Last updated: July 2017 www.ojjdp.gov/mpg

 Office of Juvenile Justice and Delinquency Prevention www.ojjdp.gov 1

Intersection between Mental Health and the Juvenile Justice 

System 

Mental health disorders are prevalent among youths in the juvenile justice system. A meta-analysis by 

Vincent and colleagues (2008) suggested that at some juvenile justice contact points, as many as 70 

percent of youths have a diagnosable mental health problem. This is consistent with other studies that 

point to the overrepresentation of youths with mental/behavioral health disorders within the juvenile 

justice system (Shufelt and Cocozza 2006; Meservey and Skowyra 2015; Teplin et al. 2015). However, 

prevalence varies depending on the stage in the justice system at which youths are assessed. In a 

nationwide study, the prevalence of diagnosed disorders increased the further that youths were 

processed in the juvenile justice system (Wasserman et al. 2010). 

While there appears to be a prevalence of youths with mental health issues in the juvenile justice system, 

the relationship between mental health problems and involvement in the system is complicated, and it 

can be hard to disentangle correlational from causal relationships between the two (Shubert and 

Mulvey 2014). 

This literature review will focus on the scope of mental health problems of at-risk and justice-involved 

youths; the impact of mental health on justice involvement as well as the impact of justice involvement 

on mental health; disparities in mental health treatment in the juvenile justice system; and evidencebased programs that have been shown to improve outcomes for youths with mental health issues. 

Defining Mental Health and Identifying Mental Health Needs 

Defining Mental Health. According to the U.S. Department of Health and Human Services, mental 

health includes a person’s psychological, emotional, and social well-being and affects how a person 

feels, thinks, and acts. Mental disorders relate to issues or difficulties a person may experience with his 

or her psychological, emotional, and social well-being. As Stein and colleagues explained, “each of the 

mental disorders is conceptualized as a clinically significant behavioral or psychological syndrome or 

pattern that occurs in an individual and that is associated with present distress (e.g., a painful symptom) 

or disability (i.e., impairment in one or more important areas of functioning) or with a significantly 

increased risk of suffering death, pain, disability, or an important loss of freedom” (2010, 1).

The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition is a standard classification tool for 

mental disorders used by many mental health professionals in the United States (American Psychiatric 

Association 2013). It includes 20 chapters of mental health disorders, including the following: 

Suggested Reference: Development Services Group, Inc. 2017. “Intersection Between Mental Health and the Juvenile Justice 

System.” Literature review. Washington, D.C.: Office of Juvenile Justice and Delinquency Prevention. 

https://www.ojjdp.gov/mpg/litreviews/Intersection-Mental-Health-Juvenile-Justice.pdf

Prepared by Development Services Group, Inc., under cooperative agreement number 2013–JF–FX–K002. Points of view or 

opinions expressed in this document are those of the author and do not necessarily represent the official position or policies of 

OJJDP or the U.S. Department of Justice.
Office of Juvenile Justice and Delinquency Prevention www.ojjdp.gov 2

 Substance-related and addictive disorders

 Bipolar and related disorders 

 Depressive disorders 

 Anxiety disorders 

 Obsessive-compulsive disorders 

 Trauma- and stressor-related disorders such as posttraumatic stress disorder and adjustment 

disorders 

 Disruptive, impulse control, and conduct disorders

 Neurodevelopmental disorders, which includes intellectual disabilities,1 attention 

deficit/hyperactivity disorder, and autism spectrum disorders 

A broader categorization divides mental health disorders into two categories: internalizing and 

externalizing. Internalizing disorders, which are negative behaviors focused inward, include depression, 

anxiety, and dissociative disorders. Externalizing disorders are characterized by behaviors directed 

toward a youth’s environment and include conduct disorders, oppositional defiant disorder, and 

antisocial behaviors. 

Tools to Identify Mental Health Needs. Juvenile justice systems use a variety of tools to identify mental 

health needs, although most fall into one of two categories:

 Screening. The purpose of screening is to identify youths who might require an immediate 

response to their mental health needs and to identify those with a higher likelihood of requiring 

special attention (Vincent 2012). It is similar to a triage process in a hospital emergency room. 

Although there are numerous screening instrument options, two commonly used are the 

Massachusetts Youth Screening Instrument—Version 2 (MAYSI-2; Grisso and Barnum 2006) 

and the Diagnostic Interview Schedule for Children (Wasserman, McReynolds, Fisher, and 

Lucas 2005). In addition to tools that screen for multiple mental health-related issues, there are 

also tools that screen for specific problems, such as the Children’s Depression Inventory (Kovacs 

1985) or the Suicidal Ideation Questionnaire (Reynolds 1988), which can help determine if a 

youth should be monitored for suicide attempts upon entry to detention or residential facility. 

 Assessment. The purpose of assessment is to gather a more comprehensive and individualized 

profile of a youth. Assessment is performed selectively with those youths with higher needs, 

often identified through screening. Mental health assessments tend to involve specialized 

clinicians and generally take longer to administer than screening tools (Vincent 2012). There are 

numerous mental health assessments. One widely studied assessment is the Achenbach System 

of Empirically Based Assessment (Achenbach and Rescorla 2001), which includes three 

instruments completed by youths (Youth Self-Report), parents (Child Behavior Checklist), or 

teachers (Teachers Report Form)2.

Scope of the Problem 

Multiple studies confirm that a large proportion of youths in the juvenile justice system have a 

diagnosable mental health disorder. Studies have suggested that about two thirds of youth in detention 

or correctional settings have at least one diagnosable mental health problem, compared with an 

 

1 A separate Model Programs Guide literature review on intellectual/development disabilities among youths in the justice 

system can be accessed here: https://www.ojjdp.gov/mpg/litreviews/Intellectual-Developmental-Disabilities.pdf

2

For more information on Risk/Needs Assessments for Youths, please see the literature review on the Model Programs 

Guide: https://www.ojjdp.gov/mpg/litreviews/RiskandNeeds.pdf
Office of Juvenile Justice and Delinquency Prevention www.ojjdp.gov 3

estimated 9 to 22 percent of the general youth population (Schubert and Mulvey 2014; Schubert, 

Mulvey, and Glasheen 2011). The 2014 National Survey on Drug Use and Health found that 11.4 percent 

of adolescents aged 11 to 17 had a major depressive episode in the past year, although the survey did 

not provide an overall measure of mental illness among adolescents (Center for Behavioral Health 

Statistics and Quality 2015). Similarly, a systematic review by Fazel and Langstrom (2008) found that 

youths in detention and correctional facilities were almost 10 times more likely to suffer from psychosis 

than youths in the general population. 

