ERIC EJ815078: Adolescent Offenders with Mental Disorders

2008·0.31 MB·English

by  ERIC

Adolescent Offenders with Mental Disorders
Adolescent Offenders with Mental Disorders
Thomas Grisso
Summary
Thomas Grisso points out that youth with mental disorders make up a significant subgroup of
youth who appear in U.S. juvenile courts. And he notes that juvenile justice systems today are
struggling to determine how best to respond to those youths’ needs, both to safeguard their
own welfare and to reduce re-offending and its consequences for the community. In this article,
Grisso examines research and clinical evidence that may help in shaping a public policy that
addresses that question.
Clinical science, says Grisso, offers a perspective that explains why the symptoms of mental
disorders in adolescence can increase the risk of impulsive and aggressive behaviors. Research
on delinquent populations suggests that youth with mental disorders are, indeed, at increased
risk for engaging in behaviors that bring them to the attention of the juvenile justice system.
Nevertheless, evidence indicates that most youth arrested for delinquencies do not have serious
mental disorders.
Grisso explains that a number of social phenomena of the past decade, such as changes in juve-
nile law and deficiencies in the child mental health system, appear to have been responsible for
bringing far more youth with mental disorders into the juvenile justice system. Research shows
that almost two-thirds of youth in juvenile justice detention centers and correctional facilities
today meet criteria for one or more mental disorders.
Calls for a greater emphasis on mental health treatment services in juvenile justice, however,
may not be the best answer. Increasing such services in juvenile justice could simply mean that
youth would need to be arrested in order to get mental health services. Moreover, many of the
most effective treatment methods work best when applied in the community, while youth are
with their families rather than removed from them.
A more promising approach, argues Grisso, could be to develop community systems of care that
create a network of services cutting across public child welfare agency boundaries. This would
allow the juvenile justice system to play a more focused and limited treatment role. This role
would include emergency mental health services for youth in its custody and more substan-
tial mental health care only for the smaller share of youth who cannot be treated safely in the
community.
www.futureofchildren.org
Thomas Grisso is a professor of psychiatry (clinical psychology) at the University of Massachusetts Medical School.
VOL. 18 / NO. 2 / FALL 2008 143
Thomas Grisso
When adolescents face to protect youth in its custody, to protect the
problems affecting their community, and to engage in interventions
welfare, most communi- that reduce crime. The purpose of the men-
ties in the United States tal health system is to treat mental disorders.
have available at least What, then, is the appropriate public service
four public systems with which to respond in response for youth with serious mental dis-
the interests of society, families, and youth. orders who engage in troubling offenses that
These four systems specialize in education, threaten the community?
child protection, juvenile justice, and mental
health. Like a mall’s storefronts, each offers a In this article, I examine research and clinical
somewhat different type of product. Each of
evidence that may help in shaping a public
the four storefronts has its own door through
policy that addresses that question. The first
which community members can pass when
step in crafting such a policy is to determine
they have determined that an adolescent’s
how and to what extent delinquency and
needs fit the professions, skills, and objectives
mental disorders co-occur. In the first two
of the personnel and products within.
sections of the following review I address this
question from two perspectives. From a clini-
In recent years, however, communities have
cal perspective, I first examine how symptoms
begun to recognize that this model of service
of adolescent mental disorders are related to
delivery for adolescents—so logical in its
aggression. And then from an epidemiologi-
organization around specific types of prob-
cal perspective, I consider the proportion
lems and services—is not consistent with the
of youth with mental disorders who offend,
nature of adolescents’ needs. The problems
the proportion of young offenders who have
in which the separate systems specialize—
mental disorders, and the prevalence of men-
learning problems, parental neglect, delin-
tal disorders among youth in juvenile justice
quent behavior, and mental disorders—are
facilities.
not like medical problems of teeth, eyes,
bones, and skin, each of which arises inde-
The heavy presence of youth with mental
pendent of the other. Hundreds of thousands
disorders in the juvenile justice system might
of youth need the services of all four of these
suggest that the solution is simply to improve
public systems at once, often because their
the way the system provides mental health
problems have interrelated causes. Commu-
services to those in its custody. But entertain-
nities whose policies organize behavioral and
ing this notion requires carefully considering
social services for youth according to
the advantages and disadvantages of assigning
a specialty-store logic often have difficulty
addressing this reality. The storefronts them- the task of treatment to the system’s juvenile
selves do not face each other and often do pretrial detention centers and correctional
not even recognize that they are serving the facilities. What is known about the value of
same customers. clinical treatment for reducing future delin-
quency? What is known about its value when
Nowhere has this difficulty been more evident delivered to youth in juvenile justice custody?
in recent years than in society’s responses to What legal and practical consequences need
delinquent youth with mental disorders. The to be considered regarding delivery of treat-
purposes of the juvenile justice system are ment in juvenile justice settings?
