Transcript Mental Health and Juvenile Justice

Mental Health
and Juvenile Justice
Class 16
CASE OF THE DAY:
Pediatric Pedophiles
• Facts
– “Sarah” is one of over 200 minors charged in the past
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year with having consensual sex with other minors
Prosecution rate is low – 12/200
Felony if one of the persons is below age 16, and
misdemeanor if age 16-17.
Jurisdiction asserted by Child Protective Services
agency, case investigated as an instance of child
physical and sexual abuse
Medical, educational and other professionals or
service providers are required to notify CPS
Both boys and girls are charged and prosecuted
• Issues
– Who is prosecuted?
• “Only those who pose problems to their families or
schools….”
• Selective?
– What is the punishment?
• Six months of court supervision
• Mandatory separation from their sexual partners
• Curfews and mandatory school attendance
– Collateral consequences
• Sex offender registration and notification for older
teens (age 18 or older, or those waived to criminal
court)
• Criminal record and other stigma
– The Legislature’s Harm Reduction Reaction
• Avoid registration is minor is four years younger or less (most
states have 3 year gap, so WI is more liberal?)
• Questions
– Legal rationale? Public health? Special interest in
protecting minors from harm and self-harm?
– Parental preference? Conflict between state and
parents’ interests?
– What should the response be when minors engage in
consensual sex?
– Should there be a differentiated response for sexual
acts other than intercourse?
– Parameters of “consensual” – age, context, nature of act
– Punishment? Culpability?
MENTAL HEALTH
• Historical Antecedents
– Hijacking of juvenile court by psychologists and
psychiatrists in its “second phase”, starting in the
1920s
– Sharp rise in admissions of minors to mental hospitals
in this era
– Commensurate with expansion of institutional and
other residential mental health services
– Deinstitutionalization movements in the 1970s (linked
to federal funding under 1974 JJDPA)
– Private sector growth: increase in use of private MH
facilities from 37% to 61% in one decade (Weithorn) –
political economy?
Practices
• Standards for court-initiated placement to
a MH institution or facility?
– Behavioral criteria
– Diagnostic Classification
– “Severe problems” attributable to a
“psychiatric disease”
– Akin to diagnosis of “dangerousness”
(Weithorn, at 787)
– MH Diagnosis as marker of dangerousness
Legal Regulation
• Case Law
– Parham v J.R. 442 U.S. 584 (1979) – court
declined to require states to regulate use of
private mental health placements. Court
refused to limit discretion of either parents or
state guardians in use of these facilities
– Conflict with Gault? Other juvenile rights?
– State interest only begins when the institution
endangers child, then parental rights are
circumscribed and state becomes protector of
child
Professional Regulation
• Standards Projects? Very little, mostly “training
and technical assistance” to improve services–
see: National Center for Mental Health and
Juvenile Justice, http://www.ncmhjj.com/
• Financial oversight through state insurance
regulators – effective?
• Mandated review of admissions – substitution of
procedural oversight instead of substantive
review of decision making
Juvenile Justice Placements
• “Transinstitutionalization” beginning in the
1970s when JJDPA limited juvenile court
jurisdiction for non-delinquents
• Sharp expansion by courts following
JJDPA (Herz, at 173)
• For delinquents, MH options expanded in
1970s within juvenile corrections agencies
for “dangerous” offenders with diagnosed
mental health problems – secure TX
• Prevalence estimates
• Detention:
– See: Linda A. Teplin, et al., Psychiatric Disorders in Youth in
Juvenile Detention, 59Arch Gen Psychiatry 1133-1143 (2002).
– DISC measurement (interviewer-guided self-report of symptoms)
– 1172 males, 657 females, ages 10-18 years in secure detention in
Cook County
– 2/3 of males and 3/4 of females met diagnostic criteria for one or
more psychiatric disorders.
– Half of males and almost half of females had a substance use
disorder, and more than 40% of males and females met criteria for
disruptive behavior disorders.
– Affective disorders were also prevalent, especially among females;
more than 20% of females met criteria for a major depressive
episode.
– Rates of many disorders were higher among females, non-Hispanic
whites, and older adolescents.
• Corrections
Source: California Youth Authority, Substance Abuse and Mental Health Needs
Assessment, 2000; Thomas Grisso, Massachusetts Youth Screening Instrument for
mental health needs of juvenile justice youths. 40 Journal of the American
Academy of Child & Adolescent Psychiatry, 541-548 (2001).
• Correctional Institutions
– Capacity of correctional institutions to protect
kids with MH problems? To treat them?
– How are classifications and decisions made?
– Validity of testing and classification measures?
• Steven Erickson, “Psychological Testimony on Trial:
Questions Arise About the Validity of Popular Testing
Methods,” XIX Law Guardian Reporter, December
2003
– Daubert tests challenge validity of MMPI,
Rorschach, others (see also NYT, 3/9/04,
Science 1).
Decision Making and Disparity
• Which offenders receive mental health
placements and which are sent to
correctional institutions?
• Disparities by race and gender?
• Balance of ‘penal proportionality’ with
treatment needs?
• Herz Study
– N=4,758 cases
– Females, Whites, Age (younger) more likely to
receive MH placement over other correctional
placements
– Prior record and offense seriousness were not
significant predictors
– Geographic and court jurisdiction variations
reflect availability of services and different
preferences of judges (PPG articles)
Current Climate
• PPG Articles
• Deinstitutionalization has depleted MH
resources, created dependence on JJ system for
kids with mental health or emotional problems
• $
• Low threshold for detention and incarceration
creates little room for risk in placement decisions
• PA HB 1448 – relaxes standards for involuntary
commitments of youths for mental health and
substance abuse treatment based on physician
recommendation
Some Issues
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Disparity by race and gender
Overuse and difficulty of regulation
Is it punishment?
Future of Parham?
Sexual abuse and institutional violence –
revictimization
• What happens if we import Hendricks
logic?