These diagnoses commonly include behavior disorders, substance use disorders, anxiety disorder, 

attention deficit/hyperactivity disorder (ADHD), and mood disorders (Chassin 2008; Gordon and 

Moore 2005; Shufelt and Cocozza 2006; Teplin et al. 2003). The prevalence of each of these diagnoses, 

however, varies considerably among youths in the juvenile justice system. For example, the Pathways 

to Desistance study (which followed more than 1,300 youths who committed serious offenses for 7 

years after their court involvement) found that the most common mental health problem was substance 

use disorder (76 percent), followed by high anxiety (33 percent), ADHD (14 percent), depression (12 

percent), posttraumatic stress disorder (12 percent), and mania (7 percent) (Schubert, Mulvey, and 

Glasheen 2011; Schubert and Mulvey 2014). A multisite study by Wasserman and colleagues (2010) 

across three justice settings (system intake, detention, and secure post-adjudication) found that over 

half of all youths (51 percent) met the criteria for one or more psychiatric disorders. Specifically, one 

third of youths (34 percent) met the criteria for substance use disorder, 30 percent met the criteria for 

disruptive behavior disorders, 20 percent met the criteria for anxiety disorders, and 8 percent met the 

criteria for affective disorder.

Many of these youths are also diagnosed with multiple disorders. For example, the Pathways to 

Desistance study found that 39 percent of youths met the threshold for more than one mental health 

problem (Schubert, Mulvey, and Glasheen 2011). Similarly, the Northwestern Juvenile Project (a 

longitudinal study that followed over 1,800 youths who were arrested and detained in Cook County, 

Illinois) found that 46 percent of males and 57 percent of females had two or more psychiatric disorders 

(Teplin et al. 2013). In a study of youths in contact with the juvenile justice systems (including 

community-based programs, detention centers, and secure residential facilities), in Texas, Louisiana, 

and Washington, Shufelt and Cocozza (2006) found that 79 percent of the youths diagnosed for one 

mental health disorder also met the criteria for two or more diagnoses. 

Impact of Mental Health Problems on Juvenile Justice Involvement 

As previously mentioned, the relationship between mental health problems and involvement in the 

juvenile justice system is complex. As Schubert and Mulvey explained, “although these two problems 

often go hand in hand, it is not clear that one causes the other. Many youths who offend do not have a 

mental health problem, and many youths who have a mental health problem do not offend” (2014, 3). 

There has been research to show how mental health diagnoses and problem behaviors are associated 

with each other. But as is often emphasized, correlation does not mean causation. In addition, certain 

risk factors could increase the occurrence of both mental health and problem behaviors in youths. For 

example, exposure to violence can increase mental health issues, such as posttraumatic stress, in youth 

and increase the occurrence of delinquent behavior (Finkelhor et al. 2009). However, although the 

research can point to a relationship between mental health issues and juvenile justice involvement, it 

remains difficult to determine the exact correlation.

Research on individual risk factors often focuses on how certain mental health problems may be 

associated with delinquency, violence, and justice system involvement. Researchers have found that 

some externalizing disorders (e.g., conduct disorders, oppositional defiant disorder, and antisocial 
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behaviors) and substance use disorders do increase the likelihood of delinquency, violence, and contact 

with the justice system (Barrett et al. 2014; Hawkins et al. 2000; Huizinga et al. 2000). 

For instance, in their meta-analysis of predictors of youth violence, Hawkins and colleagues (2000) 

found evidence that psychological factors—such as aggression, restlessness, hyperactivity, 

concentration problems, and risk taking—were consistently correlated with youth violence. However, 

they also found that internalizing disorders—such as worrying, nervousness, and anxiety—were either 

unrelated to later violence or reduced the likelihood of engaging in later violence. A recent metaanalysis by Wibbelink and colleagues (2017) also examined the relationship between mental disorders 

(including internalizing, externalizing, and comorbid disorders) and recidivism in juveniles. Similar to 

the findings from the Hawkins and colleagues (2000) meta-analysis, Wibbelink and colleagues (2017) 

found that externalizing disorders were significantly related to recidivism, while internalizing 

behaviors were not related to recidivism (and in some cases, internalizing behaviors had a buffering 

effect on recidivism). 

This link between certain mental health problems and delinquency has also been studied for youths in 

certain subpopulations. Among maltreated youths living in out-of-home care, the presence of a mental 

health disorder was significantly associated with juvenile justice system involvement, and conduct 

disorder was the strongest predictor (Yampolskaya and Chuang 2012). A study of psychiatric-inpatient

adolescents found that having a disruptive disorder, a history of aggressive behavior, and using cocaine 

were all predictors of juvenile justice system involvement (Cropsey, Weaver, and Dupre 2008). 

Trauma or exposure to violence may also increase the likelihood of juvenile justice involvement. 

Multiple studies show a connection between childhood violence exposure and antisocial behavior, 

including delinquency, gang involvement, substance use, posttraumatic stress disorder, anxiety, 

depression, and aggression (Wilson, Stover, and Berkowitz 2009; Finkelhor et al. 2009). In the 

Northwestern Juvenile Project, 92.5 percent of detained youths reported at least one traumatic 

experience, and 84 percent reported more than one (Abram et al. 2013). Other studies that have looked 

at past traumatic exposures in juvenile justice populations have also found high rates (e.g., Romaine et 

al. 2011; Rosenberg et al. 2014). 