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Adolescent Offenders with Mental Disorders
Based on existing knowledge, what recom- of the criteria for diagnosing depression in
mendations can be offered for developing a youth.6 That depressed youth are often sullen
community response to youthful offenders and belligerent, rather than simply sad, has a
with mental disorders? What could be the number of implications for aggression in
meaningful roles for various child welfare social situations. The irritable mood of such
agencies, and what role could the juvenile youth increases the likelihood that they will
justice system best play within that context? provoke angry responses from other youth
(and adults), thus augmenting the risk of
The Clinical Relation between events that escalate to physical aggression and
Mental Disorders and Aggression result in arrests. When these youth are in
A number of comprehensive studies, re- custody in juvenile justice facilities, their
viewed later, indicate that certain types of mood disorder may increase the risk of
mental disorders are common among youth altercations with other youth. In addition, the
who are arrested for delinquencies.1 Indeed, connection between anger and depression can
many of the symptoms of these disorders be directed toward themselves, so that they
themselves increase the risk of aggression present an increased risk of engaging in
and, therefore, the risk of behavior for which self-injurious behaviors, including suicide.
youth are arrested and receive delinquency
charges.2 But the picture that emerges from
this research is complex, with some disorders
A number of comprehensive
decreasing the risk and others increasing it
studies, reviewed later,
only in combination with other disorders. The
following review captures the broader picture
indicate that certain types
of what is known. Recent comprehensive
of mental disorders are
reviews of the relation of mental disorder and
aggression are available to provide greater common among youth
detail.3
who are arrested for
Risk of Aggression and Specific Disorders
delinquencies.
Research has thoroughly documented an
increased tendency toward anger, irritability,
and hostility among youth with affective Anxiety disorders in children and adolescents
(mood) disorders.4 Such disorders, mostly usually involve fearfulness and a tendency
various forms of clinical depression, are found to be withdrawn and to avoid confrontation.
in about 10 to 25 percent of youth in juvenile Many studies show that youth with anxiety
justice settings.5 Someone not familiar with disorders are less aggressive than the aver-
childhood depression may consider this age for their peers.7 The exception is youth
association odd, since depressed adults with posttraumatic stress disorder (PTSD),
frequently appear sad and withdrawn, not who are susceptible to responding to threats
angry. But so common is irritability and aggressively and unexpectedly.8 Youth with
hostility among youth with depressive disor- PTSD and conduct disorder (a disorder char-
ders that the formal psychiatric definition of acterized by antisocial tendencies) have been
childhood depression allows “irritable mood” found to be more impulsive and aggressive
to be substituted for “depressed mood” as one than youth with conduct disorder alone.9
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Thomas Grisso
Psychotic disorders such as schizophrenia Finally, there is substantial evidence for a
are fairly rare before early adulthood and are relation between substance use disorders and
not often seen in juvenile justice settings. delinquent behavior, as well as continued
Nevertheless, some youth have psychotic- aggression among substance-abusing youth
like symptoms, possibly as early forms of the with conduct disorder as they transition
disorder, that include thought disturbances to adulthood.14 For example, in one study,
—that is, unusual and sometimes bizarre substance use disorders were found in 40 to
interpretations of events. The evidence that 50 percent of delinquent youth but only 15
percent of nondelinquent youth.15 Substance
youth with “evolving” psychotic disorders
use disorder also has implications for the pro-
present a greater threat of aggression than
tection of youth in juvenile justice custody,
other youth is quite weak.10 But when youth
because youth entering juvenile detention
with psychotic features engage in serious
facilities straight off the street may engage in
delinquencies, one frequently finds that their
aggressive and self-injurious behaviors arising
disturbed thought has played a role in their
in the context of withdrawal symptoms.
aggression.
