April 21, 2010

APA Statement on Reforming the Juvenile Justice System to Improve Children's Lives and Public Safety

APA submitted the following statement to U.S. House Committee on Education and Labor in support of the Juvenile Justice and Delinquency Prevention Reauthorization Act.

On behalf of the American Psychological Association (APA), Bazelon Center for Mental Health Law, Mental Health America (MHA), and the National Disability Rights Network (NDRN), we thank you for holding this important hearing on juvenile justice.

Together, our organizations represent disability and mental health advocates, consumers, and professionals, and strongly support the Juvenile Justice and Delinquency Prevention Act (JJDPA). This critical law serves to protect communities, prevent delinquent behavior, guide the treatment of justice-involved and at-risk youth, and address dangerous conditions of confinement. We see its pending reauthorization as an opportunity to address the mental and behavioral health needs of this population which exist at rates 3 to 4 times that found in the overall population under the age of 18.

We are encouraged by Senate efforts thus far and the convening of today’s hearing. S. 678, the Juvenile Justice and Delinquency Prevention Reauthorization Act of 2009, contains a number of provisions related to mental and behavioral health that:

  • Add the Administrator of the Substance Abuse and Mental Health Services Administration to the Federal Coordinating Council for Juvenile Justice and Delinquency Prevention;
  • Add experts in mental health to the State Advisory Groups;
  • Direct states to outline in their State Plans their efforts to use evidence-based mental health and substance abuse screening and assessment programs for youth in secure facilities;
  • Provide states with training and technical assistance related to effective mental health and substance abuse screening, assessment, and treatment;
  • Authorize a much-needed study to fill in significant gaps in the research regarding the prevalence of disabilities among the juvenile justice population; and
  • Create a new incentive grant program to help State and local governments address mental health and substance abuse needs among juvenile justice-involved youth by: fostering linkages between juvenile justice and public mental health agencies; promoting the use of evidence-based prevention, identification and intervention strategies; providing staff training; and supporting at-risk youth.

These important provisions represent a sure step forward in addressing the disparate mental health needs of justice-involved and at-risk youth, and we look forward to working with the House of Representatives to identify additional ways that JJDPA can provide effective interventions for this group of young people.

Background Issues

Research shows that between 60 and 80 percent of youth involved with the juvenile justice system meet the criteria for at least one psychiatric diagnosis and that, of this group, approximately 80 percent meet the criteria for two or more mental health or substance abuse disorders. Youth experiencing serious emotional disturbance make-up approximately 15-20 percent of the population in juvenile justice facilities, a rate up to 10 times higher than their representation in the community.

In addition, recent federal reports demonstrate that juvenile justice systems regularly act as weigh-stations where youth await treatment, functions not intended for juvenile justice. In 2003, the Government Accountability Office reported on the tragedy of parents being forced to relinquish legal and physical custody of their children to child welfare and juvenile justice agencies in the often unfounded belief that doing so would secure otherwise unavailable mental health services for their children. Data for 2001 from 19 States and 30 counties showed that nearly 9,000 children and adolescents were sent to the juvenile justice system for this reason.

Furthermore, in 2004, the House Committee on Government Reform reported that two-thirds of juvenile detention facilities located in 47 states held youth with mental disorders solely due to a lack of community mental health treatment, and spent an estimated $100 million each year to house youth who are waiting for community mental health services. The survey also revealed that of more than 340 juvenile detention facilities across the country that held youth waiting for community mental health services, almost half reported suicide attempts and more than one-quarter reported having poor or no mental health treatment for youths in detention.

The price of inaction is significant. Facilities in the juvenile justice system were not designed to serve as mental health treatment centers, and most are not equipped to care for young people with special needs. Facilities are often overcrowded and understaffed, leading to poor supervision, and use of inappropriate or ineffective behavioral management strategies. Youth in these facilities often are exposed to stress, trauma and serious harms due to dangerous conditions of confinement, including physical and sexual violence. Youth who have behavioral health needs are particularly vulnerable to these harms, which has resulted in serious injuries, self-mutilation, suicides and death.

