Adolescent mental health and the juvenile justice system

Pediatric Nursing, Nov-Dec, 2006 by Elizabeth Bonham

The juvenile court system today is challenged by dramatic changes in youthful behavior that are characterized by issues such as substance abuse, sexuality, and lethal forms of violence (Yablonsky, 2000). While a variety of factors contribute to delinquent behavior, no one single factor is responsible for juvenile delinquency (Wasserman et al., 2003). Studies explain delinquent behavior from different perspectives: cultural and social learning, individual biological dysfunctions and family and religion influences (Oyserman & Markus, 1990; Quay & Werry, 1986). Substantive evidence demonstrates an increased interdisciplinary concern about the incidence of mental health issues of juvenile offenders (Baerger, Lyons, Quigley, & Griffin, 2001; Cocozza, 1992; Grisso, 1999).

While 20 % of American youth experience a mental health disorder before age 21, 1 in 10 children suffers from disease severe enough to impair daily life (American Academy of Pediatrics, 2000; Roberts, Attkisson, & Rosenblatt, 1998). However, fewer than 20% who need mental health treatment receive services (U.S. Public Health Service, 2000). Because of this lack of care, adolescent behaviors normally associated with mental illness are often identified as delinquent, with subsequent admission of mentally ill youth to the juvenile justice system.

Mental health disorders in youth committed to the juvenile justice system are more frequent than in the general adolescent population ranging from 60% to 400% (Kazdin, 2000; Montgomery, 2000). Furthermore, reports of the prevalence of mental health disorders among youth in the juvenile justice system range from 2% to 90%, depending in part on the diagnosis (Coalition for Juvenile Justice, 2002; Cocozza & Skowyra, 2000; Teplin, Abram, McClelland, Dulcan, & Mericle, 2002).

Contributing to these numbers are the thousands of American youth currently being detained in detention centers without charges while they wait for mental health services in the community (Waxman & Collins, 2004). The juvenile justice system has become the default system for youth who do not receive mental health care in the community (Boesky, 2002). The implications are enormous when one considers that over 1 million youth enter the American juvenile justice system every year (Montgomery, 2000). Adding to this concern are recent reports indicating that the treatment an adolescent receives in juvenile justice may actually contribute to a later life of criminality (Arredondo, 2003).

Developmental issues, psychiatric mental health disorders and community aspects are key risk factors influencing the development of delinquent behavior. Understanding their impact on adolescents, mental health, and delinquency prepares nurses to better advocate for the needs of this vulnerable population.

Developmental Risk Factors

An understanding of normal physical, social, emotional, and cognitive changes in adolescent development helps to frame the issue of juvenile offenders' mental health. Studies have shown that changes in normal processes such as pubertal timing, peer relationships, moral development, and intellectual functioning can influence the development of delinquent behavior. Moreover, depending on the developmental stage of the youth, juvenile detention interrupts the developmental trajectory by changing normative functioning and quite possibly causes irreparable damage to the youth (Arredondo et al., 2001; Steinberg & Schwartz, 2000). The earlier delinquency and detention occur, the more likely the outcome of persistent lifelong delinquent behavior (Huizinga, Loeber, Thornberry, & Cothern, 2000).

Physical. Jason is a tall, muscular and well-developed young man who looks much older than his age of 14. Older youth at his school frequently ask him to buy cigarettes for them.

Adolescents demonstrate dramatic phenotypic, pubertal changes that are visible and evident in measurements such as height, weight, and secondary sex characteristics (Harter, 1999; Tanner, 1972) and captured in the complex construct called pubertal timing (Richards & Larson, 1993). Current research suggests that pubertal timing influences the development of delinquency: girls who mature earlier have a greater risk for delinquency and mental health problems in adolescence (Caspi, Lynan, Moffitt, & Silva, 1993; Graber, Seeley, Brooks-Gunn, & Lewinsohn, 2004) while boys who are late maturers demonstrate increased disruptive behavior and substance abuse disorders in the trajectory to adulthood (Graber et al., 2004). Additionally, the physically mature adolescent appearing in the courtroom is at a disadvantage because the mature appearance suggests decision making and competency abilities not yet possessed (Scott & Steinberg, 2003).

A significant physical cause of delinquent behavior results from environmental effects on brain development. Adolescents who are victims of childhood maltreatment demonstrate residual physical and behavioral effects, such as brain damage and antisocial behavior, which are known risk factors for delinquent behavior (Caspi et al., 2002).