Youth, Crime, and Mental Health

Dr. Dax Urbszat, B.Sc., LL.B., Ph. D.

University of Toronto at Mississauga

Department of Psychology

Ph: 905 569 4964

E-mail: dax.urbszat@utoronto.ca

Plan for Today

Mental health issues in youth

Mental health and the juvenile justice system

Diversion programs

Treatment issues

Prevention through Education

Mental Health in Youth

• As many as 20% of youth experience serious mental health problems

• Mental disorders comprise around one-third of the burden of disease for youth

• 75% of these mental disorders will onset before age 24

• Risk for substance abuse, socioeconomic consequences, increased early mortality

Mental Health in Youth

• Few receive proper assessment, diagnosis, and treatment

• Only 25-30% of youth who require mental health treatment will actually receive it

• “Two of every three depressed children do not receive an appropriate diagnosis and only 50% receive appropriate treatment.” (Kutchner & McDougall, 2009).

Mental Health in Youth

• Long waiting lists for specialty mental health services

• Lack of mental health care in primary care• Lack of health providers with the necessary

mental health competencies• Poor coordination among health and other

government agencies for youth mental health• Lack of specific child and youth mental health

policies at provincial and federal level

Mental Health and the Juvenile Justice System

• Many youth suffering from mental health problems are being directed into the juvenile justice system due to a lack of appropriate mental health care (Canadian Institute for Health Information, 2008)

• The majority of children and youth within correctional settings suffer from one or more mental disorders (70%)

Mental Health and the Juvenile Justice System

• Prevalence of mental disorders in the criminal justice system is at least 2 to 4 times greater than in the general adolescent population

• Detention facilities have become the largest providers of mental health services for young people

Mental Health and the Juvenile Justice System

• Youth with mental illness self-medicate• Alcohol and drug use can lead to criminal

activity• Incarceration exacerbates mental illness• Presence of a mental disorder at time of

apprehension for a criminal act leads to higher rates of arrest, longer detention periods, and higher rates of recidivism

BC Policy Framework for Diversion of Persons with Mental

Disorders• “[T]here are a disproportionate number of people

with mental disorders in the criminal justice and correctional systems. This is not only seen as an inappropriate consequence for illness related behaviour, but is also increasingly seen as a waste of valuable law enforcement and criminal justice system time, and of resources that may be more effectively spent on improving community mental health services.”

Diversion Programs

• Diversion from the juvenile justice system to mental health, treatment, and support

• Preliminary results show reduced recidivism, less jail time, more involvement with mental health professionals, and increased use of community-based services

• Requires cooperation between police, judiciary, legislature, and mental health and community service providers

Diversion Programs

• Youth Mental Health Courts• Conferencing (Youth Criminal Justice Act)• Wraparound programs• Project Connect (New York State)

Disorders Impacting the Justice System

• Anxiety disorders• Mood disorders• Substance use disorders• Conduct Disorder• Oppositional Defiance Disorder• Attention Deficit Hyperactivity Disorder

Treatment Issues

• Long waiting lists for specialty clinics• Primary care physicians prescribing

medications alone• Psychiatrists likely to prescribe medication

as well

Treatment Issues

“From an evidence-based perspective, cognitive-behavioural therapy is currently the treatment of choice for anxiety and depressive disorders in children and adolescents”

Clinical Psychologists are the most likely health care providers to treat using CBT

Psychological services are not covered by OHIPWe need improved access to the best treatments for

our youth with mental health issues

Treatment Issues

• Specifically, we need to create better access and availability to CBT as it is the treatment of choice for anxiety, depression, and substance abuse disorders in children and adolescents

• Heavy reliance on medication treatments alone for certain Psychiatric disorders is an issue in all populations, but especially with children and adolescents

Psycho-Education

• Prevalence rates• Symptoms• Causes• Treatments• Risks (co-morbidity)