Finally, there are no national standards regulating conditions of confinement in facilities in the juvenile justice system. There is little or no monitoring and oversight to holding these facilities accountable for how they care for and supervise youth with mental health needs. Unlike any other residential facilities where youth with mental health, psychiatric or other disabilities are protected by national standards relating to abuse and neglect, there are no analogous standards for youth in secure juvenile justice facilities.

Recommendations

Juvenile Justice and Delinquency Prevention Act (JJDPA) Reauthorization

With regard to mental and behavioral health issues, this critical reauthorization must address two seemingly conflicting goals: helping to remove incentives to drive youth deeper into juvenile justice systems, while still fostering and ensuring an appropriate range of critical services. Our organizations strongly encourage the Committee to consider the following principles during JJDPA reauthorization.

  1. Create incentives for comprehensive and meaningful collaborations among state and local agencies, programs, and organizations that serve children, including schools, mental health and substance abuse agencies, law enforcement and probation personnel, juvenile courts, departments of corrections, child welfare, other public health agencies, and institutes of higher education.
  2. Identify vulnerable youth with mental health and substance abuse disorders post adjudication through comprehensive screening and assessments in order to provide needed treatment, supports and services. In addition, policies should be developed and implemented to screen youth at intake or the point of detention, and to ensure that vulnerable youth with mental health and substance abuse disorders are protected from abuse, neglect, self-incrimination, or misuse of health information.
  3. Provide grants to divert youth from detention and incarceration into home- and community-based care, whenever appropriate, which are less expensive and more effective settings for meeting their needs than juvenile justice facilities.
  4. Make training available through OJJDP for law enforcement officers, juvenile and family court judges, probation officers, and other decision makers about the signs and symptoms of mental and behavioral health needs, the existence and purpose of screening and assessment, and the effectiveness of home- and community-based treatment and other mental health supports and services.
  5. Develop an individualized discharge plan for each youth upon admission to any juvenile justice facility, including detention centers, in order to link them to appropriate aftercare services, including behavioral health services and supports, when they are released back into the community.
  6. Provide incentives for juvenile justice systems to implement programs and services that involve families and have been proven through research to reduce recidivism and improve outcomes for juvenile offenders, such as Functional Family Therapy, Multi-Dimensional Treatment Foster Care, and Multi-Systemic Therapy.
  7. Create a national technical assistance center and a series of regional technical assistance centers to assist juvenile justice agencies in all matters related to juveniles with mental health and substance abuse disorders, and create grants to assist state and local juvenile justice agencies as they work to reform their systems.
  8. Provide grants for increased training opportunities, including best practices related to mental health, and technical assistance for law enforcement and probation officers, corrections and community corrections personnel, court services personnel and others as an appropriate means of reducing juvenile crime.
  9. Create reporting requirements to the Department of Justice that will improve understanding of the prevalence of mental health and substance abuse disorders in the juvenile justice system.
  10. Establish safeguards to ensure that psychotropic medications given to youth in the juvenile justice system are provided only as part of a treatment plan, based on a mental health assessment performed by a qualified, licensed mental health professional.
  11. Establish and fund a system of independent monitoring and oversight to identify and remediate dangerous conditions in juvenile justice facilities.

Other key legislative priorities

  • Re-introduce and enact the Keeping Families Together Act, which would expand systems of care to address the mental health needs of children and youth and reduce the unnecessary entry of young people into the juvenile justice system;
  • Principles contained in the Mental Health Juvenile Justice Act, introduced in 2001 and 2002, respectively, by Congressman Miller and Senator Wellstone; and
  • Enact H.R. 1931, the Juvenile Crime Reduction Act, which reflects many of the principles outlined above.

Conclusion

We thank you for the opportunity to share our perspective on the intersection of juvenile justice and mental health and substance abuse, and the need for changes to the federal investment in juvenile justice and delinquency prevention. The science behind mental health issues is far beyond where the evidence-based literature was the last time JJDPA was reauthorized. We now know how to better address and ameliorate the mental health crisis among our nation’s youth. Given the progress in science and better collaboration among the stakeholders, the next reauthorization of JJDPA needs to seize this opportunity and dramatically shift the way in which it addresses mental health issues. We appreciate the Committee’s ongoing commitment and leadership to addressing vital juvenile justice issues and look forward to continuing to work with you on these critically important efforts.