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A Better Path: Juvenile Justice Mental Health Courts

According to the Department of Justice, a healthy juvenile justice system “…enhances public safety, ensures that youth are held appropriately accountable to both crime victims and communities, and empowers youth to live productive, law-abiding lives.” The U.S. justice system for youth has failed to do all these things. Its high recidivism rates leave public safety more tenuous and perpetuates the expansion and inefficient funding of a failing system. Its focus on surveillance, punishment, and force rather than positive youth development and needs-based care is not “appropriate accountability.” Finally, the system as a whole, via its stunting effects on youths’ education and the social stigma and criminal record it imparts, detracts from young people’s capacity to live empowered, meaningful lives.

On top of these detrimental effects on youth and society, the juvenile justice system tends to trap youth who live at the intersection of multiple prejudiced attributes, such as low socioeconomic status, race of color, and mental illness. Compared to the intersection of socioeconomic status, race, and the juvenile justice system, the relationship between mental illness and juvenile justice has not garnered as much attention from justice scholars. That being said, there has been a recent push among scholars, advocates, and politicians to shed light on the mental illness-juvenile justice system intersection and to research solutions, such as the juvenile mental health court.

Intersection Of Mental Illness and Juvenile Justice

According to the American Bar Association (ABA), “65 or 70 percent of youth held in American juvenile detention centers have a diagnosable mental illness.” This statistic points to a significant correlation between mental illness and involvement in the juvenile justice system. A literature review from the Office of Juvenile Justice and Delinquency Prevention (OJJDP) supports this while also emphasizing that correlation does not mean causation. In other words, the relationship between mental illness and juvenile justice system contact is complex. Some facets of mental illness, such as externalizing disorders (e.g. oppositional defiant disorder and antisocial behavior) and substance use disorders, increase the probability of youth violence and juvenile justice system contact and increase recidivism rates whereas internalizing disorders (e.g. anxiety and depression) are unrelated to youth violence and recidivism. In the other direction, juvenile justice system contact tends to intensify mental illness in youth due to the lack of referrals to proper treatment and due to “the difficulties that many juveniles face when detained or incarcerated, the increased odds of recidivating once youths are involved in the justice system, and the perceived barriers to services that can prevent youths from seeking or receiving treatment.” The first reason, namely the lack of referrals, will receive attention here.

Juvenile justice system contact often exacerbates youths’ mental illness because youth within the system do not receive proper care. The OJJDP literature review states, “Among youths involved in the juvenile justice system (including those who have been referred to court or those who have been adjudicated and placed in a residential facility), only a small percentage of those in need of services can access treatment.” This is especially concerning because the young people may be in detention due to the externalization of their mental illnesses. Thus, the vicious loop is closed. Youth struggling with mental illness are more likely to engage the juvenile justice system, and the juvenile justice system will probably worsen their mental illness. Recidivism then increases. Reentry to the juvenile justice system occurs and the cycle repeats.
The ABA also states: “every day approximately 2,000 youth are incarcerated simply because community mental health services are unavailable.” Juvenile detention centers and correctional facilities have become holding places for youth with mental illness. In many cases, the young person has committed no crime, but they are referred to the juvenile justice system only because the appropriate treatment in the community is unavailable. This waiting period is costly, not only to the young people, but also to the public, with juvenile detention facilities spending about $100 million each year to house youth waiting for mental health treatment.

When parents and guardians feel obligated to send their children to juvenile detention centers for mental health treatment, when the juvenile justice system provides a greater probability of mental health treatment for at-risk youths than services based in the free community, when governments are spending millions of public dollars to house mentally ill youth in spaces that exacerbate mental illnesses, deep change in both the juvenile justice system and in society needs to happen.

Needless to say, something is wrong in society. When parents and guardians feel obligated to send their children to juvenile detention centers for mental health treatment, when the juvenile justice system provides a greater probability of mental health treatment for at-risk youths than services based in the free community, when governments are spending millions of public dollars to house mentally ill youth in spaces that exacerbate mental illnesses, deep change in both the juvenile justice system and in society needs to happen. Such change requires united communities, radical collaboration, multidimensional, interdisciplinary problem-solving, and long-term policy solutions, a thorough discussion of which is beyond the scope of this article. Nevertheless, a promising beginning of such change lies in the juvenile mental health court.

