Poor mental health found among young offenders

The high prevalence of mental disorders highlights the need for improved psychiatric care in juvenile justice and detention centres, say the researchers.

Oxford University researchers in the Department of Psychiatry and the Department of Public Health and Primary Care, together with the Karolinska Institutet in Sweden, have carried out a large-scale review and analysis of data from 25 different psychiatric surveys involving 16,750 young people in juvenile detention facilities around the world. The results are published in the Journal of the American Academy of Child and Adolescent Psychiatry.

‘By putting all this data together, we can say with some confidence that the adequate provision of psychiatric care for adolescents in detention should be a key priority for prison services worldwide,’ says Dr Seena Fazel of the Department of Psychiatry at the University of Oxford.

For the first time, the researchers have shown adolescent girls in detention are at particular risk of depression. 29% of girls aged 10–19 were diagnosed with major depression, considerably higher than the 12% of adult women in prison reported to suffer from depression and four to five times higher than in the general youth population. 10.6% of boys suffer from major depression.

Cases of psychosis in boys and girls – severe mental illness involving loss of connection with reality – are also much more common in young offender institutions than would be expected, with rates around ten times higher than in the general population.

One in ten boys and one in five girls in young offender institutions have attention-deficit/hyperactivity disorder (ADHD). Rates of conduct disorder – a psychiatric diagnosis describing a pattern of disruptive and antisocial behaviour, for example where children consistently break rules, get into fights and play truant – are 10–20 times higher in girls in detention and five to ten times higher in boys than found in adolescents generally.

‘Currently, the care provided for incarcerated young people is patchy,’ says Dr Fazel. ‘This should be a starting point to examine where there is insufficient screening for mental ill-health, where secure facilities lack qualified staff or appropriate treatment, and where sentencing does not account for mental disorders.’

‘As well as assessing suicide risk and substance abuse, prisons should consider specific screening for mood disorders especially in girls,’ he adds. ‘Justice systems for juveniles offer the opportunity to pick up mental disorders and make a significant impact on public health. This is a chance to catch many vulnerable people who otherwise fall through the cracks.’

‘With conditions such as depression and psychosis, it is important to pick them up early. The longer you leave it, the worse the conditions become,’ explains Dr Fazel. ‘These disorders may also increase risk of drug and alcohol misuse, and perhaps indirectly, reoffending rates.’

‘In individual reports and small-scale studies there is considerable variation in the results purely by chance,’ explains Dr Fazel. ‘We’ve combined data from a number of published journal papers as well as reports by justice departments and other groups in what is called a meta-analysis. This large-scale synthesis of all the available data should help correct for any variations caused by chance or different survey methods and help prison health services by providing much more precise estimates.’

Provided by Oxford University