Impact of Justice System Involvement on Mental Health Problems

Entry into the juvenile court system may exacerbate youths’ existing mental health problems for many 

reasons. For instance, there is inconsistency across some of the decision points of the juvenile justice 

system (including in the court systems and residential facilities) in providing referrals to treatment and 

appropriately screening, assessing, and treating juveniles with mental health conditions. There are also 

the difficulties that many juveniles face when detained or incarcerated, the increased odds of 

recidivating once youths are involved in the justice system, and the perceived barriers to services that 

can prevent youths from seeking or receiving treatment (National Mental Health Association 2004).

Lack of Referrals for Treatment. Among youths involved in the juvenile justice system (including those 

who have been referred to court or those who have been adjudicated and placed in a residential facility), 

only a small percentage of those in need of services can access treatment. For example, a 2014 juvenile 

residential facility census found that 58 percent reported they evaluated all youths for mental health 

needs, 41 percent evaluated some but not all youths, and 1 percent did not evaluate any youths 

(Hockenberry, Wachter, and Sladky 2016). However, it is unknown how many of the evaluated youths 

received referrals for treatment. In a study of juvenile courts in Tennessee, Breda (2003) found that 

fewer than 4 percent of juveniles who had committed offenses (regardless of diagnosis) were referred 

for mental health services. A study of a southern California correctional facility also found that only 6 
Office of Juvenile Justice and Delinquency Prevention www.ojjdp.gov 5

percent of youths were referred for mental health services (Rogers et al. 2001).

Even among youths who have been diagnosed, treatment is not guaranteed. The Pathways to 

Desistance Project found overall low rates of services provided to youths; however, this depended on 

both the type of facility in which youths had been placed (i.e., state-run juvenile corrections facilities, 

contract residential settings, detention centers, and jails/prisons) and the diagnosable mental health 

issue (Schubert and Mulvey 2014). Similarly, the Northwestern Juvenile Project found that only 15 

percent of youths diagnosed with psychiatric disorders and functional impartment received treatment 

while in detention (Teplin et al. 2013). A study of mental health delivery patterns in Maryland found 

that only 23 percent of the youths diagnosed with a mental disorder received any treatment (Shelton 

2005). A national study found that even if juvenile justice facilities reported having the capacity to 

provide services to youths in their care, youths with a severe mental health disorder often did not 

receive any emergency mental health services (Shufelt and Cocozza 2006). Finally, numerous studies 

have revealed disparities in regard to which youths are more likely to be referred for treatment (see 

Disparities in Mental Health Treatment below for more information). 

Impact of Detention/Confinement. Juvenile detention and correctional facilities may impact youths 

with mental health issues due to overcrowding, lack of available treatment/services, and separation 

from support systems (such as family members and friends). In addition, for juveniles in correctional 

facilities, being placed in solitary confinement or restrictive housing also has the potential to worsen 

mental health issues (National Institute of Justice 2016).

Greater Likelihood of Recidivism. Given the aforementioned limitations of the juvenile justice system, 

having a mental health problem while involved in the system can increase youths’ likelihood of 

recidivating or engaging in other problem behavior (e.g., Yampolskaya and Chuang 2012). This link 

has been documented most frequently for externalizing disorders (Barrett et al. 2014; Constantine et al. 

2013; McReynolds, Schwalbe, and Wasserman 2010) and for substance use disorders (Baglivio et al. 

2014; Hoeve et al. 2013; Schubert and Mulvey 2014).

For example, in their study of Florida youths who had completed juvenile justice residential 

placements, Baglivio and colleagues (2014) found that current substance use was a predictor of rearrest. In their study of youths who were previously placed in a detention facility, Mallett and 

colleagues (2013) found that having a conduct disorder diagnosis and a self-reported previous suicide 

attempt predicted subsequent recidivism to detention placement. In their study of almost 100,000 

youths whose cases had been processed by the South Carolina Department of Juvenile Justice, Barrett 

and colleagues (2014) found that an early diagnosis of an aggressive disorder was the strongest 

predictor of recidivism. 

Perceived Barriers to Treatment among Youth. Abram and colleagues (2015) surveyed youths with 

alcohol, drug, and mental health disorders in detention and found that the most frequently cited barrier 

to services was that youths believed their problems would go away without getting any help. Other 

reported perceived barriers were that youths were unsure whom to contact or where to go for help, and 

believed it was too difficult to obtain help. Perceived barriers can impact whether youths pursue 

treatment in the first place, as well as whether they participate and remain in treatment (Abram et al. 

2015). 

Disparities in Mental Health Treatment in the Juvenile Justice System

Researchers have also found disparities—particularly by race/ethnicity, gender, and age—in who is 
Office of Juvenile Justice and Delinquency Prevention www.ojjdp.gov 6

referred for treatment in the juvenile justice system.

Race/Ethnicity. Racial disparities exist among mental health diagnoses and treatment in both the 

community and the juvenile justice system. In the community, researchers have found that youths of 

color are less likely to receive mental health or substance use treatment (Dembo et al. 1998; Garland et 

al. 2005). Researchers have also found that minority youths receive fewer services than white youths in 

the foster care and child welfare populations (Garland and Besinger 1997; Horwitz et al. 2012). Among 

youths being served by mental health systems, youths of color are more likely to be referred to the 

juvenile justice system than white youths (Cauffman et al. 2005; Evens and Vander Stoep 1997; Scott, 

Snowden, and Libby 2002; Vander Stoep, Evens, and Taub 1997). 

Once in the juvenile justice system, minority youths are less likely to be treated for mental health 

disorders than white youths (e.g., Dalton et al. 2009; Herz 2001; Rawal et al. 2004). According to a 2016 

systematic review of articles that examined racial disparities among referrals to mental health and 

substance abuse services from within the juvenile justice system, most of the studies published from 

1995 to 2014 found that there was at least some race effect in determining which youths received

services, even when including statistical controls for mental health or substance use diagnosis or need 

(Spinney et al. 2016). 

For example, an examination of detained youths in Indiana found that both African American and 

Hispanic youths were less likely than white youths to receive contact with a mental health clinician 

within 24 hours of detention center intake and to receive a referral to mental health services upon 

detention center discharge—even after incorporating statistical controls for age, gender, detention 

center site, and whether the youth had a positive MAYSI–2 screening (Aalsma et al. 2014). Additionally, 

in a study of mental health delivery patterns in the Maryland juvenile justice system, Shelton (2005) 

found that while 42.6 percent of white youths who met diagnostic criteria received mental health 

services, only 11.9 percent of the African American youths who met diagnostic criteria received these 

services. She concluded that the data reflected a racial bias in the provision of services. 

