Illinois Juvenile Justice Commission
ANNUAL REPORT TO THE
GOVERNOR AND GENERAL ASSEMBLY
for Calendar Years 2007 and 2008

February 10, 2009


MENTAL HEALTH

Increasingly, youth involved with the juvenile justice system are diagnosed with mental health disorders. The Surgeon General's 2002 Report on Children's Mental Health found that the prevalence of mental health disorders among youth in the juvenile justice system is three times higher than that among youth in the general population.

The National Center for Mental Health and Juvenile Justice, working in partnership with the Council of Juvenile Correctional Administrators, completed a comprehensive study of the mental health needs of youth in the juvenile justice system. They found that, overall, 70 percent of youth were diagnosed with at least one mental health disorder, with girls experiencing a higher rate of disorders (81.8%) when compared to males (66.8%). Many of the youth in the study exhibited more than one mental health disorder. Of those youth who were diagnosed with a mental health disorder, 79 percent met the criteria for at least one other mental health diagnosis. The majority of youth who met criteria for a mental health diagnosis also were diagnosed with a co-occurring substance use disorder (Skowyra & Cocozza, 2007).

In Illinois, there is growing concern about the number of youth in the juvenile justice system who suffer from mental health disorders that go undiagnosed or untreated. Many youth are detained or placed in the juvenile justice system for relatively minor, non-violent offenses due to the lack of community-based service options available. The placement of youth in the juvenile justice system as a means of accessing mental health care is part of a growing trend toward the "criminalization of the mentally ill" (Bell & Shern, 2002). The U.S. Department of Justice conducted a series of investigations into the conditions of confinement of youth in juvenile detention and correctional facilities across the country. These investigations consistently highlighted the lack of appropriate screening, assessment and treatment available to youth in their care.

Further, youth in the juvenile justice system have a very high rate of having been exposed to trauma. Child trauma has been defined by the National Institute of Mental Health as "the experience of an event by a child that is emotionally painful or distressful which often results in lasting mental and physical effects." Children exposed to trauma often exhibit a combination of symptoms or problems that often produce varying behaviors from youth to youth which can be confusing for those working to understand them and far too often leads to misdiagnosis as mental illness. Unfortunately in many Illinois communities there is a critical shortage of youth service organizations with the capacity for conducting professional mental and behavioral health assessments and the ability to provide proven approaches for treatment and so youth are often inappropriately remanded to the juvenile justice system.

There is ample evidence and a growing body of literature that supports the need for mental health services in the juvenile justice system. Henggeler, et al, (1992) published solid and repeated documentation of reduced recidivism as a result of Multisystemic Therapy (MST) and Functional Family Therapy (FFT) at much lower costs than incarceration. A 2000 review of the research on the characteristics of effective mental health treatments for youth in the juvenile justice system found that community-based treatment and programs are generally more effective than incarceration or residential placement in reducing recidivism, even for serious and violent juvenile offenders (Lipsey, et al, 2001). Numerous reviews of evidence-based mental health treatment interventions have found positive outcomes including decreased psychiatric symptomatolgy and reduced long-term rates of re-arrest (Henggeler, et al). These evidence-based interventions are all family and community-based models, and are being used throughout the country for youth referred from the juvenile justice system. Diverting youth into effective treatment that addresses their mental health needs and reduces the likelihood of further delinquency offers a more effective alternative than simply locking them up with limited access to effective treatment (Skowyra & Cocozza, 2007). However, these evidenced based interventions are hard to come by for many communities as they require significant administrative costs to ensure fidelity to the model. These costs, training for staff, fees for ongoing technical assistance, etc. are not generally supported by state grants and are often considerable for a community agency.

The lack of appropriate mental health treatment for youth involved in the juvenile justice system can be attributed in part to the lack of coordination between the state's mental health and juvenile justice systems. While administrative responsibility for Illinois' mental health system rests with the IDHS, there is no single entity responsible for oversight of the juvenile justice system. That responsibility is widely dispersed among agencies and organizations at the local, county, and state levels, resulting in substantial fragmentation of the system. The IDHS' Division of Community Health and Prevention administers a full range of prevention and intervention programs for system-involved youth to divert youth from the juvenile justice system in favor of community-based services. However, access to needed mental health and trauma services through those programs is limited by fiscal and programmatic constraints.

