November 11, 2003
Psychiatric Illness, Drug Abuse Common in Jailed
Youth
CHICAGO --- A study by Northwestern University researchers shows
that about half of teens in juvenile detention have two or more
psychiatric disorders and substance abuse disorders.
The study, conducted by Karen M. Abram, Linda A. Teplin and co-researchers
from the Psycho-Legal Studies Program at the Feinberg School of
Medicine at Northwestern University, also found that the most common
combination was substance abuse disorders and attention deficit
hyperactivity disorder (ADHD) or behavioral disorders, which affected
almost a third of 1,829 teens examined. Almost half also had anxiety
disorders, affective disorders or both.
More than one of 10 teens had a substance abuse disorder and
a major mental disorder, such as psychosis, manic episode or major
depressive episode. Among 305 teens with major mental disorders
in the current study, more than half of girls and almost three
fourths of boys also had a substance abuse disorder.
“Treating these youth is a real challenge,” Abram
said.
“Their disorders may get them into trouble. But detention
centers were never designed to be mental hospitals,” she
said.
Results of the study, conducted at the Cook County Juvenile Temporary
Detention Center in Chicago, were published in the November issue
of Archives of General Psychiatry. The Cook County facility was
selected because it is typical of other urban detention centers
nationwide.
Mental health professionals speculated for years that because
of failures in the mental health system, many adolescents with
serious psychiatric disorders are arrested instead of treated.
An earlier study by the Psycho-Legal Studies group found that even
after excluding conduct disorder (symptoms of which include delinquent
behaviors), approximately 60 percent of males and 70 percent of
females in juvenile detention have at least one psychiatric disorder.
Substance abuse was the most frequent disorder, affecting 50 percent
of the sample. These rates of disorder far exceed those of teens
in the community.
Abram estimated that, nationwide, there may be as many as 47,000
detained juveniles who have two or more types of psychiatric disorder;
more than 12,000 have both a major mental disorder and a substance
abuse disorder.
“Comorbidity of psychiatric disorders is the rule, not
the exception,” Abram said.
On an average day, more than 106,000 teens are in custody in
U.S. juvenile facilities, and of these, over 60 percent are racial
or ethnic minorities and from low-income families. Thus, psychiatric
disorders in detained adolescents are a significant health disparities
issue, Abram said.
The authors suggest that mental health professionals must collaborate
with the juvenile justice system to: better screen detainees for
psychiatric problems; divert youths with major mental disorders
who are not community threats to treatment facilities on arrest;
and reduce barriers to mental health services.
Abram is assistant
professor of psychiatry and behavioral sciences. Teplin is Owen
L. Coon Professor of Psychiatry and Behavioral Sciences
and director of the Psycholegal Studies Program. Their co-authors
on the study were Gary M. McClelland, research assistant professor
of psychiatry and behavioral sciences, and Mina K. Dulcan, M.D.,
professor of psychiatry and behavioral sciences and head of child
and adolescent psychiatry, Children’s Memorial Hospital.
This study was supported by grants from the National Institutes
of Health, the Substance Abuse and Mental Health Services Administration,
the Centers for Disease Control and Prevention, the Office of Juvenile
Justice and Delinquency Prevention, the Robert Wood Johnson Foundation,
the William T. Grant Foundation and a consortium of other agencies. |