Psychiatric Symptoms Among Juveniles Incarcerated in Adult Prison

Objective: Although studies reveal substantial mental health treatment needs among youths in the juvenile justice system, far less is known about young offenders transferred to adult criminal court. This statewide study examined the mental health needs of young offenders who committed serious crimes and were transferred to adult court and subsequently incarcerated in a prison for adults. Methods: Sixty-four boys aged 16 and 17 years who were incarcerated in the Texas adult correctional system completed the Massachusetts Youth Screening Instrument–Version 2 (MAYSI-2), a mental health screening measure widely used in the juvenile justice system. Scores from the youths in adult prison were compared with those of a matched sample of youths in juvenile correctional facilities, drawn from the MAYSI-2 normative data. Results: Youths in adult prison reported substantial symptoms of mental health problems. Most youths surveyed (51%) scored above the highest clinical cutoff (the “warning” range) on at least one MAYSI-2 subscale. For every clinical subscale except suicide ideation, the majority of youths (54% to 70%, depending on the subscale) scored above the “caution” range. Juveniles in adult prison reported higher rates of symptoms than did those in juvenile correctional facilities (effect sizes ranged from d=.18 to d=.65, depending on the subscale). Conclusions: Although the mental health needs of youths in the juvenile justice system are well documented, this study reveals that mental health treatment needs appear to be even more pronounced in the small subgroup of youths transferred to the adult criminal justice system and incarcerated in adult prison. (Psychiatric Services 60:1092–1097, 2009)

This poster reports on factors that influenced the rapid adoption and implementation of the Massachusetts Youth Screening Instrument-version 2 (MAYSI-2) and the perceived consequences of routine MAYSI-2 mental health screening. Semi-structured interviews and focus groups were conducted with administrators, managers, and front-line staff in juvenile detention centers in three states (n=19). Results will allow us to better inform juvenile justice facilities regarding the conditions under which screening can more often result in increases in mental health services to youth entering the system and help guide future efforts to provide technology to juvenile justice programs in the interest of youths. InTRoduCTIon Recent evidence suggests that the prevalence of mental disorders among youths in the juvenile justice system is two to three times higher than youths in the general population. Within the past five years, mental health screening upon entry to a juvenile justice facility has become standard practice across the nation. We know more about the validity and reliability of mental health screening tools used in this context than we do about the factors that facilitate their implementation. If they are not implemented properly, their adequate validity is virtually lost. Effective screening procedures require attention to how they are put in place and how they actually function within juvenile justice facilities. Introduced in 2000, the Massachusetts Youth Screening Instrument—Second Version (MAYSI-2) is now the most widely used mental health screening tool in juvenile justice secure facilities in the U.S. The National Youth Screening and Assistance Project (NYSAP), funded by the MacArthur Foundation, provides technical assistance nationwide for juvenile justice programs implementing mental health screening. ConCluSIonS And ReCommendATIonS Findings regarding the first three research questions suggest the following recommendations: n Develop a policy that avoids repetitive administration of the MAYSI-2. n Use a standard set of instructions for completing the MAYSI-2 when introducing youths to the instrument. n Use a standard set of instructions when introducing youths to the MAYSI-2 or any other screening tool. n Develop policy and practice to assure legally and clinically appropriate uses of mental health screening data.

Sex and Race Differences in Mental Health Symptoms in Juvenile Justice: The MAYSI-2 National Meta-Analysis

Prior research indicated that African American and Caucasian youth respond differently to items on the Massachusetts Youth Screening Instrument–Version 2 (MAYSI-2), a mental health screening tool used nationwide in juvenile justice systems, thus possibly affecting mental health need identification. To explore the cause for the differences, cognitive interviews were conducted with eight African American and eight Caucasian male juvenile detainees, aged 12 to 16 years, from two Midwestern detention facilities. Results indicate differences in how both groups interpreted certain mental health symptoms and the dimension of time. Both groups also similarly misinterpreted and were suspicious of some items. To address these issues, the MAYSI-2 could benefit from further examination and development.

