Youth, Crime, and Mental Health
Dr. Dax Urbszat, B.Sc., LL.B., Ph. D.
University of Toronto at Mississauga
Department of Psychology
Ph: 905 569 4964
E-mail: dax.urbszat@utoronto.ca
Plan for Today
Mental health issues in youth
Mental health and the juvenile justice system
Diversion programs
Treatment issues
Prevention through Education
Mental Health in Youth
• As many as 20% of youth experience
serious mental health problems
• Mental disorders comprise around one-third
of the burden of disease for youth
• 75% of these mental disorders will onset
before age 24
• Risk for substance abuse, socioeconomic
consequences, increased early mortality
Mental Health in Youth
• Few receive proper assessment, diagnosis,
and treatment
• Only 25-30% of youth who require mental
health treatment will actually receive it
• “Two of every three depressed children do
not receive an appropriate diagnosis and
only 50% receive appropriate treatment.”
(Kutchner & McDougall, 2009).
Mental Health in Youth
• Long waiting lists for specialty mental health
services
• Lack of mental health care in primary care
• Lack of health providers with the necessary
mental health competencies
• Poor coordination among health and other
government agencies for youth mental health
• Lack of specific child and youth mental health
policies at provincial and federal level
Mental Health and the Juvenile
Justice System
• Many youth suffering from mental health
problems are being directed into the
juvenile justice system due to a lack of
appropriate mental health care (Canadian
Institute for Health Information, 2008)
• The majority of children and youth within
correctional settings suffer from one or
more mental disorders (70%)
Mental Health and the Juvenile
Justice System
• Prevalence of mental disorders in the
criminal justice system is at least 2 to 4
times greater than in the general adolescent
population
• Detention facilities have become the largest
providers of mental health services for
young people
Mental Health and the Juvenile
Justice System
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Youth with mental illness self-medicate
Alcohol and drug use can lead to criminal
activity
Incarceration exacerbates mental illness
Presence of a mental disorder at time of
apprehension for a criminal act leads to
higher rates of arrest, longer detention
periods, and higher rates of recidivism
BC Policy Framework for
Diversion of Persons with Mental
Disorders
• “[T]here are a disproportionate number of people
with mental disorders in the criminal justice and
correctional systems. This is not only seen as an
inappropriate consequence for illness related
behaviour, but is also increasingly seen as a waste
of valuable law enforcement and criminal justice
system time, and of resources that may be more
effectively spent on improving community mental
health services.”
Diversion Programs
• Diversion from the juvenile justice system to
mental health, treatment, and support
• Preliminary results show reduced recidivism, less
jail time, more involvement with mental health
professionals, and increased use of communitybased services
• Requires cooperation between police, judiciary,
legislature, and mental health and community
service providers
Diversion Programs
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Youth Mental Health Courts
Conferencing (Youth Criminal Justice Act)
Wraparound programs
Project Connect (New York State)
Disorders Impacting the Justice
System
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Anxiety disorders
Mood disorders
Substance use disorders
Conduct Disorder
Oppositional Defiance Disorder
Attention Deficit Hyperactivity Disorder
Treatment Issues
• Long waiting lists for specialty clinics
• Primary care physicians prescribing
medications alone
• Psychiatrists likely to prescribe medication
as well
Treatment Issues
“From an evidence-based perspective, cognitivebehavioural therapy is currently the treatment of
choice for anxiety and depressive disorders in
children and adolescents”
Clinical Psychologists are the most likely health care
providers to treat using CBT
Psychological services are not covered by OHIP
We need improved access to the best treatments for
our youth with mental health issues
Treatment Issues
• Specifically, we need to create better access and
availability to CBT as it is the treatment of choice
for anxiety, depression, and substance abuse
disorders in children and adolescents
• Heavy reliance on medication treatments alone for
certain Psychiatric disorders is an issue in all
populations, but especially with children and
adolescents
Psycho-Education
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Prevalence rates
Symptoms
Causes
Treatments
Risks (co-morbidity)
Psycho-Education
• Lessens stigmatization
• Increased understanding for community members
and service providers
• Improve chances of seeking treatment
• Improves treatment outcomes by promoting early
intervention and knowing best treatments
• Decreases risk of substance use and abuse due to
self-medicating (co-morbidity)
Prevention through Education
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Judiciary
First responders
Those involved in youth justice services
Community members
Family members
schools
Take Home Messages
• Mental health issues are prevalent in youth and
can lead to both substance abuse (co-morbidity)
and involvement in the juvenile justice system
• Diversion programs have shown promise
• Access to CBT to treat youth with mental health
issues is critical
• Prevention and early intervention can be enhanced
through Psycho-education in all sectors of society
References
• Abram, K.M., Teplin, L.A., McClelland, G.M., Dulcan, M.K. (2003)
Comorbid Psychiatric Disorders in Youth in Juvenile Detention.
