Young offenders need support

EXPERTS are calling for more mental health support for Australian juvenile offenders after a longitudinal US study highlighted the prevalence of psychiatric disorders among youth 5 years after being released from detention.

The study, published in JAMA Psychiatry, was based on diagnostic interviews with 1829 youths, recruited at intake into a US juvenile detention centre from 1995–1998 and followed up about 5 years later to determine the continuity and comorbidity of psychiatric disorders. (1)

The authors found that while the prevalence rates of comorbidity decreased in youth after detention, rates remained substantial and were higher than levels in the most comparable studies of the general population.

Five years after detention, when participants were 14–24 years of age, almost 27% of males and 14% of females had comorbid psychiatric disorders. Substance abuse plus behavioural disorders was the most common comorbid profile among males, affecting one in six.

Participants with more disorders at baseline were also more likely to have a disorder 5 years after detention, and overall the authors found a substantial continuity of disorders.

The authors wrote that because many psychiatric disorders first appeared in childhood and adolescence, primary and secondary prevention presented the greatest opportunity to reduce costs to individuals, families and society.

“Only a concerted effort to address the many needs of delinquent youth will help them thrive in adulthood”, they wrote.

Dr Scott Harden, chair of the Royal Australian and New Zealand College of Psychiatrists’ Child and Adolescent Forensic Psychiatry Special Interest Group, told MJA InSight that this high prevalence of psychiatric disorders in youth detention centres was a universal trend observed across the developed world.

Dr Harden said this was because “a large proportion of young offenders come from disadvantaged areas where there they tend to have a higher exposure to risk factors for mental illnesses including childhood trauma, domestic violence, and substance abuse among peers”.

When released from detention, these young people “return to their communities without a solid support network and are exposed to the same risk factors, which increase the likelihood that they will reoffend”.

He said the fact that psychiatric disorders continued after detention was “unsurprising”, citing the inherent difficulty in developing effective, post-release care services across Australia’s many different jurisdictions.

“There is also a trend of non-compliance among these youths when it comes to maintaining mental health appointments once they leave detention. However, there is potential to integrate these psychiatric care appointments into the mandatory reporting obligations young offenders are subject to after their release”, Dr Harden said.

He also suggested that running mental health care services alongside educational and vocational training programs could help prevent young people returning to patterns of substance abuse.

Professor Debra Rickwood, professor of psychology at the University of Canberra and chief scientific advisor to headspace, Australia’s National Youth Mental Health Foundation, told MJA InSight that a major cause of the poor mental health outcomes in Australian juvenile detention centres was the fragmentation of health, community and criminal systems.

“Currently, young people are not being tracked as they move through different parts of the system and, as a result, they get lost in it”, she said.

Many young offenders with severe psychiatric disorders had “most likely already received some treatment within the community” but if they were in detention this same care was not always continued, Professor Rickwood said.

“Within a detention facility, patients may receive new care plans where they are treated by different people and receive different medications. Then when they are released, this treatment routine is disrupted again.”

Professor Rickwood believed that Australia’s various criminal systems needed “to better integrate with community, health and welfare agencies to ensure that young people receive individualised treatment plans that are followed through after detention”.

While the US researchers highlighted the need for improved early prevention efforts in high schools, Professor Rickwood said this approach alone was “too simplistic to be effective in Australia”.

She suggested that a more holistic approach was needed across all states and territories, where the different systems collaborated to provide consistent mental health support.

The ACT Government’s Blueprint for youth justice in the ACT 2012–22 was an example of such a strategy, which emphasised that the case management of young offenders should be shared across government departments and within communities, Professor Rickwood said. (2)

1. JAMA Psychiatry 2014; Online 26 November
2. ACT Government 2012; Blueprint for youth justice in the ACT 2012-2022

(Photo: andrearoad / iStock)