Treatment of mentally ill young offenders

A 16-year-old former juvenile detainee in Texas was accused of stabbing a high school teacher to death with a butcher knife. The teacher, Todd Henry, was sitting at his desk in his classroom when he was attacked in July 2009. The boy had been diagnosed with multiple mental health symptoms, including schizophrenia. Another teen in that same state who was also suffering from a mental illness was convicted of killing a roofer during a 30-minute robbery spree.

Mentally ill young offenders present an extremely complex set of problems for correctional institutions and staff. Texas hadn’t yet developed programs dealing with mental illness in their young offender correctional facilities in that state. For this reason, both of these young killers were set free after their trials by the Texas Youth Commission because the state wasn't equipped to treat their mental illnesses in their young offender facilities. Under a 1997 Texas law meant to keep mentally ill juveniles from being held in detention centers where they are not provided with proper psychiatric treatment, they were released to their parents or guardians.

Data obtained by The Associated Press revealed that the commission had released more than 200 offenders who suffered from psychiatric illnesses in the last five years and that more than one-fifth went on to commit new crimes, some of them violent. These cases highlight what some juvenile justice experts say was a loophole in the way the State of Texas treated underage offenders who have severe psychiatric problems.

It appears that since those two killers were released, that loophole is finally being closed. The Texas Youth Commission announced that it will stop releasing young offenders who are too mentally ill to rehabilitate. The commission first makes sure that young offenders discharged because of mental illness receive referrals to their local mental health/mental retardation centers.

There are approximately 126,000 juveniles who are incarcerated in youth detention facilities in the United States. Approximately 500,000 youths are brought to detention centers in a given year in that country. Many psychiatric disorders originate in childhood: disorders of mood, severe psychotic disorders such as schizophrenia, and conduct and personality disorders usually persist into adulthood.

Seventy percent of youths in juvenile justice systems have some kind of mental disorder, according to Joseph J. Cocozza, director of the ‘National Center for Mental Health and Juvenile Justice’. One in five suffers from a mental illness so severe that it impairs their ability to function as a young person and grow into a responsible adult. In most states in the USA, youthful offenders aren't discharged from custody because of mental illness unless they are being committed to hospitals.

A prevention component that targets children and youth at risk is long overdue. There has to be efforts in which society can develop plans to provide suitable alternatives—when needed—to detention for youth offenders, which would include diversion to treatment for mental health and substance abuse disorders. Juvenile suspects and detainees should be given mental health and substance abuse screening, assessment, referral, and treatment within a nation’s juvenile justice system and such treatment should be mandatory.

It has become abundantly clear that mental health is fundamental to making real progress toward keeping juvenile offenders from re-offending. Juvenile inmates “have higher rates of mental health diagnoses including learning disabilities and substance abuse compared with their peers,” as stated by Louis Kraus, M.D., co-chair of the ‘American Academy of Child and Adolescent Psychiatry Juvenile Justice Committee’. He added, “Early education and intervention programs that target at-risk children and adolescents and work with them before, during, and after the adjudication process will reduce recidivism.”

As cash-starved states slash mental health programs in communities and schools, they are increasingly relying on the juvenile corrections system to handle a generation of young offenders with psychiatric disorders. About two-thirds of the United States juvenile inmates — who numbered 92,854 in 2006, down from 107,000 in 1999 — had at least one mental illness, according to surveys of youth prisons, and are more in need of therapy than punishment.

In California’s state system, one of the most violent and poorly managed juvenile systems in the US, according to federal investigators, many youth offenders seriously injured themselves or attempted suicide — a sign, state juvenile justice experts say, of neglect and poor safety protocols. In Ohio, Governor Ted Strickland, a former prison psychologist, approved a 34 percent reduction in community-based mental health services to reduce a budget deficit. Thomas J. Stickrath, the director of the Department of Youth Services, in Ohio said continuing cuts would swell his state’s youth offender population.

Juvenile prisons have been the caretaker of last resort for troubled children since the 1980s, but mental health experts say the system is in crisis, facing a soaring number of inmates reliant on multiple — and powerful — psychotropic drugs and at the same time, there is a shortage of therapists.

When a young offender’s mental illness is compounded by other issues such as involvement with the criminal justice system, the discrimination is all-encompassing. These young offenders are often the forgotten, disenfranchised members of society, who, once dually labeled mentally ill and criminal, are given a life sentence that is marked by cycling in and out of correctional systems. The reality for many of these mentally ill youth is that they require comprehensive and responsive mental health services, not detention and isolation from society.