The Massachusetts Youth Screening Instrument–Version 2 (MAYSI-2) is a brief screening tool used to identify youth in the juvenile justice system who are at-risk of mental-health-related difficulties. The MAYSI-2 was administered to 5,205 African American and Latino/a youth throughout Chicago, Illinois, who were on probation and residing in the community. This study investigated differences (i.e., legal status, gender, age, race/ethnicity) in reporting of mental health symptoms and substance use on the MAYSI-2. Females scored above the clinical cutoffs more frequently than males, and there were few differences found between diverted and adjudicated youth. Age comparisons revealed mixed results. Overall, youth in the current sample scored above the clinical cutoffs less often than youth in the MAYSI-2 norm reference groups. Nonetheless, during the first phase of this study, the MAYSI-2 demonstrated effectiveness by accurately identifying a substantial portion of youth in need of mental health and/or substance abuse treatment.

The Massachusetts Youth Screening Instrument - version 2 (MAYSI-2) is designed to assist in identifying the mental health needs of young people admitted to secure establishments. To date, very few studies have assessed the MAYSI-2 outside the USA. This study aimed to assess the validity and clinical utility of the MAYSI-2 in England. Boys newly admitted into one large young offenders' institution, were consecutively interviewed individually and completed the MAYSI-2, the Youth Self Report (YSR), which capture similar syndrome scales - and the Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS), which allows for making psychiatric diagnoses. Two hundred and six boys, of average age 16.5 years, completed all assessments. According to the K-SADS, co-morbidity of psychiatric disorders was high (80% of the sample). The MAYSI-2 showed good convergent validity but poorer discriminant validity with the YSR. The MAYSI-2 and YSR corresponded with both conceptually and non-conceptually relevant diagnostic domains. The poor ability of the MAYSI-2 and YSR to discriminate and specify disorders is likely to reflect the high rates of co-morbidity. The fact that 90% of the participants reached the caution cut-off for any scale on the MAYSI-2, while suggesting its limited use as a screening tool for this sample, is probably best reflective of the high levels of psychopathology of incarcerated young people in England and Wales since particular efforts to divert as many as possible from custody. A more holistic and comprehensive approach to assessing health needs on admission into custody may be necessary for such a population.

This study examined the relationship of age and gender with risk of arrest among adolescents and young adults who were intensive adolescent users of public mental health services. Data were obtained from the Massachusetts Department of Mental Health (DMH) and juvenile and criminal courts. Participants were youths receiving DMH adolescent case management services sometime in 1994-1996 who were born between 1976 and 1979 (781 males and 738 females). They were cross-matched to document arrests between age seven and 25. The study examined age at first arrest, age-specific risk, and the relationship between arrest history and arrest risk by gender and age. Most males (69%) and almost half the females (46%) were arrested by age 25. First arrest was most common before age 18. As in the general population, males' arrest patterns were more concerning than those of females, although patterns were of concern in both groups. Most female arrestees had multiple arrests, many as adults. No gender differences were observed for several factors, including risk of first arrest over age 18. Risk was far greater for those arrested in the previous year than for those never arrested. Findings justify concerns of public mental health systems regarding justice system involvement of adolescent clients. Risk of first arrest was significant from early adolescence through age 24, indicating a need for arrest prevention into young adulthood. The heightened arrest risk at all ages among those who were recently arrested demarcates a population in need of immediate intervention.

Allocating limited mental health resources is a challenge for juvenile justice facilities. We evaluated the clinical utility of the Massachusetts Youth Screening Instrument, Version 2 (MAYSI-2)—an instrument designed to aid in this process—in three subsamples of justice-involved youth (ages 14-17): detained girls ( n = 69), detained boys ( n = 130), and incarcerated boys ( n = 373). For perspective, we compared its performance (in the incarcerated subsample) to that of the Youth Self-Report (YSR), a more widely-used screen. The MAYSI-2 subscales were moderately useful for detecting relevant diagnoses, and differences were observed across samples. However, as a general mental health screen, the MAYSI-2 performed well (and comparably to the YSR), correctly classifying 66% to 75% of youth. When used to differentiate youth with any and without any disorder, both instruments were effective. Given the MAYSI-2’s practical advantages over the YSR (lower cost, easier administration), it may be a better option for juvenile facilities.