Gender-Related Factors. As the proportion of girls involved in the juvenile justice system grows 

(Espinosa, Sorensen, and Lopez 2013; Odgers et al. 2005), researchers are increasingly looking at how 

gender differences impact the receipt of mental health care within the system. They are reporting a 

higher rate of referrals for females than males overall (Teplin et al. 2003; Cauffman et al. 2007; Fazel and 

Langstrom 2008; Herz 2001). In a study on juvenile offenders in Texas, Daurio (2009) found that girls 

were more likely than boys to receive mental health placements than incarceration, as a disposition 

outcome. Gunter-Justice and Ott (1997) also found that family court judges recommended mental health 

placements more frequently for girls, compared with boys. Once within the system, girls are also more 

likely to be referred for treatment by facility staff, which, as Rogers and colleagues (2001) suggested, 

may have to do with the staff members themselves being female. Finally, although girls in the juvenile 

justice system are referred for mental health treatment more frequently than boys, they are usually not 

referred for further follow-up treatment upon community reentry (Aalsma, Schwartz, and Perkins 

2014).

The following differences between boys and girls may explain why gender is a significant predictor of 

mental health placement: 

1. Girls are most often detained for status offenses and technical violations.

2. Girls report mental health symptoms and are more willing to use psychiatric services than boys.
Office of Juvenile Justice and Delinquency Prevention www.ojjdp.gov 7

3. Girls are more likely to exhibit internalizing disorders—such as anxiety, depression, and 

suicidality—than externalizing disorders such as aggression, bullying, and oppositional 

behaviors (Huizinga et al. 2000; Espinosa et al. 2013; Teplin et al. 2006). 

Odgers and colleagues (2005) also found that the rates of comorbidity of disorders increase 

exponentially for girls in the juvenile justice system. Regardless of their higher levels of referral as 

compared with boys, girls are still undertreated in the system given their high need (Espinosa et al. 

2013). 

Age-Related Factors. Age is often a determinant for who receives mental health services within the 

juvenile justice system. As various studies have indicated, younger juveniles (usually under 15 years of 

age) are more likely to be referred for mental health placements (Herz 2001; Daurio 2009). Rogers and 

colleagues (2001) found that of the youths in a Southern California juvenile correctional facility, those 

who had been arrested before the age of 14 were more likely to have been referred for treatment than 

youths arrested after the age of 14. Herz (2001) posited that this referral disparity indicates evidence of 

a “two-tiered system,” in which older adolescents receive a more punitive than rehabilitative approach 

than younger adolescents. 

Outcome Evidence

Some programs and treatment approaches for justice-involved youths, particularly those involving 

cognitive–behavioral therapy (CBT), have shown positive results. CBT is designed to help youths adjust 

their thinking and behaviors related to delinquency, crime, and violence (Little 2005; Beck 1999). CBT 

programs have also been shown to be effective in reducing recidivism rates (Jeong, Lee, and Martin 

2014). Research on other program types that specifically target youths with mental health needs, such 

as mental health diversion initiatives, have also shown positive results (Colwell, Villarreal, and 

Espinosa 2012; Cuellar, McReynolds, and Wasserman 2006). 

The following are examples of evidence-based programs from the Model Programs Guide that have 

demonstrated positive outcomes for youths with specific mental health needs, the first two of which 

specifically draw on the strategies of CBT.

Functional Family Therapy. Functional family therapy (FFT) is a family-based prevention and 

intervention program for high-risk youths ages 11–18. It concentrates on decreasing risk factors and 

increasing protective factors that directly affect adolescents who are at risk for delinquency, violence, 

substance use, or behavioral problems such as conduct disorder or oppositional defiant disorder. FFT 

is conducted over 8–12, 1-hour sessions for mild cases; it includes up to 30 sessions of direct service for 

families in more difficult situations. Sessions generally occur over a 3-month period and can be held in 

clinical settings as an outpatient therapy model or as a home-based model. 

In one large-scale study on FFT, which was delivered by community-based therapists, Sexton and 

Turner (2010) found that when adherence to the FFT model was high, FFT resulted in a significant 

reduction in felony crimes and violent crimes and a nonsignificant decrease in misdemeanor crimes. In 

addition, a study by Celinska and colleagues (2013) found that FFT had a positive effect on youths in 

the areas of reducing risk behavior, increasing strengths, and improving functioning across key life 

domains.

Multisystemic Therapy. Multisystemic Therapy (MST) is designed to help adolescents ages 12–17 who 

have exhibited serious clinical problems such as drug use, violence, and severe criminal behavior. 

Through intense family involvement, MST aims to assess the origins of adolescent behavioral problems 

and change the youth’s ecology to increase prosocial behavior while decreasing problem and 

delinquent behavior. MST typically uses a home-based model of service delivery to reduce barriers that 
Office of Juvenile Justice and Delinquency Prevention www.ojjdp.gov 8

keep families from accessing services. The average treatment occurs over approximately 4 months, 

although there is no definite length of service, with multiple therapist–family contacts occurring each 

week. 

In one evaluation of MST, Henggeler and colleagues (1992) found that, at 59 weeks post-referral, the 

group that received MST had just more than half the number of re-arrests than the comparison group, 

which received treatment as usual. Another study showed significant differences between treatment 

and comparison groups 4 years after the end of their probation: 71.4 percent of the individual therapy 

comparison group participants were arrested at least once, compared with 26.1 percent of MST 

participants (Borduin et al. 1995). 