Archives of General Psychiatry. 60:1097–1108.
• Andre, G., Pease, K., Kendall, K., & Boulton, A. (1994). Health and
Offence Histories of Young Offenders in Saskatoon, Canada. Criminal
Behaviour and Mental Health. 4:163–180.
• Canadian Institute for Health Information Improving the health of
Canadians: Mental health, delinquency and criminal activity. <
www.cihi.ca>. (Version current at October 31, 2008).
• Compton, S., March, J.S., Brent, D.A., Albano, A.M., Weersing, V. &
Curry, J.F. (2004) Cognitive behavioral therapy for anxiety and
depression in children and adolescents: An evidence based medicine
review. Journal of the American Academy of Child and Adolescent
Psychiatry, 43, 930-959.
•Leitch, K.K. (2007). Reaching for the top: A report by the advisor on
healthy children & youth. Ottawa: Health Canada; 2007. < http://www.hcsc.gc.ca> (Version current at October 31, 2008).
•Hillian, D., Reitsma-Street, M., & Hackler, J. (2006). Conferencing in the
Youth Criminal Justice Act of Canada: Policy Developments in British
Columbia. Canadian Journal of Criminology and Criminal Justice, 46(30),
343-366.
•Kirby, M.J. & Keon, W.J. (2006). Final Report of The Standing Senate
Committee on Social Affairs, Science and Technology. Out of the shadows at
last: Transforming mental health, mental illness and addiction services in
Canada.
•Kutcher, S. & McDougall, A. (2009) Problems with access to adolescent
mental health care can lead to dealings with the criminal justice system.
Pediatrics and Child Heath,v. 14(1).
•Odgers, C.L., Burnette, M.L., Chauhan, P., Moretti, M.M., Reppucci, N.D.
(2005). Misdiagnosing the problem: Mental health profiles of incarcerated
juveniles. Can Child Adolesc Psych Rev. 14:26–9.
•Sanislow, C.A., Grilo, C.M., Fehon, D.C., Axelrod, S.R., McGlashan, T.H.
(2003). Correlates of suicide risk in juvenile detainees and adolescent
inpatients. J Am Acad Child Adolesc Psychiatry.42:234–40.
•Teplin, L.A., Abram, K.M., McClelland, G.M., Dulcan, M.K., Mericle,
A.A. (2002). Psychiatric disorders in youth in juvenile detention. Archives of
general psychiatry. 59:1133–1143.
•Ulzen, T.P.M., & Hamilton, H. (1998). The nature and characteristics of
psychiatric comorbidity in incarcerated adolescents. Canadian Journal of
Psychiatry. 43:57–63.
•Waddell C, Hua JM, Garland OM, Peters RD, McEwan K. (2007).
Preventing mental disorders in children: A systematic review to inform
policy-making. Can J Public Health. 98:166–73.
•Wasserman, G.A., McReynolds, L.S., Musibegovic, H., Whited, A.L.,
Keating, J.M., & Huo, Y. (2009). Evaluating Project Connect: Improving
Juvenile Probationers’ Mental Health and Substance Use Service Access.
Adm Policy Ment Health. Nov;36(6):393-405. Epub 2009 Jul 7.