A significant number of former juvenile inmates in Chicago’s Cook County jail believe they don’t need mental health, alcohol or substance abuse treatment and most often believed their problems would go away on their own, according to research [PDF] published this month by the Office of Juvenile Justice and Delinquency Prevention’s (OJJDP) “Northeastern Juvenile Project.”

The project studied 1,892 youth between the ages of 10 and 18 who had been incarcerated at the Cook County Juvenile Temporary Detention Center between 1995 and 1998. Other bulletins in the series found that formerly incarcerated young black men and women at the detention center faced dramatically higher mortality rates than the general population, and suffered from higher rates of substance abuse and mental health disorders.

Rates of psychiatric, conduct or substance abuse disorders are very high among juvenile inmates when compared to the general population. While governments are compelled to provide a minimum of health services to inmates, OJJDP notes “youth in custody are profoundly underserved,” citing statistics that only 15.4% of detainees with mental health disorders receive treatment.

The study may be one of the first of its kind to examine the impact of former youth inmates’ perceptions on their access to healthcare.

“How youth think about services helps determine whether they cooperate with referrals or remain in treatment,” the authors wrote.

In other words, if a child did not think there were services or programs out there to support them, or did not think they needed support, they were unlikely to receive treatment.

The most common perceived barrier to healthcare was the belief that problems would go away on their own. Those with “self-identified mental health needs” most often believed they did not require treatment. Interestingly, researchers found that family members often shared this belief, leading researchers to question whether this might be an intergenerational issue.

This is perhaps one of the most important perceived barriers to overcome because, for kids to get the care and services they need, researchers say they must “first understand that they need mental health services before they will seek them out and stay in treatment.”

31% of former youth prisoners were not sure who to contact or where to go for treatment and counseling. 19.1% reported difficulty in accessing available services. 27% reported “other” barriers, including denial that a problem exists, disinterest in treatment and dissatisfaction with a therapist or treatment.

The perceived obstacles to care were especially pronounced among minority former prisoners who were also found to receive substantially fewer services than their white counterparts — a disparity that exists in the general population as well. Black and Hispanic former prisoners were more likely to suggest they did not have a problem that required treatment. More white than non-white participants said they feared being labeled or suffering negative consequences as a result of pursuing treatment.

However, it is important to note that attitudes and perceptions alone do not explain racial and ethnic disparities in services and treatments for individuals. Researchers point to “external factors such as poverty, lack of sufficient minority service providers, and sociocultural barriers” instead.

The data was also markedly different when looking at males versus females. Formerly incarcerated young men in Cook County received fewer services than females. Significantly more males than females said they did not have a problem. Males who had not been treated were also significantly more concerned about what others might think of them than women. Males who had been referred but never received services expressed uncertainty about how and where to get help, compared to those who had had access to services. For males and females alike, significantly more who had never received services were worried about the cost of treatment than those who had.

Researchers point to national studies that include similar barriers to care for people in the general population, citing a problem with the healthcare system in the United States overall, characterized by fragmented services, unavailability of longterm or ongoing care, and the segregation of substance abuse and mental healthcare from general practice which limits opportunities for continuity in treatment and collaboration between healthcare professionals.

The OJJDP recommend investigations into the “charactertistics of mental health services that high risk youth receive and why they are satisfied with these services.” They also suggest further research into the gender and racial differences in the use of services and the role of social networks in a young person’s attitude toward treatment.