The adolescent with mental health problems in the juvenile justice system
Adolescence is a stage of identity formation. The numerous physical and biological changes, shifts in thinking, social relationships, and family dynamics make it a particularly delicate and conflict-ridden period. Some adolescents are especially vulnerable due to socioeconomic and personal circumstances, a history of unconventional parenting that affects development, learning experiences that emphasize physical punishment or discipline, or personal problems that haven't been adequately addressed to foster healthy growth.
Some adolescents experience mental health problems from childhood, or it is during this period that the first symptoms appear. Despite variations in prevalence rates and differences according to the diagnostic criteria used, it has been estimated that at least 20% of children and adolescents have some type of mental disorder, and at least half of them experience a significant decline in their family, social, and school functioning .
Studies conducted to date have shown that some psychiatric disorders that begin in childhood and adolescence tend to be more severe, causing greater disruption to the functioning and daily lives of the children and adolescents who suffer from them . According to the World Health Organization (WHO), one in seven young people aged 10 to 19 worldwide suffers from some form of mental disorder. Depression, anxiety, and behavioral disorders are among the leading causes of illness and disability among adolescents. Suicide is the fourth leading cause of death among young people aged 15 to 19. Although it is estimated that one in seven adolescents aged 10 to 19 (14%) worldwide suffers from some form of mental disorder, these illnesses still largely go unrecognized and untreated.
The reasons behind transgressive behavior in adolescence
Transgressive behaviors are common in adolescence. In some cases, they result from an attempt to define an alternative social identity. In others, they are the expression of deep distress or a response to some underlying distortion stemming from symptoms of an undetected and untreated mental disorder. Impulsive aggression may emerge as the only way to resolve conflicts, or violence may arise—that is, behavior aimed at harming others, property, or objects, more intentionally, as an impulsive act without considering the consequences. These actions may constitute crimes requiring intervention from the juvenile justice system.
Dr. David Bueno Torrens
The reality of juvenile delinquency in our society remains highly stigmatized. Information about crimes committed by teenagers is often sensationalized, causing social alarm and a disapproving and rejecting attitude toward these young people. We lose interest in understanding what is happening to these boys and girls. Even less understood is the problem of adolescents with mental health disorders who engage in delinquent behavior. There is often a misconception that young people with mental health problems are more violent and dangerous than those without disorders, or we categorize all offenders as mentally ill, creating a double stigma for this population with the label of "mentally ill" and "offender."
Adolescents with mental disorders are particularly vulnerable to discrimination, social exclusion, stigmatization problems (which affect the willingness to seek help and connect with mental health services), educational difficulties, or risky behaviors.
The distress typical of adolescents is often much greater in this group. When they engage in antisocial behavior that requires intervention from the judicial system and placement in a detention center, this vulnerability increases due to the difficulties they face in coping with stressful situations or events. This produces an emotional impact that diminishes their capacity for adaptation and negatively affects the course of their disorder.
The right to comprehensive healthcare
Comprehensive healthcare is one of the most important rights of people deprived of their liberty . Juvenile justice centers must guarantee care for all health problems, prevent them, and provide specialized mental health care tailored to the needs of adolescents. This specialized care should address mental health issues, the risk of violence and recidivism, the impact of incarceration (abrupt separation from social and family life, lack of communication via telematics, restricted communications, etc.), and reduce the vulnerability of this population.
In Catalonia, there is a specialized unit for the care and treatment of adolescents who commit offenses, managed by the Sant Joan de Déu Health Park ( Therapeutic Unit of the Els Til·lers Educational Center ). Typically, the Juvenile Court Judge orders therapeutic placement for adolescents with mental health problems, allowing for specialized intervention by professionals experienced in treating these cases. However, in the rest of Spain and Europe, there are no units led by professionals from the Department of Health, and specifically from the mental health sector, that provide care and develop specific therapies for this population, despite the well-known fact that the percentage of mental disorders in the juvenile justice system is higher than in the general population.
Community engagement program for incarcerated youth
A meta-analysis of 25 studies on the prevalence of mental disorders in young people with criminal behavior concludes that adolescents with transgressive behavior are 10 times more likely to suffer from psychotic spectrum pathology, conduct disorder is 10 to 20 times higher in girls and 5 to 10 times more likely in boys; major depression is between 3 and 4 times more frequent in detained girls (Fazel et al., 2008).