Jefferson County Community Partnership. The Jefferson County Community Partnership in 

Birmingham, Ala., offers services for youth with serious emotional disturbances, which are accessible, 

community-based, individualized, culturally competent, and include an individual’s family in the 

planning and delivery of treatment. Overall, the goal of this collaborative approach is to reduce youths’ 

contact with the juvenile justice system. This includes reducing the odds of future offending and 

decreasing the seriousness of offenses, if they were committed (Matthews et al. 2013). The Jefferson 

County Community Partnership is not a program; rather, it is a collaborative framework that operates 

within a system-of-care concept. An evaluation of the Jefferson County Community Partnership found

a significant reduction in contact with the juvenile justice system among youths in the Birmingham 

system-of-care community, compared with the comparison community (Matthews et al. 2013).

Special Needs Diversionary Program. Based on the theory of therapeutic jurisprudence, the Special 

Needs Diversionary Program (SNDP) provides intensive supervision and treatment for juvenile 

probationers (ages 10–17) who display low levels of conduct and mental health disorders. The goal of 

the program is to rehabilitate the youths and prevent them from further involvement in the justice 

system. SNDP offers mental health services (including individual and group therapy), probation 

services (including life skills, mentoring, and anger management), and parental education and support. 

Specialized juvenile probation and professional mental health staff from the local mental health centers 

work together to coordinate intensive case-management services. The program follows procedures 

based on typical wraparound strategies. Services provided to juveniles include individual and family 

therapy, rehabilitation services, skills training, and chemical dependency.

In their study on SNDP, Cuellar and colleagues (2006) evaluated re-arrests for juveniles who 

participated in the program. They found that there were 63 fewer arrests per 100 youths served by the 

program over a 1-year period, compared with youths who had not been enrolled in the program.

For more information on these programs, click on the links below.

Functional Family Therapy

Jefferson County Community Partnership (Birmingham, Ala.)

Multisystemic Therapy

Special Needs Diversionary Program

Conclusion

The research presented shows that many youths with mental health issues in the justice system are in 

need of treatment. Substance use disorders are particularly prevalent. However, the intersection 
Office of Juvenile Justice and Delinquency Prevention www.ojjdp.gov 9

between mental health and the juvenile justice system represents a challenging area for policymakers 

and practitioners, because the exact relationship between mental health issues and problem behaviors 

(such as delinquency) is not always clear (Schubert and Mulvey 2014). The research indicates there are 

shared risk factors for mental health issues and juvenile justice involvement; however, the research is 

less conclusive about whether mental health problems increase the odds of youth involvement in the 

justice system or whether being a part of the justice system increases youths’ mental health problems. 

Despite the prevalence of mental health disorders among justice-involved youths, particularly for those 

processed further into the system, many do not receive services to meet their needs (Teplin et al. 2013).

In addition, there are discrepancies in referrals for treatment, particularly regarding race and gender

(Teplin et al. 2003; Spinney et al. 2016). 

However, there are several evidence-based programs that specifically target youths with mental health 

needs in the juvenile justice system and focus on reducing delinquency and other related problem 

behaviors by properly addressing both criminogenic risk factors and the mental health needs of these 

youths (Cuellar et al. 2006; Matthews et al. 2013).

References

Aalsma, Matthew C., Katherine Schwartz, and Anthony J. Perkins. 2014. “A Statewide Collaboration 

to Initiate Mental Health Screening and Assess Services for Detained Youths in Indiana.” 

American Journal of Public Health 104 (10): e82–88.

Achenbach, T.M., and L.A. Rescorla, L.A. 2001. Manual for the ASEBA School-Age Forms & Profiles. 

Burlington, VT: University of Vermont, Research Center for Children, Youth, & Families.

Abram, Karen M., Leah D. Paskar, Jason J. Washburn, Linda A. Teplin, Naomi A. Zwecker, and 

Nicole M. Azores-Gococo. 2015. Perceived Barriers to Mental Health Services Among Detained 

Youth. Juvenile Justice Bulletin. Washington, D.C.: U.S. Department of Justice, Office of Justice 

Programs, Office of Juvenile Justice and Delinquency Prevention.

Abram, Karen M., Jeanne Y. Choe, Jason J. Washburn, Linda A. Teplin, Devon C. King, Mina K. 

Dulcan, and Elena D. Bassett. 2014. Suicidal Thoughts and Behaviors Among Detained Youth. 

Juvenile Justice Bulletin. Washington, D.C.: U.S. Department of Justice, Office of Justice 

Programs, Office of Juvenile Justice and Delinquency Prevention.

Abram, Karen M., Linda A. Teplin, Devon C. King, Sandra L. Longworth, Kristin M. Emanuel, Erin G. 

Romero, Gary M. McClelland, Mina K. Dulcan, Jason J. Washburn, Leah J. Welty, and Nichole 

D. Olson. 2013. PTSD, Trauma, and Comorbid Psychiatric Disorders in Detained Youth. Juvenile 

Justice Bulletin. Washington, D.C.: U.S. Department of Justice, Office of Justice Programs, 

Office of Juvenile Justice and Delinquency Prevention.

American Psychiatric Association. 2013. Diagnostic and Statistical Manual of Mental Disorders (5th ed.). 

Arlington, Va.: American Psychiatric Publishing.

Baglivio, Michael T., Katherine Jackowski, Mark A. Greenwald, and James C. Howell. 2014. “Serious, 

Violent, and Chronic Juvenile Offenders: A Statewide Analysis of Prevalence and Prediction of 

Subsequent Recidivism Using Risk and Protective Factors.”

Criminology & Public Policy 13:83–116.

Barrett, David E., Antonis Katsiyannis, Dalun Zhang, and Dake Zhang. 2014. “Delinquency and 

Recidivism: A Multicohort, Matched-Control Study of the Role of Early Adverse Experiences, 

Mental Health Problems, and Disabilities.” Journal of Emotional and Behavioral Disorders 22(1):3–

15. 

Beck, Aaron. 1999. Prisoners of Hate: The Cognitive Basis of Anger, Hostility, and Violence. New York, 

N.Y.: HarperCollins Publishers

Borduin, Charles M., Barton J. Mann, Lynn T. Cone, Scott W. Henggeler, Bethany R. Fucci, David M. 
Office of Juvenile Justice and Delinquency Prevention www.ojjdp.gov 10

Blaske, and Robert A. Williams. 1995. “Multisystemic Treatment of Serious Juvenile Offenders: 

Long-Term Prevention of Criminality and Violence.” Journal of Consulting and Clinical 

Psychology 63(4):569–78.