According to the ‘Coalition for Juvenile Justice’ every day only 1/3 of youth who need mental health interventions receive them, twenty percent of all youth experience mental health problems to varying degrees during childhood and suicide is the third leading cause of death for 15-to 24-year-olds. .

Further, the ‘Coalition’ states that between 50 to 75% of incarcerated youth have diagnosable mental health problems, youth suicides in juvenile detention and correctional facilities are more than four times greater than youth suicides in the general public, two-thirds of juvenile detention centers hold youth who are simply waiting for mental health treatment. In 33 states, youth with mental illness are held in juvenile detention centers without any charges being filed against them rather than risk returning them to the streets untreated. One-quarter of the juvenile detention centers holding youth waiting on mental health treatment provide no or poor quality mental health services. Incarcerated African American youth are less likely than their white peers to have previously received mental health services. According to the ‘Office of Juvenile Justice and Delinquency Prevention’, approximately 20 percent of youth in the juvenile justice system have serious mental health problems, and a significant number have co-occurring mental health and substance abuse disorders.

The United States is an extremely advanced society but if they are failing to appropriately treat their young offenders who are suffering from mental illnesses, what is being done with mentally ill young offenders in less advanced nations?

I would be remiss however if I didn’t mention that the United States lawmakers had previously introduced the ‘Mentally Ill Offender Treatment and Crime Reduction Act’ of 2004, which addresses the needs of individuals with mental illness who become involved in the criminal justice system. The bill was passed by the U.S. House of Representatives on October 6th and by the Senate on October 11th. The Act was signed into law by the President on October 30th. This legislation authorized a $50 million federal grant program for states and counties to establish more mental health courts, expand prisoners' access to mental health treatment while incarcerated and upon re-entry into the community, provide additional resources for pre-trial jail diversion programs and related initiatives, and fund cross-training for law enforcement officials and mental health personnel dealing with adult and juvenile offenders with mental health disorders. The ‘Mentally Ill Offender Treatment and Crime Reduction Act’ expands upon Sen. DeWine's and Rep. Strickland's ‘America's Law Enforcement and Mental Health Project’ the innovative ‘Mental Health Courts’ pilot program that became law in 2000. The new law, recognizing the needs of offenders with mental health disorders, is consistent with the recommendations of former President Bush's ‘New Freedom Commission on Mental Health’ which cited jail diversion and community re-entry programs as best practices.

Canada's criminal justice system is a complex network of independent but procedurally connected police, prosecutors, courts, correctional facilities, and parole boards. Federal, provincial, territorial, and municipal agencies and organizations all play a part, but no agency or jurisdiction has control or ownership of the entire system.

Canada's adult incarceration rate is currently third highest in the world, after United States and Hungary. We also imprison more young people than most other industrialized nations. Among those that we incarcerate are people with mental disorders. Growing numbers of individuals are falling into the ‘cracks’ between social services and health systems and landing in the criminal justice system. In recent years, the need to promote alternatives to imprisonment has become increasingly pressing.

Extensive closure of provincial psychiatric beds followed by lack of necessary investments in community care has resulted in swelling numbers and greater visibility of people on the streets who exhibit nuisance or ‘scary’ behaviour. Many of these ‘scary’ people were young offenders who didn’t get proper psychiatric treatment when it was needed.

Both the Government of Ontario through its Ministries (Health and Long Term Care; Solicitor General; Community, Family and Children’s Services; Corrections) and Ontario youth service providers have demonstrated and expressed an ongoing commitment to improving services for the children and youth of Ontario.
Further to an Ontario government announcement on May 5, 2000 of a new strict discipline young offender facility, located at the ‘Rideau Correctional and Treatment Center’, the ‘Royal Ottawa Health Care Group’ undertook to establish a cooperative effort between the ROHCG and the Ministry of Correctional Services aimed at identifying opportunities to improve coordination and plan services for mentally ill young offenders in Eastern Ontario.

At this time it was recognized that the ‘Royal Ottawa Hospital Youth Forensic Functional Program’ was designed to meet the needs of both Phase I (under age 16 years) and Phase II (16 - 18 years) persons in conflict with the law and who suffered from a form of serious mental illness.

People with mental disorders are significantly over-represented in prison: A 2007 study showed that 34 percent of men and 56 percent of women in Vermont’s prisons suffered from a mental illness. For this reason, a special court in Chittenden County in Virginia was created that deals with mentally disturbed suspects. It is called the ‘Chittenden County Mental Health Court’ and it was presided over by Judge Geoffrey Crawford one day a week until he was transferred to a higher court. Vermont’s mental health court was created in 2003 as one of 37 demonstration projects funded by the U.S Department of Justice.