Specifically in Catalonia, adolescents served by the juvenile justice system exhibit higher rates of mental disorders than those found in the general population. Fifty percent of those who commit serious offenses and are placed in a juvenile justice center, under a custodial regime, require immediate intervention from mental health services. Ten percent present with a mental disorder requiring admission to a therapeutic juvenile justice unit. A 2018 study (Ribas et al., 2018) describes the clinical, social, and familial characteristics of the population receiving therapeutic treatment and compares them with the population served in juvenile justice centers without mental disorders, revealing significant differences. In this regard, adolescents with mental health problems have parents with relatively low rates of delinquency (27%), and a greater number of parents are raising their children with consistent and appropriate discipline, receiving suitable supervision and parental involvement. Families are better equipped to provide emotional support. Regarding their living environment, young people in therapeutic care reside in areas with low levels of crime, poverty, or violence. However, these adolescents experience greater peer rejection, are at high risk of stress and difficulty coping with challenges, tend to exhibit aggressive responses, are highly impulsive, have greater concentration and attention problems, and demonstrate low academic engagement.
There are protective factors in the socio-familial environment of adolescents with mental health problems who commit offenses, compared to young people without mental illness. However, they also present risk factors . One in two young people has grown up in contexts or conditions that do not favor adequate developmental growth, characterized by some type of abuse or parental neglect. Although there is no single factor that explains violent behavior in adolescents, abuse suffered during childhood, whether within or outside the family, can lead to mental health problems, substance abuse, increased difficulties in interpersonal relationships, a higher probability of suicide, and criminal behavior (Wood et al., 2002; Widom and Maxfield, 2001). When treated by mental health professionals, one in four young people presents with moderate or severe depression, high impulsivity, feelings of anger, and a tendency to interpret others as hostile toward them, which interferes with optimal psychosocial functioning and their ability to adapt to their environment. Sporadic or habitual substance use prior to admission to a care facility occurs in 50% of cases, usually as a strategy to escape emotional distress they are unable to manage; one in four presents symptoms related to a serious mental disorder. Furthermore, it is important to note that one in three has a mild intellectual disability. For all these reasons, this population requires care that recognizes the uniqueness of each adolescent, designed, adapted, and agreed upon with each young person based on their needs, strengths, experiences, shortcomings, life history, the crime committed , and so on.
Specialized mental health care within the juvenile justice system must, and is therefore the approach taken in Catalonia, be geared towards a comprehensive intervention that goes beyond addressing the specific symptoms of the disorder these adolescents experience. They receive psychological and psychiatric therapies, educational and training interventions, general healthcare from nurses, and interventions from occupational therapists focused on finding meaning in their work.
All of this is not possible without creating a safe and protective environment for the adolescent, in which there is a genuine interest in their situation and experiences , unconditional acceptance, and availability when they need to be heard, not judged, but understood and accompanied in their own process of personal recovery, growth, and development of their identity.
In this way, these boys and girls can express their distress in a different way, reflecting on and understanding that they have difficulties and anxieties typical of this stage of life (losses, grief over lost childhood, the pressure to function like an adult, etc.) and also additional problems related to their disorder, their environment, and their lived experiences, which are often very traumatic. Interventions must take into account each person's individual developmental stage, listening to and respecting their wishes and preferences, their life plans, or helping them develop an interest in academic and personal areas they have dismissed without even trying to explore them. A comprehensive biographical narrative should also be constructed, allowing the adolescent to understand the social, personal, familial, cultural, and other factors that have led to their delinquent behavior and to develop the capacity to forgive themselves and reconcile with their environment.
Achieving self-acceptance and recovery for the adolescent, promoting and activating all their resources and capacities to overcome or integrate their disorder without it becoming the center of their life, achieving community reintegration, preventing transgressive behaviors, and fostering successful social integration are priority objectives in professional intervention within the mental health and judicial system. Work in and with the community begins while the adolescent is serving a court-ordered placement in a juvenile justice center. This support ensures social inclusion, minimizes risks, and allows for an understanding of the adolescent's interaction with their environment, their relationships with peers, and with society, by sharing their personal experiences in their natural living environment. In this regard, a variety of activities can be developed, ranging from inclusive theater in community centers to an integrated and implemented substance abuse prevention program in community schools, or providing home visits and recreational activities. When we manage to understand the arguments of the adolescent, pay attention and listen to what is important to them, encourage them to achieve their goals, we can generate confidence in themselves and in others, as well as real possibilities to share life in freedom.
Featuring