Breda, Carolyn S. 2003. “Offender Ethnicity and Mental Health Services Referrals from Juvenile 

Courts.” Criminal Justice and Behavior 30(6):644–67.

Cauffman, Elizabeth, Sarah H. Scholle, Edward Mulvey, and Kelly J. Kelleher. 2005. “Predicting FirstTime Involvement in the Juvenile Justice System among Emotionally Disturbed Youth 

Receiving Mental Health Services.” Psychological Services 2(1):28–38.

Cauffman, Elizabeth, Frances Lexcen, Asha Goldweber, Elizabeth Shulman, and Thomas Grisso. 2007. 

“Gender Differences in Mental Health Symptoms among Delinquent and Community Youth.”

Youth Violence and Juvenile Justice 5:287–307.

Celinska, Katarzyna, Susan Furrer, and Chia-Cherng Cheng. 2013. “An Outcome-Based Evaluation of 

Functional Family Therapy for Youth with Behavioral Problems.” OJJDP Journal of Juvenile 

Justice 2(2): 23-36.

Center for Behavioral Health Statistics and Quality. 2015. Behavioral Health Trends in the United States: 

Results From the 2014 National Survey on Drug Use and Health. (HHS Publication No. SMA 15-

4927, NSDUH Series H-50). Rockville, Md.: U.S. Department of Health and Human Services, 

Substance Abuse and Mental Health Services Administration, Center for Behavioral Health 

Statistics and Quality. 

Chassin, L. 2008. “Juvenile Justice and Substance Use.” Future Child 18(2):165-83.

Colwell, Brian, Soila F. Villarreal, and Erin M. Espinosa. 2012. “Preliminary Outcomes of a 

Preadjudication Diversion Initiative for Juvenile Justice Involved Youth With Mental Needs in 

Texas.” Criminal Justice and Behavior 39(4):447–60.

Constantine, Robert J., Ross Andel, John Robst, and Eugenia M. Givens. 2013. “The Impact of 

Emotional Disturbances on the Arrest Trajectories of Youth as They Transition into Young 

Adulthood.” Journal of Youth and Adolescence 42 (8): 1286–98.

Cropsey Karen L., Michael F. Weaver, and Madeline A. Dupre. 2008. “Predictors of Involvement in 

the Juvenile Justice System among Psychiatric Hospitalized Adolescents.” Addictive Behaviors

33:942–49.

Cuellar, Alison E., Larkin S. McReynolds, and Gail A. Wasserman. 2006. “A Cure for Crime: Can 

Mental Health Treatment Diversion Reduce Crime Among Youth?” Journal of Policy Analysis 

and Management 25(1):197–214.

Dalton, Richard F., Lisa J. Evans, Keith R. Cruise, Ronald A. Feinstein, and Rhonda F. Kendrick. 2009. 

“Race Differences in Mental Health Service Access in a Secure Male Juvenile Justice Facility.” 

Journal of Offender Rehabilitation 48(3):194–209.

Daurio, R. 2009. Factors Associated with Court Decisions to Provide Juvenile Offenders with Mental Health 

Placements (Order No. 3368964). Available from ProQuest Criminal Justice; ProQuest 

Dissertations & Theses Full Text: The Humanities and Social Sciences Collection. (305176884). 

Dembo, R., J. Schmeidler, James Schmeidler, Pollyanne Borden, Sue Camilla Chin, and Darrell 

Manning. 1998. “Use of the POSIT Among Arrested Youths Entering a Juvenile Assessment 

Center: A Replication and Update.” Journal of Child & Adolescent Substance Abuse 6(3):19–42. 

Espinosa, Erin M., Jon R. Sorensen, and Molly A. Lopez. 2013. “Youth Pathways to Placement: The 

Influence of Gender, Mental Health Need and Trauma on Confinement in the Juvenile Justice 

System.” Journal of Youth and Adolescence, 42(12):1824–36. 

Evens, Carina C., and Ann Vander Stoep. 1997. “Risk Factors for Juvenile Justice System Referral 

Among Children in a Public Mental Health System.” Journal of Mental Health Administration 

24(4):443–55.

Fazel, Seena, Helen Doll, and Niklas Langstrom. 2008. “Mental Disorders Among Adolescents in 

Juvenile Detention and Correctional Facilities: A Systematic Review and Metaregression 
Office of Juvenile Justice and Delinquency Prevention www.ojjdp.gov 11

Analysis of 25 Surveys.” Journal of the American Academy of Child & Adolescent Psychiatry

47(9):1010–19.

Finkelhor, David, Heather Turner, Richard Ormrod, Sherry Hamby, and Kristen Kracke. 2009. 

Children’s Exposure to Violence: A Comprehensive National Survey. Juvenile Justice Bulletin. 

Washington, D.C.: U.S. Department of Justice, Office of Justice Programs, Office of Juvenile 

Justice and Delinquency Prevention.

Garland, Ann F., Anna S. Lau, May Yeh, Kristen M. McCabe, Richard L. Hough, and John A. 

Landsverk. 2005. “Racial and Ethnic Differences in Utilization of Mental Health Services 

among High-Risk Youths.” American Journal of Psychiatry 162 (7):1336–43.

Garland, A. F., and B. A. Besinger 1997. “Racial/Ethnic Differences in Court Referred Pathways to 

Mental Health Services for Children in Foster Care.” Children and Youth Services Review

19(8):65166.

Gordon, Jill A., and Page Malmsjo Moore. 2005. “ADHD Among Incarcerated Youth: An Investigation 

on the Congruency with ADHD Prevalence and Correlates Among the General Population.” 

American Journal of Criminal Justice 30(1):87–97.

Grisso, Thomas, and Richard Barnum. 2006. Massachusetts Youth Screening Instrument, Youth Version 2: 

User’s Manual and Technical Report. Sarasota, Fla.: Professional Resource Press.

Gunter-Justice, T.D., and D.A. Ott. 1997. “Who Does the Family Court Refer for Psychiatric Services?” 

Journal of Forensic Science 42(6):1104–6.

