Psychiatrists Pressing for Better Care for Young Criminals

From the WebMD Archives

Oct. 1, 1999 (Washington) -- A host of juvenile justice provisions that some psychiatrists believe may help the nation's troubled youngsters is in congressional limbo. The provisions, which are tied up in a bill fraught with controversial gun control policies, were part of the discussion here just last week at the annual panels committees meeting of the American Psychiatric Association (APA).

The measures, sparked by the high school shooting in Littleton, Colo. last April, would establish mental health screenings for all juveniles entering the justice system. They would also mandate that states provide plans for mental health services for juveniles in order to receive federal dollars, and that they assess what mental health services are available to juveniles in the system.

William Buzogany, MD, chairman of the APA juvenile justice committee, tells WebMD, "It's probably the first time that ? mental health language has been incorporated in a piece of federal legislation dealing with juvenile justice."

About one million youths enter the juvenile justice system each year, with about 100,000 placed into correctional facilities. Experts believe that many youths in the justice system suffer mental illness, but estimates vary widely.

"The few studies that have been done to actually evaluate youngsters in that system show that there are over 50%, and up to 70% in some, identified as having definite psychiatric disorders," Lois Flaherty, MD, chair of the APA's committee on psychiatry and mental health in schools, tells WebMD. "We, as a profession, are becoming more aware of the fact that many of the people who need our services are not in our offices."

When care is provided to these youngsters -- and how often this occurs is not well evaluated -- it may leave something to be desired. "To the best of my knowledge, it's very inadequate," Buzogany tells WebMD.

The incident at Columbine High School in Littleton was the deadliest school shooting in U.S. history; 15 people were killed. It not only raised juvenile justice policy questions for the nation, but it also placed school violence on the front burner of national issues.

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Psychological interventions are crucial to helping to stem violence, psychiatrists and others assert. Flaherty tells WebMD that schools have increasingly -- and with promising results -- implemented peer mediation, conflict resolution, and anger management programs.

"If you only did that ? and nothing else, it might not have that much of an effect," she says. "But if you combine that with teacher education, parent education, and efforts to improve the overall climate in the school, then they can have a pretty big impact."

As for the causes of violence, any number of factors can influence the mind. "It is not simplistic," Buzogany tells WebMD. "Most everybody, of course, wants to come up with that one thing [to blame]," he adds, citing Nintendo and the Internet as examples.

To Flaherty, isolation and lack of community hamper early interventions ? and breed fear. "We have these communities where you've got people living in $500,000 houses, but they can't see the next house. You're just as isolated as somebody who's afraid to leave his apartment in the city because it's so dangerous."

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