In Toronto, Canada, there is a special court that was opened in 1998 that hears cases where the accused are suspected of being mentally ill. It is called the ‘Mental Health Court’ and it is presided over by Justice Richard Schneider who sits in that court as a Justice of the Ontario Court of Justice. He previously worked as a criminal defence lawyer, often representing individuals with mental disorders. Between 1994 and 2000, he was Counsel to the ‘Ontario Review Board’, a body designated under Canada’s Criminal Code to provide annual reviews of persons who have been found unfit to stand trial or not criminally responsible for their crimes on account of a mental disorder. His unique understanding of many of the issues related to mental illness and the courts also stems from his previous experience as a clinical psychologist in an outpatient forensic program in Calgary, Alberta, Canada.

In his capacity as the sitting judge of that special court, he can give community treatment orders which can be extended from six months to a year with automatic reviews to ensure that the treatment is successful and that the individuals, needing the treatment can be trusted to keep up their treatment.

We have youth courts in Canada but I don’t know of any of them that are presided over by a judge with Justice Schneider’s training and experience in dealing with mental illnesses. It seems to me that cities should have at least one judge sitting in youth courts that is qualified through training and experience to deal with young offenders who are suffering from mental illnesses who appear in his or her court.

The question that comes to fore is; should there be special young offender psychiatric treatment facilities that only house young offenders who suffer from psychiatric illnesses. My response to that rhetorical question is; no there shouldn’t be such facilities. The reason is obvious. No child wants it to be common knowledge that he or she was sent to such a facility. The stigma would be too much to bear. Instead, what should be available to those young offenders in need of psychiatric treatment is a unit within regular young offender facilities where those in need of psychiatric treatment can be given the treatment they need.

There are two young offender centres located in Edmonton and Calgary, Canada that have ‘house open custody, secure custody and remand status for young offenders’. Medical and mental health services are provided to all young offenders in these correctional centres. These services include nursing, medical, dental, psychological and psychiatric care. Referrals are made to community resources where appropriate. Counselling in the centres is available and includes individual and group counselling as well as referrals to in-centre and community professional resources. These resources very from centre to centre but can include: sex offender treatment, dealing with addictions, anger management and the centres include intervention programs, transition programs and self-esteem programs. They are taught how to form healthy relationships. They are also taught how to deal with sexual and physical abuse and they are further taught life skills and parenting. Those in need of psychiatric help are given it.

Adolescent girls in young offender institutions are particularly vulnerable to depression according to a large-scale study led by Oxford University. The researchers have found incidences of mental health problems in both boys and girls are many times greater in juvenile detention centres than in the general population. The high prevalence of mental disorders highlights the need for improved psychiatric care in juvenile justice and detention centres, say the researchers.

For the first time, the researchers have shown adolescent girls in detention are at particular risk of depression. 29% of girls aged 10-19 were diagnosed with major depression, considerably higher than the 12% of adult women in prison reported to suffer from depression and four to five times higher than in the general youth population. 10.6% of boys suffer from major depression.

Cases of psychosis in boys and girls --- severe mental illness involving loss of connection with reality --- are also much more common in young offender institutions than would be expected, with rates around ten times higher than in the general population.

One in ten boys and one in five girls in young offender institutions have attention-deficit/hyperactivity disorder. Rates of conduct disorder --- a psychiatric diagnosis describing a pattern of disruptive and antisocial behaviour, for example where children consistently break rules, get into fights and play truant --- are 10-20 times higher in girls in detention and five to ten times higher in boys than found in adolescents generally.

Currently, the care provided for incarcerated young people is patchy. There should be a starting point to examine where there is insufficient screening for mental ill-health, where secure facilities lack qualified staff or appropriate treatment, and where sentencing does not account for mental disorders.

As well as assessing suicide risk and substance abuse, young offender facilities should consider specific screening for mood disorders especially in girls. Justice systems for juveniles should offer the opportunity to pick up mental disorders and make a significant impact on public health. This is a chance to catch many vulnerable people who otherwise fall through the cracks.

There can be no doubt in anyone’s minds that we are failing our young people and in doing so, we are going to cause grief to those in the future who will live beyond our own lives after we pass on. We cannot stand about and ignore what is happening to the young people in our era who desperately need psychiatric help and expect those in the future to deal with the problems we in our era are ignoring. It is truly a sad commentary of our society in our era that we spend so much on improving the lives of all of us at the expense of those unfortunates who suffer from psychiatric illnesses and who truly need our help.

Our young people are our future. As we grow older, we have to rely on the young people of our era to protect our own offspring so that they and everyone else in the future will be safe from crime. It is up to us in our own era to help these young people, especially those in need of psychiatric help.