Juvenile Mental Health Courts (JMHCs)

As a response to the general failings of the U.S. juvenile justice system, justice advocates have pushed for diversion programs, which serve as an alternate justice pathway for youth from the traditional juvenile justice system. Juvenile mental health courts (JMHCs) are a new development within this diversion movement. JMHCs are specialty courts that developed from the adult mental health court (AMHC) due to its empirical success in “reducing subsequent arrests and jail days.” Similar to AMHCs, JMHCs feature “a separate docket, some form of community supervision to monitor compliance with court orders, judicial review to monitor a youth’s progress, and use of a multi-disciplinary team that oversees JMHC cases and makes recommendations to the judge.” There are 250 AMHCs and 40 JMHCs nationwide. 

JMHCs address the particular needs of mentally ill youth in contact with the juvenile justice system. According to the OJJDP: “JMHCs are voluntary diversion programs that adhere to a paradigm of therapeutic jurisprudence…” JMHCs seek to separate mentally ill youth from the often harmful environment of the traditional juvenile justice system. JMHCs also embrace a pluralistic method of treatment by bringing in the input and service of community mental health providers, ensuring that the complexity of each young person’s needs receives attention. Moreover, this aspect answers one of the biggest problems in the mental illness-juvenile justice system relationship: the lack of access to treatment. Many youths who engage the juvenile justice system only do so because community-based treatment is unavailable. JMHCs have much more leverage with social services in the community than individual families and can use that leverage to compel social service agencies to give treatment (such as counseling, family therapy, or substance abuse treatment) to youths. JMHCs also provide civil advocates who aid youths and their families to navigate civic conundrums such as Medicaid, consumer protection, privacy and consent laws, and the court process in general. The ability of JMHCs to address the needs of youths with mental illness is its greatest contribution to juvenile justice.

This needs-based, collaborative approach shows positive results. Heretick and Russel (2013) performed a comparison study of a Colorado JMHC versus the traditional Colorado probation program. They found that the JMHC significantly reduced “both recidivism while in the program and during at least 1 year following successful completion.” Other preliminary studies in other states (such as California’s Santa Clara County Court for the Individualized Treatment of Adolescents) found the same. Unfortunately, the data is not yet available across enough states to perform a comprehensive statewide statistical analysis. While recidivism rates alone are not sufficient in judging whether the JMHC is truly ensuring public safety, holding youths appropriately accountable, and empowering them to live better lives, they serve as a helpful proxy in gauging these deeper, unquantifiable values. According to the recidivism rates, at least, JMHCs outperform the traditional juvenile justice system.

JMHC Model: California’s Santa Clara County Court for the Individualized Treatment of Adolescents (CITA)

CITA is one of the first JMHCs (began in February 2001), and it provides a robust model of a healthy JMHC. We will give a brief outline of the CITA process and then discuss its effectiveness.

The process begins when a minor gains a referral to the CITA program. The referral can come from any source, such as a deputy district attorney, a parent/guardian, a judge, or a probation officer. The referral must be pre-disposition (pre-sentencing), and the youth must admit to the alleged charges. If the minor is eligible, a psychiatric social worker assesses the minor, which includes, among other things, meeting the minor and the family, reviewing medical/psychiatric records and IEPs, and completing an Individual Comprehensive Mental Health Evaluation and a Needs Assessment. The minor is then screened for suitability (e.g. professional diagnosis of a serious mental illness, a supportive adult at home, and a suitable home environment). Moreover, the Screening Team must determine by group consent that CITA would appropriately address the minor’s need. If the minor meets suitability and the Screening Team accepts, then the minor’s case will transfer officially to CITA.

At the point of acceptance, CITA becomes responsible for an intimidating list of over 40 responsibilities encompassing possible youth needs, including: engaging the minor and family in services, connecting the minor to wraparound services, counseling for the whole family, drug treatment and counseling, connecting the minor to vocational services and assuring employment, and Aftercare services. During the time of CITA implementation, frequent reviews are held, both with and without the minor, in order to discuss progress, difficulties, and next steps. In many of these reviews, the CITA Multidisciplinary Team is present, which includes two certified psychiatric social workers, two CITA probation officers, three to five juvenile civil advocate attorneys, and the presiding judge, among others. Finally, graduation from CITA occurs when the minor is:

  • Connected with appropriate mental health services and community supports;
  • Stabilized and has an individualized treatment plan in place;
  • Attending school, working, or in vocational training;
  • Not a danger to self or others;
  • Free of new law offenses and probation violations for 4 months;
  • Connected with the Department of Revenue with an account set up to pay restitution, if applicable, and payments are being made;
  • Receiving at least 3 consecutive positive CITA reviews.

Moreover, the CITA team must agree that the minor can graduate.

An (Incomplete) Picture of Long-Term Care

The CITA program rigorously assesses the needs of and comprehensively cares for the youths in its care, CITA embraces a multisystemic/interdisciplinary approach in addressing youth needs and involves the family as much as possible along the way, the CITA process includes frequent checkpoints to ensure that its participants are progressing and/or that new developments are made known and met, and CITA connects its participants with the community, both with respect to treatment (which comes through service providers in the community) and with respect to job/school placement. CITA does much to empower youth to live better lives long-term.

