Mental health screening and assessment in juvenile justice

Abstract

The editors of Mental Health Screening and Assessment in Juvenile Justice start with the premise that every year an increasing number of children with associated mental health disorders enter the juvenile justice system. They note that an administrator of a juvenile justice correctional program stated that the “three most pressing issues in juvenile justice facilities today are mental health, mental health, and mental health.” When asked the same question 15 years earlier, another mental health administrator stated “public safety, public safety, and public safety.” The difference in these quotes highlights the shift in focus from juvenile crime prevention to the current crisis with, and recognition of, mental health disorders among incarcerated youths today. Mental Health Screening and Assessment in Juvenile Justice is a comprehensive book organized into six sections: Preparing for Screening and Assessment, Multidimensional Brief Screening Tools, Unidimensional Screening Tools, Comprehensive Assessment Instruments, Risk for Violence, and Recidivism and Forensic Assessment Tools. Each section reviews tools principally developed after 1990 in the context of increasing focus on juveniles and their mental health needs. The tests reviewed in the book were chosen for four basic reasons: (1) they are easily available through commercial test publishers; (2) they have been developed for use in juvenile justice settings; (3) their procedures satisfy basic test construction criteria; and (4) they have shown reliability and validity in juvenile justice settings. The book lends itself to a comprehensive and thorough review of each instrument because the developers of the tests are typically the authors of the chapters. The preface, citing a recent review by the U.S. House of Representatives subcommittee, states that 15,000 youth are incarcerated every year because of mental health-related disorders. In this context, detention centers have a “custodial obligation” to these children and must be prepared to identify them and to facilitate their treatment in a timely manner. Moreover, a child’s rights around “due process,” such as the rights to avoid self-incrimination and to waive or obtain representation by an attorney, may be placed in jeopardy if a mental health disorder goes untreated. Clearly, treatment of a child’s mental health needs is important on many levels, and a lack of appropriate screening and assessment tools within a detention center does not absolve the center of their responsibility to the child. Section I, Chapter 2 is entitled “A Developmental Perspective on Adolescent Personality, Psychopathology, and Delinquency.” In it the authors provide a comprehensive review of how developmental issues affect the understanding of child psychopathology. As an example, the authors introduce the concept of “instability of youth” or mental health-related phenomena that may reflect serious psychopathology as an adult but is seen as developmental and more ageappropriate for a juvenile. Issues surrounding the concept of developmental appropriateness come up again in Section V around the Hare Psychopathy Checklist: Youth Version. Also in Chapter 2, the authors discuss a juvenile’s risk for violence. While the literature is described as “largely inconsistent,” the authors state that youth who manifest disruptive disorders in combination with a lack of empathy and remorse are at higher risk for delinquency and violence. The authors report a 5 to 20 times greater likelihood that children involved with substances will exhibit violent and delinquent tendencies later in life. Mood disorders are also cited as a potential risk for violence. As an example, a sullen, depressed, irritable youth could elicit abrupt and aggressive responses from others. His depression may also result in a greater propensity to interpret annoyances as “direct threats,” thereby leaving him at risk for interpersonal discord and physical altercations. The functionality and practicality of screening devices are reviewed in Chapter 3. At a minimum, the authors state that screening tools must focus on depression and anxiety; provide an indicator around the likelihood of short-term aggression; have the capacity to identify suicidal youth; and indicate the likelihood of a substance abuse or dependence diagnosis. These elements allow for more effective decisionmaking and an increasingly efficient allocation of resources surrounding a child’s mental health and/or substance abuse needs.