Until now, no one has documented on a large scale what happens to the mental health of young people who have been in the juvenile justice system. A study in the Oct. 1 Archives of General Psychiatry fills that gap. The results are sobering: More than 45 percent of young men and 30 percent of young women had one or more psychiatric disorders five years after detention, generally representing much higher rates of disorders than in the overall youth population. For instance, 20 percent of males in the study had substance use disorder, compared with 7 percent in the National Comorbidity Survey, the authors found.

The most prevalent conditions at five years were substance use disorders and disruptive behavior disorders, particularly among non-Hispanic white males, the data also show.

The study, headed by social psychologist Linda A. Teplin, PhD, of the Northwestern University Feinberg School of Medicine, is the first large-scale, longitudinal study to examine mental health issues in this population. Her team, including psychologist Karen M. Abram, PhD, interviewed 1,829 randomly selected young people when they were first arrested and detained in Cook County, Ill., from 1995 to 1998. The article reports on subsequent interviews between three and five years post-detention, with up to four follow-up interviews per participant.

The study provides critical information about a high-need, underserved group, says Melodee Hanes, acting administrator at the federal Office of Juvenile Justice and Delinquency Prevention, which funded the project along with the National Institute on Drug Abuse, the National Institute on Alcohol Abuse and Alcoholism, and a consortium of other federal agencies and private foundations.

"This research highlights the importance of screening to identify the kids in the system who have mental health and substance use issues, connecting them to appropriate treatment, and ensuring services continue even after they return to their communities," Hanes says.

Other key findings include:

  • African-Americans had much lower rates of substance use disorders than non-Hispanic whites. The finding adds to data dispelling stereotypes that African-American youth have the highest rates of drug abuse among youth, and leads to questions about why they are disproportionally incarcerated, says Teplin.
  • At five years, young men were more likely to have substance use disorders than young women, who had higher rates of depression. 
  • At five years, Hispanics were more than twice as likely to have an anxiety disorder than non-Hispanic whites and almost four times more likely to have panic disorder than African-Americans.
  • Non-Hispanic whites had the highest rates of disruptive behavior disorder as they got older, again challenging stereotypes that African-American youth are more likely to act out than other ethnic groups, says Teplin.

The findings underscore the need for services tailored to the different issues confronting young people who have been in the juvenile justice system, says Teplin. In particular, young men need more treatment options, as they make up 85 percent of youth in correctional facilities but often lack adequate services. "We have done a great job developing special programs for girls, but now we need to focus on the boys," she says.

For psychologist Scott Henggelar, PhD, who directs the Family Services Research Center at the Medical University of South Carolina, that treatment would ideally take place in community rather than in residential settings. "Data show the best interventions for juvenile offenders are family-based, rehabilitative in nature and use behavioral intervention techniques within the youth's natural environment," he says.

Tori DeAngelis is a writer in Syracuse, N.Y.