U.S. Department of Justice

Office of Justice Programs

Office of Juvenile Justice and Delinquency Prevention 

Office of Juvenile Justice and Delinquency Prevention ojjdp.gov

September 2015 Melodee Hanes, Acting Administrator Robert L. Listenbee, Administrator

Beyond Detention 

Even though research indicates that 

the majority of youth in the juvenile 

justice system have been diagnosed with 

psychiatric disorders, reports issued by 

the Surgeon General and the President’s 

New Freedom Commission on Mental 

Health show that juvenile detainees 

often do not receive the treatment and 

Perceived Barriers to Mental Health 

Services Among Detained Youth 

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

and Nicole M. Azores-Gococo 

services they need. 

This bulletin series presents the results of 

the Northwestern Juvenile Project, the 

first large-scale, prospective longitudinal 

study of drug, alcohol, and psychiatric 

disorders in a diverse sample of juvenile 

detainees. Individual bulletins examine 

topics such as suicidal behaviors in 

youth in detention, posttraumatic 

stress disorder and trauma among this 

population, functional impairment in 

youth after detention, and barriers for 

youth who need to receive mental health 

services. 

Nearly all detained youth eventually 

return to their communities and the 

findings presented in this series provide 

empirical evidence that can be used 

to better understand how to meet 

youth’s mental health needs and provide 

appropriate services while in detention 

and after their release. The Office 

of Juvenile Justice and Delinquency 

Prevention hopes this knowledge will 

help guide innovative juvenile justice 

policy and create a better future for 

youth with psychiatric disorders in the 

justice system. 

Highlights 

This bulletin is part of a series that presents the results of the Northwestern 

Juvenile Project—a longitudinal study of youth detained at the Cook County 

Juvenile Temporary Detention Center in Chicago, IL. The authors examine 

youth’s perceptions of barriers to mental health services, focusing on youth 

with alcohol, drug, and mental health disorders. 

Findings include the following: 

•	 Most frequently, youth did not receive services because they believed

their problems would go away without outside help (56.5 percent).

•	 Nearly one-third of youth (31.7 percent) were not sure whom to

contact or where to get help.

•	 Nearly one-fifth of the sample (19.1 percent) reported difficulty in

obtaining help.

•	 African American and Hispanic detainees received significantly

fewer services in the past compared with non-Hispanic white youth.

Male detainees also received significantly fewer services in the past

when compared with female detainees.
2 Juvenile Justice Bulletin 

SEPTEMBER 2015

 

Perceived Barriers to Mental Health Services Among 

Detained Youth 

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

More than 2 million youth are arrested each year (Snyder, 

2005), and more than 61, 000 juveniles were placed 

in custody on any given day in 2011 (Sickmund et al., 

2013). Of the many youth involved in the juvenile justice 

system, most meet the criteria for psychiatric disorders 

that warrant mental health treatment (Teplin et al., 2002; 

Vermeiren, Jespers, and Moffit, 2006; Wasserman et 

al., 2002). Estimates indicate that nearly 70 percent of 

female detainees and 60 percent of male detainees have a 

psychiatric disorder other than a conduct disorder (Teplin 

et al., 2002) and that approximately half have two or 

more disorders (Abram et al., 2003). Rates of psychiatric 

ABOUT THIS SERIES 

Studies in this series describe the results of statistical 

analyses of the Northwestern Juvenile Project, a 

longitudinal study of youth detained at the Cook County 

Juvenile Temporary Detention Center in Chicago, IL, 

between 1995 and 1998. The sample included 1,829 male 

and female detainees between ages 10 and 18. The data 

come from structured interviews with the youth. 

Topics covered in the series include the prevalence of 

suicidal thoughts and behaviors among juvenile detainees, 

posttraumatic stress disorder and trauma within this 

population, functional impairment after detention (at work, 

at school, at home, or in the community), psychiatric 

disorders in youth processed in juvenile or adult court, 

barriers to mental health services, violent death among 

delinquent youth, and the prevalence of psychiatric 

disorders in youth after detention. The bulletins can 

be accessed from the Office of Juvenile Justice and 

Delinquency Prevention’s (OJJDP’s) website, ojjdp.gov. 

disorder among youth in the juvenile justice system are 

substantially higher than rates in the general population 

(Teplin et al., 2002). 

Jails are required to provide a minimum of psychiatric 

care to inmates (American Association of Correctional 

Psychology, 2000), yet reports issued by the Surgeon 

General (U.S. Department of Health and Human Services, 

2000) and The President’s New Freedom Commission on 

Mental Health (2004) suggest that youth in custody are 

profoundly underserved. 

In addition to the funding that OJJDP provided, the 

research also was supported by the National Institute 

on Drug Abuse, the National Institute of Mental Health, 

the National Institute on Alcohol Abuse and Alcoholism, 

the Substance Abuse and Mental Health Services 

Administration (Center for Mental Health Services, Center 

for Substance Abuse Prevention, and Center for Substance 

Abuse Treatment), the Centers for Disease Control and 

Prevention (National Center for Injury Prevention and 

Control and National Center for HIV/AIDS, Viral Hepatitis, 

STD, and TB Prevention), the National Institutes of Health 

Office of Research on Women’s Health, the National 

Institute on Minority Health and Health Disparities, the 

Office of Rare Diseases, the Office of Behavioral and Social 

Sciences Research, the U.S. Departments of Labor and 

Housing and Urban Development, the William T. Grant 

Foundation, and the Robert Wood Johnson Foundation. 

