October 2003

Q: Why are mental health services for juveniles lacking?

This topic is an issue for most states. The sentiment that mental health services should be available for delinquent youth is espoused by families, juvenile justice workers and administrators, judges, attorneys, advocates, mental health clinicians, educators, and many law enforcement officers. Each admits to having regular interaction with children and youth entering the juvenile justice system, where they know there is little chance of treatment for so many in need of mental health and substance use/abuse treatment.

Lack of funding for treatment and community awareness of the severity of this problem are major barriers to treatment. Insurance restrictions on where reimbursable treatment can occur present yet another barrier. Understanding the difference between mental health issues and disorders and "bad acting" or "just acting out" is difficult for juvenile justice personnel; this lack of understanding translates into a problem for children and youth in the juvenile justice system. All too often, what is determined to be noncompliance with a program in juvenile justice is met with sanctions or punishment instead of a deeper look to see whether the action is characteristic of one of the many diagnoses prevalent in the population of youth served in juvenile justice programs.

Mental health professionals are at a premium in juvenile justice settings and often have very strict restrictions on whom they can see and how long they can spend with children in that system. A psychiatrist at one of the system of care sites also works in the secure juvenile corrections program in her state. She is concerned that she is not allowed to spend more than 30 minutes with any child in that setting. Certainly, she gives much of her own time to compensate for that shortcoming, but she is seeking ways to get appropriate services to children who are in secure juvenile correctional settings in her state.

More than 25 states are currently using the MAYSI-2 to screen for the "emotional temperature" of a child/youth transitioning to different parts of the juvenile justice system. The MAYSI 2 is only a screen. It is intended to identify those children who could benefit from a clinical interview to determine whether a diagnostic assessment is appropriate. When it is determined that a diagnostic assessment is necessary, fear strikes in the hearts of many juvenile justice and mental health professionals because they know that most systems lack the capacity to meet the needs that an assessment might identify.

This absence of services and supports is yet another reason that so many seriously emotionally disturbed children and youth in the juvenile justice system are not receiving treatment. It is critical that systems find ways to braid the existing funding in multiple agencies for these youth to ensure appropriate and timely treatment of their mental health and substance use/abuse needs. By no means is this braiding going to be easy, given the budget cuts in every agency and the increasing demands for service in this population.