Hawkins, J. David, Todd I. Herrenkohl, David P. Farrington, Devon Brewer, Richard F. Catalano, 

Tracy W. Harachi, and Lynn Cothern. 2000. “Predictors of Violence.” Juvenile Justice Bulletin. 

Washington, D.C.: U. S. Department of Juvenile, Office of Justice Programs, Office of Juvenile 

Justice and Delinquency Prevention. 

Henggeler, Scott W., Gary B. Melton, and Linda A. Smith. 1992. “Family Preservation Using 

Multisystemic Therapy: An Effective Alternative to Incarcerating Serious Juvenile 

Offenders.” Journal of Consulting and Clinical Psychology 60(6):953–61.

Herz, D. C. 2001. “Understanding the Use of Mental Health Placements by the Juvenile Justice 

System.” Journal of Emotional Behavioral Disorders 9(3):172–81.

Hockenberry, Sarah, Andrew Wachter, and Anthony Sladky. 2016. Juvenile Residential Facility Census, 

2014: Selected Findings. National Report Series. Washington, D.C.: Office of Juvenile Justice and 

Delinquency Prevention.

Hoeve, Machteld, Larkin S. McReynolds, Gail A. Wasserman, and Cary McMillan. 2013. “The 

Influence of Mental Health Disorders on Severity of Reoffending in Juveniles.” Criminal Justice 

and Behavior 40(3): 289–301.

Horwitz, Sarah McCue, Michael S. Hurlburt, Jeremy D. Goldhaber-Fiebert, Amy M. Heneghan, Jinjin 

Zhang, Jennifer RollsReutz, Emily Fisher, John Landsverk, and Ruth E.K. Stein. 2012. “Mental 

Health Services Use by Children Investigated by Child Welfare Agencies.” Pediatrics

130(5):86169.

Huizinga, David, Rolf Loeber, Terence Thornberry, and Lynn Cothern. 2000. Co-occurrence of 

Delinquency and Other Problem Behaviors. Juvenile Justice Bulletin. Washington, D.C.: Office of 

Juvenile Justice and Delinquency Prevention. 

Jeong, S., B.H. Lee, and J.H. Martin. 2014. “Evaluating the Effectiveness of A Special Needs 

Diversionary Program in Reducing Reoffending Among Mentally Ill Youthful Offenders.”

International Journal of Offender Therapy and Comparative Criminology 58(9):1058–80.

Kovacs, M. 1985. “The Children’s Depression Inventory.” Psychopharmacology Bulletin 21:995–98.

Little, Gregory L. 2005. “Meta-Analysis of Moral Reconation Therapy: Recidivism Results from 

Probation and Parole Implementations.” Cognitive–Behavioral Treatment Review 14:14–16. 

Mallett, Christopher A., Moyuki Fukushima, Patricia Stoddard-Dare, and Linda Quinn. 2013. “Factors 

Related to Recidivism for Youthful Offenders.” Criminal Justice Studies 26(1):84–98.
Office of Juvenile Justice and Delinquency Prevention www.ojjdp.gov 12

Matthews, Shelley Keith, Anna Krivelyova, Robert L. Stephens, and Shay Bilchik. 2013. “Juvenile 

Justice Contact of Youth in Systems of Care: Comparison Study Results.” Criminal Justice Policy 

Review 24(2):143-65.

McReynolds, Larkin S., Craig S. Schwalbe, and Gail A. Wasserman. 2010. “The Contribution of 

Psychiatric Disorder to Juvenile Recidivism.” Criminal Justice and Behavior 37:204–16.

Meservey, Fred, and Kathleen R. Skowyra. 2015. “Caring for Youth with Mental Health Needs in the 

Juvenile Justice System: Improving Knowledge and Skills.” Research and Program Brief 2(2).

National Institute of Justice. 2016. Restrictive Housing in the U.S.: Issues, Challenges, and Future 

Directions. Washington, D.C.: U.S. Department of Justice, Office of Justice Programs, National 

Institute of Justice.

National Mental Health Associations. 2004. Mental Health Treatment for Youth in the Juvenile Justice 

System: A Compendium of Program Practices. Alexandria, VA: National Mental Health 

Associations

Odgers, Candice L., Mandi L. Burnette, Preeti Chauhan, Marlene M. Moretti, and N. Dickon 

Reppucci. 2005. “Misdiagnosing the Problem: Mental Health Profiles of Incarcerated 

Juveniles.” The Canadian Child and Adolescent Psychiatry Review 14(1):26–9.

Rawal, Purva, Jill Romansky, Michael Jenuwine, and John S. Lysons. 2004. “Racial Differences in the 

Mental Health Needs and Service Utilization of Youth in the Juvenile Justice System.” Journal 

of Behavioral Health Services and Research 31(1):242–54.

Reynolds, W.M. 1988. Suicidal Ideation Questionnaire Professional Manual. Odessa, Fla.: Psychological 

Assessment Resources. 

Romaine, Christina R. L., Naomi E. Sevin, Elizabeth Hunt Goldstein, and David DeMatteo. 2011. 

“Traumatic Experiences and Juvenile Amenability: The Role of Trauma in Forensic 

Evaluations and Judicial Decision Making.” Child & Youth Care Forum 40(5):363–80. 

Rogers, Kenneth M., Bonnie Zima, Elaine Powell, and Andres J. Pumariega. 2001. “Who is Referred to 

Mental Health Services in the Juvenile Justice System?” Journal of Child and Family Studies

10(4):485–94. 

Rosenberg, Harriet J., John E. Vance, Stanley D. Rosenberg, George L. Wolford, Susan W. Ashley, and 

Michael L. Howard. 2014. “Trauma Exposure, Psychiatric Disorders, and Resiliency in 

Juvenile-Justice-Involved Youth.” Psychological Trauma: Theory, Research, Practice, and Policy 6 

(4):430–37. 

Scott, Michelle A., Lonnie Snowden, and Anne M. Libby. 2002. “From Mental Health to Juvenile 

Justice: What Factors Predict This Transition?” Journal of Child and Family Studies 11(3):299–311.

