Health interventions and youth justice

YOUTH justice legislation varies between states and territories in Australia, but generally applies to children and adolescents aged between 10 and 17 years old. Ideally, these processes centre around efforts for rehabilitation, with preferential diversion from the correctional system; however, children as young as 10 years old can be sentenced to serve time in detention. This reflects the current age of criminal responsibility in Australia and does not align with known neurodevelopmental milestones.

This has been a focus of recent advocacy efforts by doctors and lawyers alike (here and here), with calls to increase the age of criminal responsibility to 14 years in line with international understanding of child development and recommendations from the United Nations Committee on the Rights of the Child. Indeed, both the Royal Australasian College of Physicians and the Royal Australian and New Zealand College of Psychiatrists support the call to raise the age of criminal responsibility (here and here).

During 2020, the Australian Council of Attorneys-General met to consider a proposal to increase the age of criminal responsibility but has since deferred decision making on this issue until 2021. An interjurisdictional working group is currently reviewing this matter, comprising of representation from each state, territory and the Commonwealth. It is therefore timely to consider the complexities associated with childhood offending, and the role of health care rather than punishment in addressing problematic behaviour.

To set the scene, on an average day in Australia, there are approximately 5500 young people under youth justice supervision, including 900 young people in detention and 4600 young people under community-based supervision. Although many people may associate youth offending with diagnoses such as oppositional defiant disorder, conduct disorder and antisocial personality disorder, this represents only part of the relationship between mental illness and offending in childhood and adolescence.

Indeed, many young offenders also meet criteria for post-traumatic stress disorder, secondary to high rates of previous exposure to childhood abuse and neglect, and other forms of trauma. The association between child maltreatment and the involvement of a young person in the justice system is particularly significant in Australia, impacting upon more than half of the young people in Juvenile Justice in New South Wales. Lived experience of sexual abuse is particularly common for young female offenders.

The prevalence of speech, language and communication problems is also higher in young offenders than in the general community, and is linked to the development of social and other behavioural difficulties during adolescence (here and here). Indeed, approximately half of all young people in custody in NSW are estimated to have severe language difficulties, with more than 78% of these young people experiencing severe difficulties with reading comprehension.

Furthermore, while the prevalence of foetal alcohol spectrum disorder in adolescent offenders in Australia is largely unknown, one international study has suggested that young people with this disorder are up to 19 times more likely to be incarcerated than other adolescents within the community. This highlights that the full suite of precipitants involved in the development of offending behaviour in childhood and adolescence may not yet be delineated and can even lead to miscarriages of justice (here).

Finally, numerous studies suggest that the process of detention exacerbates mental illness for young people, with potential for retraumatisation. Children experience isolation differently from adult prisoners due to their stage of development, and have higher rates of suicidal ideation in more isolating environments (here and here). Approximately 25% of youth in detention report an increase in suicidal and self-harm thoughts after entering custody (here and here).

With these considerations in mind, further examination of the interrelationship of offending behaviour with health in childhood is likely to deliver opportunities to address mental, physical and social health needs across key intervention points. As health practitioners, we therefore have a duty to review systemic and other contributors to offending behaviour in order to best support a change in the trajectory of the lives of vulnerable young people.

Dr Skye Kinder is a trainee with the Royal Australian and New Zealand College of Psychiatrists and is a passionate advocate for marginalised and disadvantaged patients. She is the Victorian 2019 Young Australian of the Year. She can be found on Twitter at @skyekinder

The statements or opinions expressed in this article reflect the views of the authors and do not represent the official policy of the AMA, the MJA or InSight+ unless so stated.