"These are the first guidelines to give real-world advice for how to treat the mental health needs of youth in correctional facilities," says lead author Joseph V. Penn, MD, CCHP, with the Bradley Hasbro Children's Research Center (BHCRC) in Providence, RI.
According to the authors, although many psychiatrists provide consultation to institutions that house youth with juvenile/family court involvement, there are virtually no guidelines for effective psychiatric evaluation. For example, there are no set standards for consultation, managing potential role conflicts, prescribing psychotropic medications, or the use of seclusion and restraints, nor have they received adequate training to handle these kinds of situations.
"The need is immediate, and it is only getting worse – this is a rapidly growing population and these kids are more suicidal and face more mental health, substance use, and learning issues than any other patient population. Until now, there's been no practical guidelines regarding how to approach these youths in these challenging settings," says Penn.
The guidelines recommend educating clinicians on the unique system issues they will face in juvenile correctional facilities and to screen and monitor all juvenile offenders for mental health or substance abuse disorders. They also recommend referring all juvenile offenders who discuss or attempt suicide for a more systematic mental health evaluation and treatment.
Penn was prompted to write the guidelines because of his own experience as a child psychiatrist entering clinical practice in juvenile correctional systems in 1999. He was "amazed by the lack of literature providing practical clinical approaches for navigating numerous potential land mines in this area."
Since mental and substance-related disorders are significantly more common among juvenile offenders than in other youths, they present a unique challenge to the family/juvenile courts, probation, social service agencies, and the juvenile justice system.
"Mental health professionals in this setting face myriad hurdles – potential role conflicts, confidentiality issues, mandated reporting requirements, negative perceptions toward delinquent youth – and other practical issues in addressing the multiple needs of these youths in the constraints of correctional systems," the authors write.
Penn and his colleagues hope the new recommendations will help guide psychiatrists and other child professionals with the challenges commonly faced with this vulnerable patient population. Consequently, they expect that youth in the juvenile justice system will be given better screening, evaluation and treatment. In addition, they believe that there will be a reduction in suicides, seclusions and restraints, and injuries to youth and staff.
In the long-term, Penn believes that the practice parameter will serve as a practical tool for clinicians, as well as a call for additional research funding regarding evidence-based approaches for this population. The end-result will be to reduce juvenile offenders' recidivism, re-arrest, and re-incarceration, and have a decrease in violent and other criminal offending.
"Better mental health care for youthful offenders serves the intended goal of rehabilitation," Penn says.
Founded in 1931 as the nation's first psychiatric hospital for children, Bradley Hospital (www.bradleyhospital.org) remains a premier medical institution devoted exclusively to the research and treatment of childhood psychiatric illnesses. Bradley Hospital, located in Providence, RI, is a teaching hospital for Brown Medical School and ranks in the top third of private hospitals receiving funding from the National Institutes of Health. Its research arm, the Bradley Hasbro Children's Research Center (BHCRC), brings together leading researchers in such topics as: autism, colic, childhood sleep patterns, HIV prevention, infant development, obesity, eating disorders, depression, obsessive-compulsive disorder (OCD) and juvenile firesetting. Bradley Hospital is a member of the Lifespan health system.
Journal
Journal of the American Academy of Child & Adolescent Psychiatry