Schubert, Carol A., and Edward P. Mulvey. 2014. Behavioral Health Problems, Treatment, and Outcomes 

in Serious Youthful Offenders. Juvenile Justice Bulletin. Washington, D.C.: U.S. Department of 

Justice, Office of Justice Programs, Office of Juvenile Justice and Delinquency Prevention.

Schubert, Carol A., Edward P. Mulvey, and Cristie Glasheen 2011. “Influence of Mental Health and 

Substance Use Problems and Criminogenic Risk on Outcomes in Serious Juvenile Offenders.” 

Journal of American Academy of Child & Adolescent Psychiatry 50(9): 925–37.

Sexton, Thomas L., and Charles W. Turner. 2010. “The Effectiveness of Functional Family Therapy for 

Youth With Behavioral Problems in a Community Practice Setting.” Journal of Family 

Psychology 24(3):339–48.

Shelton, Deborah. 2005. “Patterns of Treatment Services and Costs for Young Offenders with Mental 

Disorders.” Journal of Child and Adolescent Psychiatric Nursing 18(3):103–12.

Shufelt, Jennie L., and Joseph. J. Cocozza 2006. Youth with Mental Health Disorders in the Juvenile Justice 

System: Results from a Multistate Prevalence Study. Research and Program Brief, 1–6. Delmar, N.Y.: 

National Center for Mental Health and Juvenile Justice.

Spinney, Elizabeth, Martha Yeide, William Feyerherm, Marcia Cohen, Rachel Stephenson, and 

Courtnie Thomas. 2016. “Racial Disparities in Referrals to Mental Health and Substance Abuse 
Office of Juvenile Justice and Delinquency Prevention www.ojjdp.gov 13

Services from the Juvenile Justice System: A Review of the Literature.” Journal of Crime and 

Justice 39(1):153–73.

Stein, Dan J., Katharine A. Phillips, Derek Bolton, K. W. M. Fulford, John Z. Sadler, and Kenneth S. 

Kendler. 2010. “What is a Mental/Psychiatric Disorder? From DMC-IV to DMS-V.” 

Psychological Medicine 40(11):1759–65.

Teplin, Linda A., Leah J. Welty, Karen M. Abram, Mina K. Dulcan, Jason J. Washburn, Kathleen 

McCoy, and Marquita L. Stoke. 2015. Psychiatric Disorders in Youth After Detention. Juvenile 

Justice Bulletin. Washington, D.C.: U.S. Department of Justice, Office of Justice Programs, 

Office of Juvenile Justice and Delinquency Prevention.

Teplin, Linda A., Karen M. Abram, Gary M. McClelland, Amy A. Mericle, Mina K. Dulcan, and Jason 

J. Washburn. 2006. Psychiatric Disorders of Youth in Detention. Juvenile Justice Bulletin. 

Washington, D.C.: U.S. Department of Justice, Office of Justice Programs, Office of Juvenile 

Justice and Delinquency Prevention.

Teplin, Linda. A., Karen M. Abram, Gary M. McClelland, and Mina K. Dulcan. 2003. “Comorbid 

Psychiatric Disorders in Youth in Juvenile Detention.” Archives of General Psychiatry

60(11):1097–108. 

Teplin, Linda. A., Karen M. Abram, Jason J. Washburn, Leah J. Welty, Jennifer A. Hershfield, and 

Mina K. Duncan. 2013. The Northwestern Juvenile Project: Overview. Juvenile Justice Bulletin. 

Washington, D.C.: U.S. Department of Justice, Office of Justice Programs, Office of Juvenile 

Justice and Delinquency Prevention.

Underwood, Lee A., and Aryssa Washington. 2016. “Mental Illness and Juvenile Offenders.” 

International Journal of Environmental Research and Public Health 13(2):228–36.

Vander Stoep, Ann, Carina C. Evens, and Jennifer Taub. 1997. “Risk of Juvenile Justice System 

Referral among Children in a Public Mental Health System.” Journal of Mental Health 

Administration 24(4):428–42.

Vincent, G. M., Thomas Grisso, Anna Terry, and Steven M. Banks. 2008. “Sex and Race Differences in 

Mental Health Symptoms in Juvenile Justice: The MAYSI-2 National Meta-Analysis.” Journal of 

the American Academy of Child and Adolescent Psychiatry 47(3):282–90.

Vincent, G. M. 2012. Screening and Assessment in Juvenile Justice Systems: Identifying Mental Health Needs 

and Risk of Reoffending. Washington, D.C.: Technical Assistance Partnership for Child and 

Family Mental Health.

Wasserman, Gail A., Larkin S. McReynolds, Prudence Fisher, and Christopher P. Lucas, C. P. 2005. 

“Diagnostic Interview Schedule for Children: Present State Voice Version.” In T. Grisso, G. 

Vincent, and D. Seagrave (eds.). Mental Health Screening and Assessment in Juvenile Justice. New 

York, N.Y.: Guilford Press, 224–239.

Wasserman, Gail A., Larkin S. McReynolds, Craig, S. Schwalbe, Joseph M. Keating, and Shane A. 

Jones. 2010. “Psychiatric Disorder, Comorbidity, and Suicidal Behavior in Juvenile Justice 

Youth.” Criminal Justice and Behavior 37(12):1361–76. 

Wibbelink, Carlijn J.M., Machteld Hoeve, Geert Jan J.M. Stams, and Frans J. Oort. 2017. “A MetaAnalysis of the Association between Mental Health Disorders and Juvenile Recidivism.” 

Aggression and Violent Behavior, available online first. doi: 10.1016/j.avb.2017.01.005

Wilson, Helen W., Carla S. Stover, and Steven J. Berkowitz. 2009. “Research Review: The Relationship 

between Childhood Violence Exposure and Juvenile Antisocial Behavior: A Meta-Analytic 

Review.” Journal of Childhood Psychology and Psychiatry 50(7): 769-79.

Yampolskaya, Svetlana, and Emmeline Chuang. 2012 “Effects of Mental Health Disorders on the Risk 

of Juvenile Justice System Involvement and Recidivism among Children Placed in Out-OfHome Care.” American Journal of Orthopsychiatry 82(4):58593.