In contrast, the evidence is quite clear that
youth with disruptive behavior disorders, Many specific mental
such as conduct disorder (CD) and attention-
disorders and their co-
deficit hyperactivity disorder (ADHD),
manifest substantially increased rates of morbidity increase the risk
physically aggressive behavior.11 This finding is
of aggression because their
not surprising, given the features of these
disorders. Aggressive and delinquent behav- emotional symptoms (such
iors are part of the criteria for obtaining a CD
as anger) and self-regulatory
diagnosis, and ADHD is diagnosed in part by
impulsiveness, which can often lead a youth to symptoms (such as impulsive-
respond to emotional situations without
ness) themselves increase the
pausing to consider the consequences. We
cannot simply dismiss conduct disorder as risk of aggression.
“not really a mental disorder, but merely bad
character,” because there is considerable
evidence that the great majority of youth in
Complex Clinical Factors and Aggression
the juvenile justice system diagnosed with CD
In considering the relation of aggression to
also meet diagnostic criteria for other clinical
symptoms in each of these disorders, it is
disorders.12 Conduct disorder and ADHD also important to recognize that not all youth with
are important to consider because of their a given diagnosis are identical. Among those
longer-range implications for criminal behav- who meet criteria for a disorder, some may
ior. While only about one-third of adolescents experience their symptoms more severely
with CD eventually develop antisocial person- than others. Youth may also vary in their
ality disorder in adulthood, about two-thirds capacities to cope with their symptoms.
have nonviolent or violent offense records Some have the disorder persistently across a
as adults.13 significant period of time, while others meet
146 THE FUTURE OF CHILDREN
Adolescent Offenders with Mental Disorders
criteria for the disorder for only a short time. The second type of clinical complexity with
Among the latter, some will have recurring implications for policy and practice involves
episodes of the disorder, while others will a class of youth often called “seriously
experience only one episode. Because of emotionally disturbed.” Such youth have
these complex individual differences, merely multiple mental disorders, manifested from
knowing a youth’s diagnosis does not tell us before adolescence, that persist throughout
everything we need to know about the risk of their adolescence and into adulthood. They
aggression in individual cases. account for a relatively small proportion of
youth in the community with mental disor-
Two other complexities of child disorders ders (estimated at 10 percent). But the extent
have significant implications for policy and of their disabilities is such that they consume
nearly half of the community’s mental health
practice. The first is co-morbidity, or the
resources.20 Almost all of them have juvenile
presence of more than one mental disorder,
justice contact during their adolescence,
which is very common among adolescents
and a majority continues to have criminal
with mental disorders.16 Among youth in
justice contact—for both minor and serious
juvenile justice facilities who meet criteria for
offenses—as they transition into adulthood.21
having any mental disorder, about two-thirds
They have been estimated to account for
meet criteria for two or more disorders.17
about 15 to 20 percent of youth in juvenile
justice facilities.22 Seriously emotionally
Research has underscored the importance
disturbed youth typically have acquired a
of co-morbidity for understanding the rela-
significant number of diagnoses consecutively
tion between adolescents’ mental disorders
or together in adolescence.
and their aggressive behaviors. For example,
many disorders that offer only a modestly
In summary, research confirms that many
increased risk of aggression appear to aug-
specific mental disorders and their co-
ment the risk when they are found in com-
morbidity increase the risk of aggression
bination with other disorders. Co-morbidity
because their emotional symptoms (such as
of CD and ADHD has been identified as
anger) and self-regulatory symptoms (such as
increasing the likelihood of chronic and
impulsiveness) themselves increase the risk of
repeated offending during adolescence.18
aggression. The increased risk of aggression,
Co-morbidity recently was examined in a
in turn, increases the risk that youth with
study addressing how mental disorders in
these symptoms will be arrested, charged,
adolescence relate to later offending in young
and convicted of delinquencies and may have
adulthood.19 Depression or anxiety (and even
continued criminal justice contact as they
the two together) during adolescence only move into adulthood.
