just 23.5 percent of those in the juvenile justice system are imprisoned for truly violent offenses. Many face legal penalties for far less distressing behavior that is consistent with fighting a psychiatric illness, such as truancy or other minor school infractions. Youth as young as eight end up in the juvenile justice system after struggling with undiagnosed mental disorders. Only a small fraction of children and adolescents who need treatment for mental disorders ever receive it, and the care within the juvenile justice system is often the best their communities can offer.

But historically, this approach has not been successful at treating mental illnesses, and it has proved insufficient for effecting change. Rather, it may be more useful to provide treatment before young people enter the justice system. University of Massachusetts Medical School professor Thomas Grisso told the HPR that he considers such programs to often be a better solution and cites many that have been established recently in locations across the country. “Those with mental health problems can be dealt with more adequately in the community,” he explained.

Currently, half of high school students with a mental disorder drop out of school, the highest rate of any disability. Their failure to graduate leaves them at greater risk of health problems and with little future in the working world, which are risk factors for delinquent behavior. In keeping with the zero-tolerance policies many schools have adopted for breaking even minor rules, other students who live with mental disorders such as emotional disturbances are expelled and sent into the juvenile justice system. Barkoff commented, “Many kids with mental health needs or behavioral disorders are very badly supported in schools, and what we call the school-to-prison pipeline is happening for a lot of these kids. … If you look at the referral rate of kids into juvenile justice from school, it’s a very high proportion of kids with mental health needs.”

To Receive Care

Access to school-based mental health care can provide these students support that will let them remain and succeed in school. Schools already recognize the need for better mental health care: many would rather pay for a mental health professional than the typical school nurse, according to Julia Lear of The Center for Health and Health Care in Schools in a 2009 interview with the Monitor on Psychology. Barkoff, too, explained that “school is certainly a very big piece of [supporting youth with mental disorders], but so is the children’s mental health system.” Merging expertise from both fields, then, may offer an effective way to reach these young people.

The Children’s Defense Fund, a national organization that advocates for children’s rights, considers improving access to mental health care to be among the “key immediate action steps” with potential to prevent what the organization calls the “Cradle to Prison Pipeline.” Students are 21 times more likely to use a school health center’s mental health services than similar services offered elsewhere in a community, since they feel more comfortable when they are familiar with the setting in which they receive care. And even with the current shortcomings of schools’ mental health capabilities, the majority of young people who are in treatment for mental disorders still receive that help through their schools. Therapists and teachers can collaborate to address a range of needs, keeping youth both psychologically healthy and academically successful—two significant factors that protect against juvenile delinquency.

Of school health centers operating now, 80 percent include some kind of mental health care, but fewer than 2,000 centers existed as of 2009. Many schools throughout the country lack even the number of guidance counselors that the U.S. Department of Education considers adequate. Raising the percentage of licensed clinical social workers, psychologists, and child and adolescent psychiatrists in schools is vital in providing the level of support required for young people battling mental disorders. That support is unattainable without intentional and sustained effort: the vast majority of American counties lack even one child and adolescent psychiatrist, and neither social workers nor psychologists are permitted to prescribe medication, a step that is sometimes needed. According to Barrett, even in Cambridge, Massachusetts—a city with extensive mental health resources—mental health professionals “get filled up quickly in terms of caseloads, and sometimes we’ll hear these stories of families on month-long [or] two-month-long wait lists.”

School-based mental health care also offers a cost-effective way to treat children and adolescents. Though the model requires government funding, the sum that the Department of Education must pay to provide the needed staff is relatively small. On the other hand, juvenile incarceration costs an average of $148,767 per year per person (10 times the cost of attending public school for 1 year) and lacks the transformative and equalizing power that school-based mental health care possesses. Children growing up in low-income households are more likely to struggle with a mental disorder and less likely to receive adequate insurance to support treatment. Health centers in these children’s schools thus are able to reduce, or even eliminate, that discrepancy in a manner that avoids detention.

To Gain Protection

Barrett adds that an integral piece of this effort is “getting people to talk to one another” through facilitated communication among school officials, mental health professionals, and police departments’ youth officers. He was part of a team in Cambridge that created the Cambridge Safety Net Collaborative, an initiative that achieves this very goal. In the last five years, Barrett reports, Cambridge’s juvenile incarceration rate has dropped roughly 60 percent, while its rate of referral to mental health resources has risen. The Cambridge Safety Net Collaborative does not yet possess data explicitly linking these two trends, but the inverse relationship between them is encouraging. And studies in Texas and Chicago have shown mental health treatment to be effective in preventing juvenile crime, establishing strong support for this sort of program. “It really comes down to these issues of identification and access,” said Barrett. “The more schools can identify kids who are at risk before they show delinquency, the better able we would be to get them hooked up with services.”

Minnesota has already implemented a school-based program to keep young people with serious mental health needs out of the juvenile justice system. The model is designed to be applicable to any school in the nation and depends on collaboration among mental health professionals, school officials, families, and the students themselves. Students who engage in behavior involving a serious infraction receive mental health and trauma screening, a practice University of Massachusetts Medical School professor Gina Vincent supports. In an interview with the HPR, she explained, “I think generally the kids start acting out and, for some reason, they come to the attention of a teacher or principal or a school psychologist or school counselor and, from there, they should get screened. Mental health screenings in schools, set up in a thoughtful way, would be … [a] very good way to divert kids from getting into juvenile justice.”

Image credit: Elizabeth Albert/Flickr

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