Mental health and substance use disorders: The reality of youth in custody.

Abstract

Young offenders experience a higher prevalence of mental health disorders and substance use disorders than the general population, estimated to be between 70% and 90%. (Indig et al. 2011; Kenny et al., 2006; Lader et al., 2000; Teplin et al., 2002). In addition, comorbidities affect many young offenders, with over 60% presenting with two or more disorders (Justice Health & Forensic Mental Health Network and Juvenile Justice NSW, 2015). The prevalence of mental health disorders is higher among females, with young female offenders more likely to be diagnosed with anxiety and depressive disorders, as well as substance-induced disorders (Justice Health & Forensic Mental Health Network and Juvenile Justice NSW, 2015). 2015 YPI Aboriginal and Torres Strait Islander youth are over-represented within the juvenile justice system. In a report by the Australian Institute of Health and Welfare, it was found that 50% of young offenders in 2016–2017 identified as Aboriginal and/or Torres Strait Islander (Australian Institute of Health and Welfare 2018). Mental health and substance use disorders are the most common non-communicable diseases among this group with 33% reporting high to very high levels of psychological distress (Azzopardi et al. 2018). Furthermore, there is evidence to suggest that poor family cohesion and the presence of adverse events in this group of adolescents are a reliable predictor of negative mental health outcomes (Young et al. 2016). A recent Australian study reported the strongest predictor of incarceration and re-incarceration was problematic alcohol and drug use (Indig et al., 2016). Indig et al. found that young people who were heavy drinkers were seven times more likely to have been previously incarcerated and three times more likely to be re-incarcerated within 18 months. Indig et al. (2016) also found that illicit substance use was a consistent predictor of incarceration and re-incarceration. In addition to issues with drugs and alcohol, many incarcerated young people also report experiencing adverse childhood experiences during their childhood years with as many as 90% reporting at least one traumatic event (Ford et al., 2012). A recent Australian study found that 60% of young offenders reported a history of child abuse or neglect, 20% met the criteria for posttraumatic stress disorder (PTSD) (Moore et al. 2013). A history of adverse childhood experiences is the main predictor of a diagnosis of PTSD (Moore et al. 2013). Evidence suggests a link between exposure to adverse childhood experiences and the occurrence of various mental health difficulties among young offenders (McReynolds & Wasserman, 2011; Wasserman & McReynolds, 2011; Wilson et al., 2009). It is unfortunate that many troubled youth are not recognized as being distressed or having mental health difficulties, and so do not have access to appropriate mental health care. Furthermore, these young people and their families may have very low levels of mental health literacy. However, once these young people come to the attention of the justice system, we have an opportunity to raise mental health literacy and provide appropriate services. There is a need for programmes and services that address mental health and substance use issues to assist young people improve their health outcomes and reduce their offending behaviours. Programmes such as monthly recovery management check-ups in the first 90 days postrelease could help to achieve this outcome (Indig et al., 2016). Given the high rate of adverse childhood experiences in incarcerated youth and the known link to PTSD, we need to ensure that services are informed by a trauma informed approach (Moore et al. 2013). There is also an identified need to invest in prevention and early intervention for young people. Currently, there are diversion programmes offered within the local court system in NSW for adult offenders exhibiting mental health (Statewide Community & Court Liaison Service) or substance use disorders (Magistrates Early Referral Into Treatment (MERIT)). However, these programmes are not available to offenders under the age of 18 years and adolescent diversion programmes are not routinely or diversely available to young people residing outside of the Sydney metropolitan area. The mental health and substance use issues affecting young offenders challenge us to respond with effective interventions. Mental health nurses have an important role to play in improving the services and interventions available to these young people. Changes have been made to services for young offenders but more needs to be done. Research has shown that diversion and treatment services delivered in the community using a trauma informed approach are more effective in this population (Dierkhising et al. 2013). Moving forward, mental health nurses have an opportunity to take the lead in this important area.