Embed Doc
Copy Link
Readcast
Collections

CommentGo Back

Download

H o s t e d b y w w w . i j j o . o r g

Author

Thomas Grisso

Title

'Guiding Principles when Developing Treatment Programs for Young Offenders with Mental Disorders'

H o s t e d b y w w w . i j j o . o r g

GUIDING PRINCIPLES WHEN DEVELOPING TREATMENT PROGRAMSFOR YOUNG OFFENDERS WITH MENTAL DISORDERSThomas GrissoUniversity of Massachusetts Medical SchoolWorcester, Massachusetts, USAAt the Fourth IJJO Conference, RomeNovember 9, 2010

We have much evidence that many young people coming into the juvenile justice system in the US and in Western Europe have mental health problems. Researchhas shown that among young people in juvenile justice settings, about two in everythree will meet criteria for a mental disorder or substance use disorder. Not all of theseyouth need immediate treatment for their disorders. But about 15 to 20 percent ofyouth in juvenile justice have serious mental disorders—often more than one—that willbe long-term problems in their lives. Treatment for their mental health or substanceuse problems will be necessary in order to advance their development and to reducetheir delinquent behaviors.Before proceeding further, let me define what I mean when I say “treatment.”Sometimes the word “treatment” is used in juvenile justice discussion to mean any kindof method intended to change young people’s attitudes and capacities so that theyare less likely to engage in illegal behaviors. But today, when I use the word“treatment,” I am referring instead to “clinical treatments”---that is, anything that we dothat is aimed specifically at

reducing a youth’s symptoms of mental disorder or substance use.

We are all aware that we have an obligation to provide treatment for youth withmental and substance use disorders when they are arrested and are in our care. Buthow can we do that? The juvenile justice system is not a mental health system. Yet itmust respond to youths’ mental health needs, for youths’ own welfare and to reducethe risk of youths’ offending.I will not try to answer all of the questions we face in this area. But what I will do isdescribe a few basic principles to guide us as we think about what we can do. Whatare the basic things that we need to consider? I will emphasize five guiding principles:The need for intake screening and assessment

Valutazione e diagnosi dei nuovi giunti

The need for emergency mental health services

Servizio di salute mentale (psichiatrico) di emergenza

The need to integrate clinical treatment and general rehabilitation

Unire il trattamento clinico e i metodi di riabilitazione

H o s t e d b y w w w . i j j o . o r g

3The need for evidence about the value of our treatment methods

Evidenza dell'efficacia della metodologia

The need to place limits on what we try to do

Definire i limiti di ciò che cerchiamo di fare

Intake Screening and Assessment

Our first guiding principle is to improve our ability to identify youth with mentalhealth and substance use disorders when they enter the juvenile justice system. By“enter” the system, I mean the earliest point in our contact with youth, or when theyenter various facilities within the juvenile justice system as they are placed or referredthere. So this refers to the point right after they are arrested and placed in pre-trialdetention centers, or when they are placed later in juvenile justice programs forrehabilitation. At these points, we must have ways to know which of our youths havespecial mental health needs that require clinical treatment.There are two reasons we must do this. One is to identify, at the time of intakeinto the system, whether the youth has any immediate needs that require our attention.Examples are youth who have thoughts of suicide at the time they are arrested andplaced in detention, or youth who are undergoing serious mental health crises at thatmoment. The other reason is to identify which youth might need mental healthtreatment as part of their long-term care, and what type of treatment they might need,if they remain in the juvenile justice system for rehabilitation for many months.To do this, we must have methods that identify those youth reliably as they enterthe system. The challenge here is that this requires evaluating every youth at the timethey enter the system. And we do not have enough clinical psychologists orpsychiatrists to evaluate them, and are not likely every to be able to afford that manyof them.We have been working on this problem in the U.S., and have had some successin dealing with it. The guiding principle used there is a two-step process: screening,then assessment. Screening is the use of a tool or instrument that is sufficiently brief thatit can be given to every youth within a few hours after they enter the system, and thatdoes not require a clinically trained person. Assessment is the more individualizedprocess that is used to examine youth for whom screening suggests a likelihood ofmental disorder.In the U.S., our lab at Univ of Massachusetts Medical School developed, 10 yearsago, a mental health screening tool called the Massachusetts Youth ScreeningInstrument, or MAYSI. It requires only 10 minutes for a youth to answer 52 questions, andprovides scores on seven scales—such as Suicide Ideation, and Depressed-Anxious—indicating whether the youth is high in comparison to other youth in symptoms in thoseareas. The scales have been validated in over 50 research studies. The MAYSI is usedin juvenile justice programs in a majority of states in the U.S., and more recently it isbeing applied and researched in many European countries, such as Netherlands, UK,Belgium, Germany, Switzerland, Spain, Italy and Turkey.