Transcript Mental Health and Juvenile Justice

Mental Health
and Juvenile Justice
Class 19
Mental Health
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Historical Antecedents
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Hijacking of juvenile court by psychologists and
psychiatrists in its “second phase”, starting in the
1920s (shift from social work interventionist model)
Sharp rise in admissions of minors to mental hospitals
in this era
Commensurate with expansion of institutional and
other residential mental health services
Deinstitutionalization movements in the 1970s (linked
to federal funding under 1974 JJDPA)
Private sector growth: increase in use of private MH
facilities from 37% to 61% in one decade (Weithorn) –
political economy?
Recent Trends
•There appears to be an increasing number of youth with mental disorders
entering the juvenile justice system. The Texas Youth Commission reported
a 27% increase in the number of youth with mental disorders entering the
state's juvenile justice system between 1995 and 2001 (TYC, 2002).
•Many of these youth are incarcerated for minor, non-violent offenses. A
review in Louisiana found that 73% of youth in Louisiana were incarcerated
for non-violent offenses. A similar review in Texas found 67%
(Schwank et al., 2003).
•There is concern that the juvenile justice system is becoming the system
of "last resort" for many youth. A 1999 survey by the National Alliance for
the Mentally Ill (NAMI)found that 36% of their respondents reported having
to place their children in the juvenile justice system in order to access
mental health services that were otherwise unavailable to them (NAMI, 1999).
A more recent study conducted by the U.S. General Accounting Office (GAO)
found that in 2001, parents placed over 12,700 children into the child welfare
or juvenile justice systems in order to access mental health services (GAO,
July 2003).
Source: National Center for Mental Health and Juvenile Justice, 2005
Mental Health as Prediction
 IQ
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and personality scores
Psychopathy - stable and enduring trait,
explanation for lack of tractability of
delinquents to treatment
Measurement
• The PCL Y-R
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Utility in Prediction?
Deviance or development?
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Factor 1 - Interpersonal/Affective
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p0pcl01 - Impression Management.
p0pcl02 - Grandiose Sense of Self Worth.
p0pcl04 - Pathological Lying.
p0pcl05 - Manipulation for Personal Gain.
p0pcl06 - Lack of Remorse.
p0pcl07 - Shallow Affect.
p0pcl08 - Callous/Lack Empathy.
p0pcl16 - Failure to Accept Responsibility
Factor 2 - Socially Deviant Lifestyle
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p0pcl03 - Stimulation Seeking.
p0pcl09 - Parasitic Orientation.
p0pcl10 - Poor Anger Control.
p0pcl12 - Early Problem Behaviors.
p0pcl13 - Lacks Goals.
p0pcl14 - Impulsivity.
p0pcl15 - Irresponsibility.
p0pcl18 - Serious Criminal Behavior.
p0pcl19 - Serious Violations of Conditional Release.
Practices
 Standards
for court-initiated placement to
a MH institution or facility?
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Behavioral criteria
Diagnostic Classification
“Severe problems” attributable to a
“psychiatric disease”
Akin to diagnosis of “dangerousness”
(Weithorn, at 787)
MH Diagnosis as marker of dangerousness
Legal Regulation
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Case Law
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Parham v J.R. 442 U.S. 584 (1979)
What are minor’s due process rights when parents
seek to institutionalize child in mental health facility
Should this be an adversarial proceeding?
Federal district court ruled in favor of child, enjoined
commitments without full due process
Also ordered expenditure of funds to create noninstitutional alternatives
SCOTUS Reversed. Court recognized stigmatizing
consequences of mental health placement but
distinguished it from stigma of “delinquent”
• Therefore, not in conflict with Gault, 6th or 14th amendment
concerns
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SCOTUS declined to require states to regulate use of
private mental health placements sought by parents.
Court refused to limit discretion of either parents or
state guardians in use of these facilities
• “Parents generally have the right, coupled with the high
duty….to recognize symptoms of illness and to seek and
follow medical advice”
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But Court does recognize risk of error in mental health
placement by parents, calls for review in “independent
procedure”…just not by a legal professional….”Thus, a
staff psychiatrist will suffice” (see Addington v
Texas”…. “Judges certainly can’t do a better job than a
trained mental health professional”
• Risk of error does not translate into constitutional protection
• “…Not necessary for deciding physician to conduct a formal or
quasi-formal hearing…”
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State interest only begins when the institution
endangers child, then parental rights are circumscribed
and state becomes protector of child
 Brennan
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Cannot assume that parents act in child’s best
interest when commitment to mental
institution is at stake
 Other
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Dissent
Critiques
What are the obligations of a court to
determine whether family functioning meets
“best interest” standard?
