The Mental Health Needs of Young Offenders: Forging Paths Toward Reintegration and Rehabilitation

Empirical findings have shown that justice-involved youths have diagnosable and treatable mental disorders. Despite this, youth mental health services are usually among the early services to be jettisoned by budget-conscious agencies. Is this the right policy? Does this practice reduce youth recidivism in a cost-effective manner? The answers to these questions are found, along with the available evidence, in The Mental Health Needs of Young Offenders: Forging Paths Toward Reintegration and Rehabilitation, edited by Carol L. Kessler and Louis James Kraus.

The book is divided into 20 readable chapters. The first chapter provides a basic overview, while Chapter 2 uses epidemiological findings to identify specific psychiatric disorders that have been diagnosed in youths in juvenile detention. The authors review major psychiatric morbidities that affect juvenile offenders; prevalence rates are characterized by ethnicity and age. Also, the authors describe the limitations of studies in this area and discuss the implications of these shortcomings for youth and juvenile justice.

Chapters 5 and 11 are important with regard to court-ordered evaluations. Chapter 5 describes how to assess a child's competence to stand trial, including developmental considerations and areas of focus. Chapter 11 examines the role of science in juvenile death penalty litigation. The chapters delve into legal concepts such as Miranda rights and evolving standards of decency, as well as cognitive and legal culpability. Although it is ideal for juvenile court mental health evaluations to be performed by child- and adolescent-trained forensic psychiatrists and psychologists, the dearth of such professionals often shifts responsibility to general psychiatrists, forensic psychiatrists, and forensic psychologists.

While the authors of Chapters 7, 8, and 9 discuss the problems of substance abuse, suicide, and juvenile sex offenders, Kayla Pope and Christopher R. Thomas use Chapter 6 to propose a comprehensive biopsychosocial approach to the etiology of antisocial behavior across the developmental spectrum. They flesh out the interactions among biological variables, including genetics, environmental toxins, and neurochemicals; psychological variables such as attachment, temperament, and academic performance; and social factors such as parenting, child abuse, and peer relationships. They use epidemiological findings and cluster analysis to develop future policies and research.

In Chapter 10, “Educational Needs of Youth in the Juvenile Justice System,” the authors use evidence-based data to highlight challenges faced by juvenile justice facilities that strive to meet educational service provisions. The authors offer constructive and practical suggestions to improve educational services for youths involved in the justice system. Chapters 13, 14, and 15 contain discussions about mental health screening and the importance of neuropsychological testing in youth. The tests may identify deficits in executive function skills and other areas that could enhance youth outcomes by fostering development of individually targeted interventions.

My favorite part of the book is Chapter 16, which examines the use of evidence-based treatments for justice-involved youths. Through adept discussion and the use of a table (Table 16.1), Eric Trupin delves into various types of treatment. He describes the theoretical framework, goals, strategies, and outcomes of each treatment modality. For example, readers may appreciate that diversion programs prevent stigmatization, reduce recidivism, and save substantial cost. Trupin reviews alternative approaches to the punitive model of crime control and drives home the essence of the chapter with specific case scenarios.

The role of ethics, which is reviewed in Chapter 19, may be taken for granted by forensically trained individuals, as this is a major focus of forensic training. However, clinicians with no forensic training should be aware of the ethics-related pitfalls involved when they serve in the dual role of evaluator and treating clinician.

As a general and forensic psychiatrist, my main criticism of the book involves Chapter 15, which deals with the use of psychotropic medications in juvenile delinquents. The evidence presented in Table 15.1 would be more balanced if the limitations of the studies were briefly discussed. For example, about 25 of the listed studies were underpowered, with samples of fewer than 30 youths. Also, some of the studies were open-label and retrospective. The inherent methodological limitations were not given due consideration by the authors.

Overall, the editors and expert contributors have written a textbook that is concise, yet comprehensive, in a difficult subject area. The book, which contains numerous figures and tables, is richly referenced and will help readers appreciate the challenges and complexities involved in the field of juvenile justice. It should be on the shelves of all general and forensic psychiatrists and psychologists, as well as all professionals who work in the justice system.

• American Academy of Psychiatry and the Law