Some potential concerns remain. CITA does not expunge its participants’ criminal records. While CITA does aid with job and school placement, does CITA ensure that graduated youths have long-term mobility in their vocational and school settings and that their criminal records will not prove as chronic setbacks? Furthermore, does CITA ensure that graduated youths continue to receive adequate mental health care? Although CITA is a great start / provides help for youths when they are within their program, helping graduated youths in the aftermath is something they have to address / could improve on.

Intersection Of JMHCs and Public Justice

The Center For Public Justice offers a unique lens through which to view the systems, mores, and phenomena of human community. This unique lens is the principle of public justice. CPJ’s seventh guideline for government defines public justice as having two principles:

  1. Upholding the common good of the political community in its own right, which includes protecting citizens from domestic and foreign injustice.
  2. Recognizing in law the non-political responsibilities that belong to those which live in the territory of government’s jurisdiction.

The first principle has to do with the government’s direct interaction with its citizens, such as taxation for national health, education, and defense purposes. The second principle deals with the government’s recognition of independent spheres of human life that it has no right to control but every right to influence if the public welfare calls for it. These spheres include, for example, family, religious institutions, and private business enterprises. The two dimensions help to understand that the government has a complex role in society. Government must not only see that it executes its functions (e.g. national security) well, but it must also oversee the complex interrelations of all the independent spheres among which its citizens have their being, both ensuring that “safety, welfare, and public order” are maintained and ensuring that it does not overstep the bounds of government.

The public justice framework can help us understand the proper roles of government and other community institutions when it comes to JMHCs. Government has a responsibility to and interest in providing JMHCs because JMHCs are strongly related to the state/national concerns of safety, welfare, and public order. Likewise, as the government provides for citizens through the establishment of JMCHs, it recognizes that civil society institutions have significant roles to play in promoting the wellbeing of the youth in our communities as well.

In fact, the work of juvenile justice and JMHCs will be accomplished best if all institutions, including the government, unite with their distinct resources.

In fact, the work of juvenile justice and JMHCs will be accomplished best if all institutions, including the government, unite with their distinct resources. We can see how well this works with JMHCs. Their multisystemic approach in meeting the needs of young people (e.g. using their governmental leverage to engage otherwise unavailable service providers in the community, calling for youth advocates, and involving the family in every step of the process) is a step toward a system that actually restores justice-involved youth. Moreover, there ought to be further conversation as to the role of businesses (e.g. not automatically turning away employable candidates who have a criminal record), nonprofits (e.g. researching effective programs and coordinating community efforts), and communities of faith (e.g. participating in youth advocacy, offering faith-based mental services, or walking alongside youths in youth-led juvenile justice movement) in the JMHC movement.

The Collaborative Work of Healing

The JMHC comes much closer to attaining the Department of Justice’s definition of a healthy juvenile justice system than the traditional juvenile justice system does. JMHCs empower youths to live better lives by rigorously assessing their mental health needs, connecting them with appropriate community-based treatment and support, frequently reviewing their progress to maintain appropriate accountability, involving the entire family, and reducing recidivism rates (i.e. breaking unhealthy patterns of behavior). Such youth empowerment ultimately leads to increased public safety and welfare.

At the same time, JMHCs serve a very specific purpose, namely to solve the mental health crisis in the juvenile justice system. It provides a space for the many youth with mental illness in the juvenile justice system, especially those who are there merely because no services are available in the community, to receive proper, comprehensive treatment and to reintegrate into society. Long-term, we hope that the traditional juvenile justice system will learn from the principles and methods of JMHCs and diversion programs in general and rekindle its original tenet of therapeutic jurisprudence. We also hope that civil society institutions, such as mental health providers, faith communities, nonprofits, and businesses will prioritize juvenile justice in their respective institutional missions and will collaborate in the great work of healing the future. These young people are the future. We end with the words of Jesus: “Let the little children come to me, and do not hinder them, for the kingdom of heaven belongs to such as these.” (Matthew 19:14) Are we as a society allowing our young ones to come, to receive blessing, to be healed?

Kyle Chu is a graduate from Messiah University with a degree in Political Science and International Relations, along with a minor in music and in statistics. His passions span many areas, including, first and foremost, family and loved ones, foreign languages (Chinese, Latin, and Biblical Greek and Hebrew), omnivorous reading, multicultural eating, playing and composing music, house remodeling, jiu jitsu and calisthenics, and creating planted aquariums.

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