Editor:

The article “Mental Health Care In Juvenile Detention Facilities: A Review,” by Desai et al.¹ was well written and timely, drawing attention to neglected clinical and forensic issues. In two sections, Psychotropic Medications, and Medication Management, the authors present an overview of existing limited national data regarding patterns of psychotropic medications use in juvenile detention facilities nationwide, and considerations for the continuation of and initiation of psychotropic medications for incarcerated juveniles. The authors did not mention a developing area for forensic psychiatrists—requests to render opinions regarding standards of care and practice in juvenile correctional facilities (i.e., suicide litigation, medical malpractice, class action/federal conditions of confinement litigation, or accepted standards of medical practice for state medical licensure and other regulatory/oversight matters).

The authors also did not report the accepted practice of reassessing recent psychotropic medication regimens, and when indicated, holding or discontinuing one or more psychotropic medications. Some examples of clinical situations to consider holding or not reinitiating one or more psychotropic medications include pregnancy in females, medication noncompliance, lack of youth assent/parental informed consent, recent substance abuse, and the need for clinical reassessment of the youth in a contained, structured setting. The need to use psychotropic medications in a safe and appropriate manner and only as part of a comprehensive treatment plan is particularly important due to recent controversies regarding psychotropic medication use in nonincarcerated youth in state custody.

Apart from these issues related to psychotropic medication, the authors state that there is no widely accepted or published best practice standards of behavioral health care in juvenile detention settings (page 209). The American Academy of Child and Adolescent Psychiatry did release the practice parameter for the Assessment and Treatment of Youth in Juvenile Detention and Correctional Facilities in 2005.^2,3

• American Academy of Psychiatry and the Law