• When is this “dumping” the kid?
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Should states provide an adult standard for
mental health commitments? Aren’t all
commitments of minors “involuntary”?
Professional Regulation
Standards Projects? Very little, mostly “training
and technical assistance” to improve services–
see: National Center for Mental Health and
Juvenile Justice, http://www.ncmhjj.com/
 Financial oversight through state insurance
regulators – effective?
 Mandated review of admissions – substitution of
procedural oversight instead of substantive
review of decision making
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Juvenile Justice Placements
 “Transinstitutionalization”
beginning in the
1970s when JJDPA limited juvenile court
jurisdiction for non-delinquents
 Sharp expansion by courts following
JJDPA (Herz, at 173)
 For delinquents, MH options expanded in
1970s within juvenile corrections agencies
for “dangerous” offenders with diagnosed
mental health problems – secure TX
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Prevalence estimates
Detention:
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See: Linda A. Teplin, et al., Psychiatric Disorders in Youth in
Juvenile Detention, 59Arch Gen Psychiatry 1133-1143 (2002).
DISC measurement (interviewer-guided self-report of symptoms)
1172 males, 657 females, ages 10-18 years in secure detention in
Cook County
2/3 of males and 3/4 of females met diagnostic criteria for one or
more psychiatric disorders.
About one in five had “serious” disorder
Half of males and almost half of females had a substance use
disorder, and more than 40% of males and females met criteria for
disruptive behavior disorders.
Affective disorders were also prevalent, especially among females;
more than 20% of females met criteria for a major depressive
episode.
Rates of many disorders were higher among females, non-Hispanic
whites, and older adolescents.
• Corrections
Source: California Youth Authority, Substance Abuse and Mental Health Needs
Assessment, 2000; Thomas Grisso, Massachusetts Youth Screening Instrument for
mental health needs of juvenile justice youths. 40 Journal of the American
Academy of Child & Adolescent Psychiatry, 541-548 (2001).
 Correctional
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Institutions
Capacity of correctional institutions to protect
kids with MH problems? To treat them?
How are classifications and decisions made?
Validity of testing and classification measures?
• Steven Erickson, “Psychological Testimony on Trial:
Questions Arise About the Validity of Popular Testing
Methods,” XIX Law Guardian Reporter, December
2003
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Daubert tests challenge validity of MMPI,
Rorschach, others (see also NYT, 3/9/04,
Science 1).
Decision Making and Disparity
 Which
offenders receive mental health
placements and which are sent to
correctional institutions?
 Disparities by race and gender?
 Balance of ‘penal proportionality’ with
treatment needs?
 Herz
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Study
N=4,758 cases
Females, Whites, Age (younger) more likely to
receive MH placement over other correctional
placements
Prior record and offense seriousness were not
significant predictors
Geographic and court jurisdiction variations
reflect availability of services and different
preferences of judges (PPG articles)
Current Climate
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PPG Articles
Deinstitutionalization has depleted MH
resources, created dependence on JJ system for
kids with mental health or emotional problems
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 Low threshold for detention and incarceration
creates little room for risk in placement decisions
 PA HB 1448 – relaxes standards for involuntary
commitments of youths for mental health and
substance abuse treatment based on physician
recommendation
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Unchallenged as a result of Parham
Example of how this area of juvenile justice is driven
far more by statute than by case law
The MAYSI
Questionnaire and Coding Scheme
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Thomas Grisso et al., Massachusetts Youth Screening
Instrument for Mental Health Needs of Juvenile Justice
Youths, 40 J. Am. Acad. Child Adolesc. Psychiatry 541
(2001)
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“The MAYSI-2 was intended primarily for use at the
front door of juvenile justice programs to identify
youths who may be in need of immediate clinical
intervention” … “as a triage instrument rather than for
formal diagnoses or to identify long-term treatment
needs.”
Some Residual Issues
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Disparity by race and gender
Methods of legal or social regulation of
placement decisions and conditions
 Can you make an argument that mental health
placement is punitive?
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Wouldn’t that require that Parham be overturned?
Sexual abuse and institutional violence – revictimization
 What happens if we import Hendricks logic?
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Correctional placement as pathway to mental health
placement when offender is violent?
Either non-responsive to institutional care or history of
violence triggers Hendricks/Crane evaluation?