Juvenile inmates are far more likely to be hospitalized for mental health disorders compared to non-incarcerated young people, according to researchers from Stanford University School of Medicine. The hospital stays of young inmates last longer as well, suggesting that their underlying mental health issues are more severe than those in the general population.
“We know young people in the juvenile justice system have a disproportionate burden of mental illness, but I was really surprised by the magnitude of the problem, because hospitalizations typically occur for very severe illness,” said the study’s lead author, Arash Anoshiravani, M.D., clinical assistant professor of adolescent medicine.
The researchers analyzed nearly two million hospitalizations of California children over a 15-year period. They found that mental health diagnoses were responsible for 63 percent of hospital stays by young people in the juvenile justice system, compared to 19 percent for those not in the system.
The study’s large size and assessment of hospital stays gives new insight into the widespread nature and severity of mental health diagnoses among juvenile inmates.
Mental-health hospital stays were even more common in detained girls than boys, noted Anoshiravani, who is also an adolescent medicine specialist at Lucile Packard Children’s Hospital Stanford and medical director of the Santa Clara County Juvenile Custody Institutions.
“If you just looked at girls, 74 percent of their hospitalizations were for mental illnesses,” he said. “That’s pretty sobering.”
For incarcerated teens, the types of diagnoses suggest that a good portion of their mental health problems developed in response to stressful and traumatic childhood experiences, such as being abused or witnessing violence, Anoshiravani said.
“They’re regular kids who have had really, really horrible childhoods,” he said, adding that he hopes the new findings will motivate social change around the problem.
“We are arresting kids who have mental health problems probably related to their experiences as children,” he said. “Is that the way we should be dealing with this, or should we be getting them into treatment earlier, before they start getting caught up in the justice system?”
The research covered all California hospital discharges between 1997 and 2011 for 11- to 18-year-olds. Data on non-California residents were excluded, leaving 1.9 million hospitalizations. Of these, 11,367 were for patients who had come from or were being discharged to a juvenile detention facility.
Median hospital stays for inmates lasted about one day longer than non-inmates (six compared with five days). However, for certain categories of hospitalization, the gap in length of stay was much greater: Those who were transferred to substance-abuse treatment programs had a median stay of as long as 71 days if they were in the juvenile justice system, versus 28 days for non-detained young people.
Because more juvenile inmates are publicly insured, these longer stays increase public expenditure, too.
The types of mental health diagnoses were similar among inmates and non-inmates: Depressive disorders, substance abuse and conduct disorders were the most common mental health problems in both groups, with conduct disorders occurring somewhat more often in detained youth.
The findings are published in the Journal of Adolescent Health.