Formerly incarcerated youth in Cook County, Chicago, were diagnosed with psychiatric disorders at a rate higher than that of the general population, according to a research bulletin [PDF] published by the federal Office of Juvenile Justice and Delinquency Prevention’s (OJJDP) “Northeastern Juvenile Project” in September. The research also found Black former juvenile inmates had lower prevalence rates for psychiatric and substance abuse disorders over time than compared to whites and Hispanics, despite the fact that they constitute a disproportionately larger segment of the incarcerated population.
The findings are part of a longitudinal study of 1,892 youth between ages 10 and 18, who were incarcerated at the Cook County Juvenile Temporary Detention Center between 1995 and 1998. A separate bulletin published as part of the series found that formerly incarcerated young Black men and women at the detention center faced dramatically higher mortality rates than the general population.
For this study, researchers conducted three interviews with participants over the course of five years, using the Diagnostic Interview Schedule for Children (DISC), version 2.3 in English and Spanish. The interview schedule is based on the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM–III–R), and is used to “assesses the presence of disorders in the past 6 months.”
They found that 60% of youth heading into detention centers were diagnosed with psychiatric disorders, not including oppositional defiance disorder or conduct disorder, but their ongoing exposure to “risk factors,” such as maltreatment, substance abuse or a dysfunctional family life, increased the likelihood their disorders would worsen during and after detention.
To further complicate matters, short stays in jail combined with a lack of access to services on the outside may have contributed to the decline in their mental health. “Among detained juvenile offenders, only 28 percent of youth are in facilities 30 days or more, which greatly limits any efforts to diagnose and treat them,” the authors wrote. “Therefore, they may pose problems in the community when they are released and may continue to burden society as they age.”
Substance abuse was the most prevalent diagnosis, regardless of gender, and was most commonly found among non-Hispanic whites and Hispanics. Compared with African Americans, white and Hispanic former inmates were more likely to have a drug or alcohol abuse disorder. White former youth inmates also had the highest rates of disruptive behavior disorder over time, followed by Hispanics. About one-in-five participants had a mood disorder that continued into the second interview, regardless of gender.
The racial/ethnic breakdown in diagnoses is interesting given the high incarceration rates of African Americans. The researchers write that their findings are “consistent with the views of many researchers—that disproportionate minority confinement for drug offenses is due, in part, to disparate enforcement of drug laws in African American communities rather than higher rates of drug use or dealing.”
While prevalence rates for most disorders declined over time, researchers found that “a substantial proportion of delinquent youth continue to have disorders as they age.”
For some youth, detention may coincide with a period of crisis that subsequently abates. Many youth, however, continue to struggle: 5 years after detention, when participants were ages 14 to 24 years, nearly 50 percent of males and nearly 30 percent of females had one or more psychiatric disorders, with their associated impairments.
The authors recommended mental health policy focus on males, who face higher rates of persistent psychiatric and substance abuse disorders than females. It also urges governments to diagnose and treat disorders in detention and after release.
Notably, researchers believe that “despite the promise of the Patient Protection and Affordable Care Act and the healthcare reform it will bring, the law may not improve mental health services for persons such as those who participated in this study, who may frequently cycle through correctional facilities. Incarceration disrupts community treatment and Medicaid benefits. Therefore, services must be improved both in correctional facilities and in the community, where the majority of detainees will eventually return.”