slightly increased the odds of adult offending,
and adolescent substance use disorder had a What is not clear from the clinical research
modestly greater relation to adult offending. itself is how much the mental disorders of
But either depression or anxiety in combina- adolescents contribute to a community’s
tion with substance use disorder during ado- delinquency or to the burden on its juvenile
lescence greatly increased the odds of serious justice system and other child welfare agen-
and violent adult offending and was far more cies. Answering this question requires exam-
predictive than substance use alone. ining a different type of research, focused on
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Thomas Grisso
the prevalence of mental disorders among and youth in contact with the community’s
delinquent youth. juvenile court.23 These studies are few in
number, but they have found that the risk of
The Prevalence of Mental Disorders juvenile court involvement among a commu-
among Adolescent Offenders nity’s young mental health clients is substan-
Two kinds of studies address questions about tial. For example, a study in one city found
the social consequences of the links between that adolescents in contact with the commu-
mental disorders and delinquency. One type nity’s mental health system during a nine-
examines the degree of “overlap” between a month period were two to three times more
community’s population of youth with mental likely to have a referral to the juvenile justice
disorders and its population of youthful system during that period than were youth in
offenders. Knowing this overlap gives some the city’s general population.24 Youth in contact
notion of the risk of official delinquency for with a mental health system’s services, how-
youth with mental disorders and the degree ever, are not the sum of a community’s youth
to which mental disorders of youth contribute with mental health needs because many
to a community’s overall delinquency. The receive no services. The results of the study
second type of study examines the propor- above probably represent the proportion of
tion of youth with mental disorders within more seriously disturbed youth who have
juvenile justice facilities or programs. These juvenile justice contact. Even so, merely
studies provide information with which to knowing that youth “have contact” with the
formulate policy about treating and manag- juvenile justice system tells us little about their
ing youth with mental disorders in juvenile offenses or even whether they offended at all.
justice custody.
Very few studies have used samples that
It is important to recognize that these two make it possible to identify both the propor-
types of research begin with very different tion of delinquent youth in a community who
populations, even though they both address have mental disorders and the proportion of
the relation between mental disorder and youth with mental disorders who have been
delinquency. The first typically focuses on all delinquent. The few that have, however, are
delinquent youth in the community, while large studies with careful designs.
the second examines only delinquent youth
placed in juvenile pretrial detention centers One examined a community population
when they are arrested or in juvenile cor- (drawn from several cities) that identified
rectional facilities when they are adjudicated. youth with persistent serious delinquency
This distinction is further complicated, as (repeat offending) and youth with persistent
discussed later, by the fact that not all youth mental health problems (manifested multiple
in juvenile justice facilities are necessarily times).25 About 30 percent of youth with per-
delinquent. sistent mental health problems were persis-
tently delinquent. But among all persistently
Epidemiologic Studies of Mental delinquent youth, only about 15 percent had
Disorder and Delinquency persistent mental health problems.
Some studies have identified a significant
overlap between the populations of youth Another recent study examined the relation
served by community mental health agencies between mental disorders during adolescence
148 THE FUTURE OF CHILDREN
Adolescent Offenders with Mental Disorders
and criminal behavior when those youth although the share is somewhat dispropor-
became adults.26 Delinquencies and adult tionately greater than their prevalence in the
criminal arrests were recorded for a sample general community. If those youth received
of youth in a large geographic region aged treatment that reduced their delinquency, it
nine through twenty-one. The youth were is possible that overall rates of delinquency in
also assessed for mental disorders three times the community would fall somewhat, but the
between the ages of nine and sixteen. A diag- majority of delinquencies are not related to
nosis at any one of these three points identi- mental disorders.
fied the youth as having a mental disorder
“sometime during childhood or adolescence.” Third, rates of delinquency are higher among
youth with certain types of emotional disor-
In this study, youth who were arrested ders—for example, depression or anxiety
between the ages of sixteen and twenty-one co-morbid with substance use disorders—
included a considerably greater share of youth and among youth with chronic and multiple
who had had mental disorders in adolescence disorders (seriously emotionally disturbed
than those who were not arrested—for males, youth). Finally, a few studies have suggested
51 percent as against 33 percent. This finding that youth with mental disorders make up a
does not mean that 51 percent of the arrested somewhat greater proportion (although still a
group had mental disorders at the time of minority) of youth who were arrested for more
their arrest, but that they had had a mental serious and violent delinquencies or crimes.27
disorder sometime in adolescence. It also
does not mean that the majority of youth who Mental Disorder in Juvenile
had mental disorders in adolescence were Justice Settings
arrested in adulthood. A different statistical Research on the subset of delinquent youth
procedure in this study, called “population who enter juvenile pretrial detention cen-
attributable risk,” addressed that question. ters and correctional programs cannot tell
It showed that the risk of adult arrest among us the relation between mental disorder and
individuals who had mental disorders at some delinquency, because most youth who engage
time during adolescence was about 21 percent in delinquencies are not placed in secure
for women and 15 percent for men. juvenile justice programs. Such studies,
however, are extremely important for public
These few studies suggest the following policy, because they identify the scope and
conclusions, all of which need further con- nature of mental disorder among youth for
firmation. First, consistent with the clinical whom the juvenile justice system has custo-
research reviewed earlier, youth who have dial responsibility.