Psycho-Education

• Lessens stigmatization • Increased understanding for community members

and service providers• Improve chances of seeking treatment• Improves treatment outcomes by promoting early

intervention and knowing best treatments • Decreases risk of substance use and abuse due to

self-medicating (co-morbidity)

Prevention through Education

• Judiciary• First responders• Those involved in youth justice services• Community members• Family members• schools

Take Home Messages

• Mental health issues are prevalent in youth and can lead to both substance abuse (co-morbidity) and involvement in the juvenile justice system

• Diversion programs have shown promise• Access to CBT to treat youth with mental health

issues is critical• Prevention and early intervention can be enhanced

through Psycho-education in all sectors of society

References• Abram, K.M., Teplin, L.A., McClelland, G.M., Dulcan, M.K. (2003)

Comorbid Psychiatric Disorders in Youth in Juvenile Detention. Archives of General Psychiatry. 60:1097–1108.

• Andre, G., Pease, K., Kendall, K., & Boulton, A. (1994). Health and Offence Histories of Young Offenders in Saskatoon, Canada. Criminal Behaviour and Mental Health. 4:163–180.

• Canadian Institute for Health Information Improving the health of Canadians: Mental health, delinquency and criminal activity. < www.cihi.ca>. (Version current at October 31, 2008).

• Compton, S., March, J.S., Brent, D.A., Albano, A.M., Weersing, V. & Curry, J.F. (2004) Cognitive behavioral therapy for anxiety and depression in children and adolescents: An evidence based medicine review. Journal of the American Academy of Child and Adolescent Psychiatry, 43, 930-959.

• Leitch, K.K. (2007). Reaching for the top: A report by the advisor on healthy children & youth. Ottawa: Health Canada; 2007. < http://www.hc-sc.gc.ca> (Version current at October 31, 2008).

• Hillian, D., Reitsma-Street, M., & Hackler, J. (2006). Conferencing in the Youth Criminal Justice Act of Canada: Policy Developments in British Columbia. Canadian Journal of Criminology and Criminal Justice, 46(30), 343-366.

• Kirby, M.J. & Keon, W.J. (2006). Final Report of The Standing Senate Committee on Social Affairs, Science and Technology. Out of the shadows at last: Transforming mental health, mental illness and addiction services in Canada.

• Kutcher, S. & McDougall, A. (2009) Problems with access to adolescent mental health care can lead to dealings with the criminal justice system. Pediatrics and Child Heath,v. 14(1).

• Odgers, C.L., Burnette, M.L., Chauhan, P., Moretti, M.M., Reppucci, N.D. (2005). Misdiagnosing the problem: Mental health profiles of incarcerated juveniles. Can Child Adolesc Psych Rev. 14:26–9.

• Sanislow, C.A., Grilo, C.M., Fehon, D.C., Axelrod, S.R., McGlashan, T.H. (2003). Correlates of suicide risk in juvenile detainees and adolescent inpatients. J Am Acad Child Adolesc Psychiatry.42:234–40.

• Teplin, L.A., Abram, K.M., McClelland, G.M., Dulcan, M.K., Mericle, A.A. (2002). Psychiatric disorders in youth in juvenile detention. Archives of general psychiatry. 59:1133–1143.

• Ulzen, T.P.M., & Hamilton, H. (1998). The nature and characteristics of psychiatric comorbidity in incarcerated adolescents. Canadian Journal of Psychiatry. 43:57–63.

• Waddell C, Hua JM, Garland OM, Peters RD, McEwan K. (2007). Preventing mental disorders in children: A systematic review to inform policy-making. Can J Public Health. 98:166–73.

• Wasserman, G.A., McReynolds, L.S., Musibegovic, H., Whited, A.L., Keating, J.M., & Huo, Y. (2009). Evaluating Project Connect: Improving Juvenile Probationers’ Mental Health and Substance Use Service Access. Adm Policy Ment Health. Nov;36(6):393-405. Epub 2009 Jul 7.