Mental Health Pilot Initiative

In 2005/2006 IDHS in collaboration with the Illinois Collaboration on Youth/Youth Network Council (ICOY/YNC) implemented the Juvenile Justice Mental Health Initiative (JJMHI). This initiative operated through 22 IDHS provider organizations at 38 sites throughout Illinois to provide mental health services to youth who were in contact with either the law enforcement or juvenile justice system and who had been assessed as having a mental health disorder. Ninety-five percent (95%) of the youth who were served by JJMHI had no additional law enforcement contact during the pilot period. Nearly two-thirds of the young referred to the program had histories of offenses against other persons, while more than two-thirds (69%) also had histories of alcohol and/or drug-related problems. Three-quarters (75%) of youth enrolled had been diagnosed with a serious mental illness, per the Diagnostic and Statistical Manual (DSM- IV). Of those youth with a single diagnosis, those diagnoses most commonly indicated were: substance abuse, depression and conduct disorders. Those youth who were diagnosed with dual or multiple diagnoses most frequently were also abusing substances in "numbers that are higher than would be expected." This initiative highlights the success of reduced recidivism as a result of timely access to mental health treatment at a community-based level.

IJJC Action and Recommendations

Action

  • In SFY2007 the Commission provided $1,607,317 to fund 16 Delinquency Intervention Services grants designed to intervene in the lives of youth determined to be at high risk of further involvement in the juvenile justice system. Youth targeted were adjudicated delinquent and placed on probation. These youth were provided services based on an individualized case plan and the providers were required to implement evidenced-based programming and services. The most common approaches were Multisystemic Therapy and Functional Family Therapy. Over the three year grant period, these 16 providers served approximately 1,000 youth with 72 percent completing the program successfully with no incidence of re-offending.
  • The Commission has initiated the Youth Services - Medicaid Pilot. The IDHS youth services system is and has been chronically under-funded. Consequently, it struggles to provide needed services to youth, in particular mental health services. Building on the success of the earlier JJMHI pilot, this initiative is to identify and provide mental health services to youth that come into contact with the youth service system. Further, it is to create a mechanism by which youth services providers can, through Illinois Department of Healthcare and Family Services, claim Federal Medicaid reimbursement. These federal reimbursed funds would be distributed back to the youth services providers in the form of a grant increase in subsequent years. Eighteen IDHS youth services providers are currently under consideration for funding as part of the pilot.
  • In 2007/2008 the Commission, through funds awarded to ICJIA, began to assess the various mental health tools used in the juvenile justice system. The types of assessments, the point at which they are used in the juvenile justice system as well as the credentials of the individual administering these assessments are the focus of the study. The study is necessary to determine what exists and the possible deficiencies in mental health screening and assessment practices. The results of the study are expected in late spring 2009.
  • Mental illness and substance abuse are closely linked among justice populations, and particularly among juvenile justice populations. They are so common that most federal funding initiatives now presume their co-occurrence and require assessment and treatment of both. The Mental Health Pilot initiative confirmed this link, revealing that more than two-thirds (69%) of the youth referred to the program had histories of alcohol and/or drug-related problems and were frequently abusing substances in "numbers that are higher than would be expected." Substance abuse and mental illness are also self-perpetuating in tandem. The mentally ill individual may not possess the behavioral temperance that would otherwise discourage drug use, and drug use and addiction in turn impair judgment, further weaken mental faculties, and may incline an individual to commit acts to support the physiological addiction. In delinquent populations, that behavior is often criminal in nature. Because mental illness and substance use appear together, they must be addressed together. In 2009, the Commission will begin to take the steps necessary to focus attention on the issue of substance abuse prevention, treatment, and recovery within the broader context of mental health services to youth. The Commission recognizes that the absence of services to address either issue dramatically hinders the opportunity for a successful outcome.

Recommendations

  • The Governor and General Assembly must increase funding for the Comprehensive Community-Based Youth Services system at IDHS. This system is mandated by statute and has received relatively flat funding for more than a decade. As the number of youth in need of services increases, coupled with the increasing severity of those needs, the system struggles to provide sufficient services to those youth identified as in an "immediate crisis". The lack of resources creates a cycle in which many youth are showing up in the juvenile justice system because needs are going unidentified and untreated in the youth services system.
  • Direct funding to community-based youth services providers to build and maintain the capacity to deliver evidence-based mental health treatment interventions such as MST and FFT as well as trauma-focused treatments recognized by the National Child Traumatic Stress Network.