This study replicates and extends studies of the Massachusetts Youth Screening Instrument, Version 2 (MAYSI-2) in a sample of 479 urban, rural, and suburban 12–16 year old youths (68% boys; 41% African American, 23% Latino) consecutively admitted to juvenile detention centers. Six principal components replicated the MAYSI-2 factor-analytically-derived subscales except for Depression/Anxiety, and suggested modifications of specific items in each sub-scale. Findings supported the internal consistency and validity of the modified MAYSI-2 sub-scales. Few gender differences emerged, except that girls reported higher levels of hopelessness and trauma than boys. Five sub-groups were identified based on component profiles: (1) non-clinical, (2) addiction, somatic problems, and suicidality, (3) anger problems, (4) thought disturbance, and (5) addiction and traumatic stress. The findings support the validity of the MAYSI-2 for juvenile justice mental health screening while highlighting possible refinements in scoring in order to identify delinquent youths with distinctive psychosocial risks and needs.

Given the high prevalence of mental health and substance use disorders in the juvenile justice system and the emphasis on efficient screening and referrals, the current study sought to further validate the use of the Massachusetts Youth Screening Instrument version 2 (MAYSI-2). Using data from institutionalized delinquents (N=836) committed to the California Youth Authority, finite mixture modeling was employed to identify distinct latent classes based on MAYSI-2 scale scores. Identified classes were then compared across a range of covariates, including prior offenses, official records of misconduct, and multiple measures of mental health and psychological well-being. Findings revealed a three-class, gradient-based structure: low distress (n=380), moderate distress (n=327), and high distress (n=129). Overall, the MAYSI-2 identified juvenile offenders with mental health and substance use issues, but it did not differentiate youths with respect to offending patterns.

The high prevalence of mental health disorders among incarcerated juveniles is a matter of national and global concern. Juvenile justice personnel need accurate screening measures that identify youth requiring immediate mental health services. The purpose of this study was threefold: (a) to examine the utility of the Massachusetts Youth Screening Instrument, Version 2 (MAYSI-2) in identifying juveniles with mental health concerns in a large sample of juveniles (N = 4,009), (b) to provide data regarding rates of identified mental health needs in incarcerated youth, and (c) to provide descriptive comparisons to other studies using the MAYSI-2. Mean scores of subscales were compared with the MAYSI-2 normative samples and other recent studies. Results indicated that this population has a high occurrence of mental health symptoms and there is high variability in the severity of the symptoms. In addition, a multivariate analysis of variance test found significant differences in mental health problems across ethnic groups.

The Massachusetts Youth Screening Instrument—Version 2 (MAYSI-2) is a brief triage tool designed to pinpoint youth in the juvenile justice system at risk for mental health—related difficulties. The current study investigated the relation between the MAYSI-2 and institutional maladjustment at a residential treatment facility specializing in the rehabilitation of severe male juvenile offenders. Institutional maladjustment data were collected during the first 90 days of commitment for 104 male juvenile offenders who also completed the MAYSI-2 during orientation to the facility. The Angry-Irritable subscale of the MAYSI-2 uniquely predicted severe rule violations and intensive supervision placement. However, hit rate analyses revealed a high level of false negatives for the published subscale cut scores. Implications of these and related findings are discussed.

Thousands of juveniles with mental health disorders enter the juvenile justice system every year. The Massachusetts Youth Screening Instrument−Version 2 (MAYSI-2) is often used to assess them. The disproportionate numbers of African American youth in the juvenile justice system and the large numbers of youth with mental health needs necessitate accurate screening across racial groups, but recent evidence indicates that groups may be interpreting MAYSI-2 items differently. A total of 90 male juvenile detainees participated in a structured interview exploring what factors might mediate race and impact MAYSI-2 scores. Results confirmed which factors influence MAYSI-2 scores for African American participants.

The prevalence of mental health disorders is higher among justice-involved youth than youth in the general population. Despite mental health being a pressing contemporary issue in the juvenile justice system, fewer than half of the states in the United States mandate the use of a mental health screening for youth in the juvenile justice system. The need to utilize a mental health screening tool in all 50 states should be a national priority. The Massachusetts Youth Screening Instrument-Version 2 (MAYSI-2) is the recommended screening tool that should be adopted nationally. Currently, 21 of the 24 states that mandate the use of a screening tool utilize MAYSI-2. Furthermore, it is recognized as having the most empirical evidence as an instrument at the juvenile justice system’s entry and transitional points.

A Cluster-Analytic Investigation of MMPI Profiles of Serious Male and Female Juvenile Offenders