In juvenile hall, most may have mental disorders

Youths in juvenile detention centers were certain to have their share of mental illness, researchers thought. What they didn’t expect was the size of the problem: More than two-thirds of detained youths have diagnosable psychiatric disorders, they found.

Researchers from Northwestern University near Chicago found that nearly two-thirds of boys and three-quarters of girls, ages 10 to 18, had at least one psychiatric disorder. In the general population, about 15% of children have mental illnesses or substance abuse disorders.

Previous studies on the rates of mental illness among detained youths ranged widely. The new study, in the December issue of the Archives of General Psychiatry, sampled 1,829 youths of various ethnicities, both boys and girls, upon admission to the Cook County Juvenile Temporary Detention Center.

“In this, a random sample of kids in a typical detention center -- Cook County is typical; it’s not a particularly bad or good center -- our findings were quite alarming. We anticipated high rates, but not this high,” said Linda A. Teplin, a professor of psychiatry at Northwestern and lead author of the study.

For example, she said, while researchers expected to find that many children used drugs and alcohol, they were surprised that about half of the detainees had diagnosable substance abuse disorders, which involve serious addiction or long-term abuse.

The study also found that 20% of the females met the criteria for major depression.

“We often think of kids in detention as being delinquent or bad. But depression is a very serious mental disorder with serious impairment in your day-to-day life,” Teplin said.

Although many youth offenders have conduct disorder, defined as a persistent pattern of aggressive and destructive behavior, the rates of psychiatric illness remained high even when that diagnosis was excluded; 60% of boys and two-thirds of girls still had a diagnosable disorder.

The report is the first in what Teplin anticipates will be a series of studies aimed at understanding the mental health needs of youth who run afoul of the law. Her research group gained attention in the 1990s with the first detailed analyses showing high rates of mental illness among incarcerated adults.

“We feel, in part because of our studies, that those populations received a lot more attention and resulted in jails nationwide being much more concerned about treatment of mentally ill detainees in their care,” said Teplin. “We anticipate that this study will have a similar impact.”

In the paper, Teplin and her group hypothesize that more poor and disadvantaged children than ever are not receiving adequate mental health care.

The shift to managed care, in which mental health care is often not covered by insurance, and the trend toward welfare-to-work programs may leave more children without services. For example, families on welfare can receive Medicaid benefits to obtain mental health services. But many parents leave welfare for jobs that do not supply insurance or offer affordable co-payments.

“Because of cuts in the funding of children’s mental health care

The researchers plan to publish studies early next year on HIV risk and sex abuse among detained youth.