mental disorders are at greater risk of engag-
ing in offenses than youth without mental Until recently the precise prevalence of
disorders. It is possible that treating their mental disorders among youth in juvenile
disorders would reduce that risk. But most justice custody was unknown. Estimates
youth with mental disorders do not engage varied widely from study to study, largely
in offenses that involve them in juvenile or because of inadequate research methods or
criminal justice systems. Second, youth with differences from one study site to another.28
mental disorders represent only a minority of In the past decade, however, well-designed
all youth who engage in delinquent behavior, studies executed in a variety of sites have
VOL. 18 / NO. 2 / FALL 2008 149
Thomas Grisso
provided a reliable and consistent picture. response to mental disorders among youth in
Those studies have found that among youth its custody. The high prevalence of mental
in various types of juvenile justice settings— disorder in juvenile justice facilities does not
for example, pretrial detention centers where necessarily define the need for treatment.
youth are taken soon after arrest—about Some youth who meet criteria for mental
one-half to two-thirds meet criteria for one or disorders are experiencing their disorders
more mental disorders.29 The prevalence of temporarily and need only emergency
mental disorders is much higher in juvenile services, while a smaller share—about one in
justice settings than it is among youth in the ten—represents a core group of youth with
U.S. general population, which is about 15 to chronic mental illness who can be expected to
25 percent.30 continue to need clinical services into adult-
hood.34 Some are functioning fairly well
despite their symptoms, while others are
During the 1990s, most states
barely able to function at all. And some have
saw a reduction in the mental health needs, such as learning disabili-
ties, that were not even included in the recent
availability of public mental
studies of prevalence among youth in juvenile
health services for children.
justice settings.
Many communities began
Reasons for the High Prevalence
using the juvenile justice
of Mental Disorders in Juvenile
system to try to fill the Justice Programs
Why are mental disorders so prevalent among
gap caused by decreased
adolescent offenders in juvenile justice
availability of mental settings? Three perspectives—clinical,
socio-legal, and inter-systemic—help to
health services.
explain. They are not competing explanations.
All probably play a role, and no evidence
Across these studies, the rate is higher for suggests that one is more important than
girls than for boys.31 The overall prevalence the others.
rate does not vary greatly between younger
and older adolescents or for youth with vari- From a clinical perspective, it is likely that
ous ethnic and racial characteristics, although the same symptoms of mental disorder that
age and race differences are sometimes found increase the risk of aggression also increase
for specific types of disorders and symptoms.32 the likelihood that youth will be placed in
As described in the earlier clinical review, secure juvenile justice facilities for any
about two-thirds of youth in juvenile justice significant period of time. When police
custody who meet criteria for a mental dis- officers arrest youth, usually those youth are
order (that is, about one-third to one-half of not placed in pretrial detention. Nor is
youth in custody) meet criteria for more than detention reserved for the most serious
one disorder.33 offenders—in fact, youth arrested for very
violent offenses typically do not make up the
I will focus later on the implications of these majority of youth in detention. Those youth
statistics for the juvenile justice system’s best who are detained more than a few hours are
150 THE FUTURE OF CHILDREN
Adolescent Offenders with Mental Disorders
those who have been more unruly or unman- in secure juvenile facilities, thus reducing the
ageable at the time of their arrest, which likelihood that youth could receive mental
satisfies detention criteria regarding a risk health services in the community after their
that they will be endangered, or might adjudication. An unintended consequence of
endanger others, if not detained. these changes in law, therefore, was an
increase in the share of youth with mental
Youth with mental disorders frequently have disorders coming into the system rather than
symptoms involving impulsiveness, anger, being diverted on the basis of the juvenile
and cognitive confusion that can make them court’s discretion.
less manageable and a greater risk to them-
selves or others, especially under the stress A final, inter-systemic, explanation involves
associated with their offense and arrest. Thus, the dynamic relation between systems that
among youth who are detained, a significant serve youth. During the 1990s, most states
share is likely to have mental disorders that saw a reduction in the availability of public
create unmanageable behavior—more so mental health services for children, especially
than for youth without mental disorders and inpatient services.36 It is possible that less
more so than their peers with less severe adequate treatment contributed to increased
mental disorders. This likelihood makes it delinquencies among youth with mental
no surprise that youth with mental disorders disorders. But it is certain that many commu-
contribute disproportionately to detention nities began using the juvenile justice system
populations. to try to fill the gap caused by decreased
availability of mental health services.
From a socio-legal perspective, recent
changes in laws applied to youths’ delinquen- This phenomenon was documented in media
cies may have increased the likelihood that articles, the observations of juvenile justice
youth with mental disorders will enter the personnel, and government reports beginning
juvenile justice system. Before the 1990s, law in the mid-1990s and continuing into the
enforcement officers, juvenile probation early 2000s.37 Some parents of children with
departments, prosecutors, and judges serious mental disorders began urging police
typically had some discretion regarding to arrest their children, knowing that courts
whether they would arrest or prosecute youth could “order” mental health services that
with mental disorders when they engaged in were becoming nearly impossible for parents
illegal behaviors, especially if those behaviors to get on their own. Soon the local juvenile
involved minor offenses committed by pretrial detention center was becoming the
younger adolescents without offense histo- community’s de facto mental health center
ries. But a wave of serious juvenile violence that provided emergency mental health
during the late 1980s caused virtually all services or simply acted as a holding place
states to revise their juvenile justice statutes for seriously disturbed youth who had no-
during the 1990s to rein in this discretion.35 where to go.
Under the new laws, certain charges or
offenses required legal responses based on In summary, these three factors—clinical,
the nature of the offense alone, not the socio-legal, and inter-systemic—may together
characteristics or needs of the individual produce a prevalence of mental disorder
youth. Penalties more often involved custody in juvenile justice settings that does not
VOL. 18 / NO. 2 / FALL 2008 151
Thomas Grisso
represent the actual relation between adoles- treatment for mental disorders will reduce
cent mental disorder and delinquency. That delinquency. Then I consider how well
high prevalence does, however, represent juvenile justice can manage that treatment.
a demand on the juvenile justice system to Finally I look at the evidence for broader
respond to youth in custody who have mental community-based alternative treatment
disorders, and the demand is almost over- strategies.
whelming. Some of those youth are in secure
custody because they have committed serious This discussion presumes two things about
crimes, others because the legal system has the purposes of public child welfare agencies.
widened the door to juvenile justice process- First, all such agencies, including the juvenile
ing, and many because their symptoms make justice system, are responsible for dealing
them difficult to handle and they have no with mental health crises of youth who are
place else to go. in their custody. Mental health agencies
are responsible specifically for meeting the
The problem requires a solution, and the mental health needs of youth, but all agencies
multiple causes of the problem as well as the must respond to acute needs that threaten
various types of youth involved suggest that youths’ safety. Second, all public child welfare
the solution will be complex. What have clini- agencies are responsible for reducing delin-
cians and researchers learned that can help quency, but that is the primary mandate for
us determine the appropriate response?38 the juvenile justice system, consistent with
its responsibilities for community safety. This
A Community Response mandate will come to bear especially when
Typically, the call for a response to the needs community safety would be increased by
of youth in juvenile justice with mental treatment of mental disorders among youth
disorders focuses on “more treatment.” Yet who have been identified as delinquent.
treatment often is left undefined. Moreover,
the need for “more treatment” often has been The Values and Limits of
presumed to refer to the need for more Clinical Treatment
services within the juvenile justice system. Ample research evidence attests to the ben-
Research evidence, however, suggests the efits of treatment for youth in acute distress
need both to define carefully what is meant because of mental disorders. Among the most
by treatment and to avoid depending on the common and effective treatments are profes-
juvenile justice system to respond to the sional clinical care, psychopharmacological
broader question of adolescent mental intervention when necessary, and structuring
disorders and crime. Certainly the juvenile the environment to protect the youth and to
justice system has a treatment responsibility reduce stress during a crisis.
for youth in its care. But research and current
logic suggest that this role should be focused, The literature on the effectiveness of psy-
limited, and based on collaboration with the chopharmacological options for treating
broader community in meeting that mental disorders in adolescents is remarkably
responsibility. mixed, depending on the specific disorder.39
There is no doubt that youth with some types
Before explaining those conclusions, I first of mental disorders can benefit from certain
examine evidence regarding whether medications. But studies that test the effects
152 THE FUTURE OF CHILDREN