The John D. and Catherine T. MacArthur Foundation, the 

Open Society Foundations, and the Chicago Community 

Trust provided additional funds. 
This bulletin describes the results of a study that examined 

youth’s perceptions of barriers to mental health services. 

The authors interviewed 1,829 juveniles detained in 

Chicago to determine their need for, use of, and barriers 

to services. 

Background 

Although more than 70 percent of detention centers now 

screen for mental disorders (Goldstrom et al., 2000), 

research suggests that only 15.4 percent of detainees with 

major mental disorders receive treatment (Teplin et al., 

2005). Males, older youth, and racial/ethnic minorities 

with major mental disorders are significantly less likely to 

receive treatment than females, younger detainees, and 

non-Hispanic whites with major mental disorders (Teplin 

et al., 2005). 

Youth in the juvenile justice system have many of the 

characteristics associated with lower rates of service use: 

poverty and poor education (Buckner and Bassuk, 1997; 

Heflinger, Chatman, and Saunders, 2006; Pumariega et 

al., 1998), inadequate health insurance and ineligibility for 

Medicaid (Flores et al., 2002; Holl et al., 1995; Moffitt 

and Slade, 1997), racial/ethnic minority status (Heflinger, 

Chatman, and Saunders, 2006; McMiller and Weisz, 

1996), a history of arrest (Rogers et al., 2001; Teplin et 

al., 2002), and a small social network (Harrison, McKay, 

and Bannon, 2004; McKay, McCadam, and Gonzales, 

1996). 

Although much is known about these external barriers 

to mental health service use, less is known about youth’s 

perceived barriers and attitudes toward service use. How 

youth think about services helps determine whether 

they cooperate with referrals or remain in treatment. 

To date, three studies have examined perceived barriers 

to substance abuse treatment among detained youth 

(Johnson et al., 2001; Kim and Fendrich, 2002; Lopez, 

2003). Kim and Fendrich (2002) and Lopez (2003) found 

that a youth’s perceived need for treatment, regardless 

of his or her race or ethnicity, determined whether he 

or she sought services for substance abuse. Johnson and 

colleagues (2001) found that detainees who believed they 

could handle their own problems or that problems would 

simply go away had lower rates of service use. However, 

these studies only examined services for substance abuse. 

To the authors’ knowledge, no study until this point had 

investigated perceived barriers to mental health service 

use among juvenile detainees. The study described in 

this bulletin was designed to address this omission in the 

literature. Because prior evidence suggests that perceptions 

of services may differ across sociodemographic groups, the 

study also examines gender and racial/ethnic differences 

in perceived barriers (Diala et al., 2000, 2001; Gonzalez, 

Alegria, and Prihoda, 2005; Ojeda and Bergstresser, 2008). 

Methods 

This section provides a brief overview of the authors’ 

methods. Additional, detailed information on the 

methodology can be found in Abram et al. (2003) and 

Teplin et al. (2002). 

Participants and Sampling Procedures 

Participants were part of the Northwestern Juvenile 

Project (NJP), a longitudinal study of 1,829 youth (ages 

10–18) arrested and detained between November 20, 

1995, and June 14, 1998, at the Cook County Juvenile 

Temporary Detention Center (CCJTDC) in Chicago, 

IL. The random sample was stratified by gender, race/ 

ethnicity (African American, non-Hispanic white, 

Hispanic), age (10–13 years, or older than 14 years), 

and legal status (processed as a juvenile or as an adult) 

to obtain enough participants to examine key subgroups 

(e.g., females, Hispanics, younger children). 

Like juvenile detainees nationwide, the majority of 

CCJTDC detainees are male and most belong to racial/ 

ethnic minority groups (77.9 percent African American, 

5.6 percent non-Hispanic white, 16 percent Hispanic, 

and 0.5 percent other racial/ethnic groups). The age 

and offense distributions of the CCJTDC detainees are 

also similar to detained juveniles nationwide (Snyder and 

Sickmund, 2006). 

The authors chose the detention center in Cook County 

(which includes Chicago and surrounding suburbs) for 

three reasons: 

• Nationwide, most juvenile detainees live in and are 

detained in urban areas (Pastore and Maguire, 2000). 

• Cook County is ethnically diverse and has one of the 

largest Hispanic populations in the United States. 

Studying this population is important because Hispanics 

are the largest minority group in the United States 

(U.S. Census Bureau, 2000, 2001). 

• The detention center’s size (daily census of 

approximately 650 youth, intake of 20 youth per day) 

ensured that a large enough pool of participants would 

be available. 

Detainees were sampled for the study regardless of their 

psychiatric morbidity, state of drug or alcohol intoxication, 

or fitness to stand trial. Participants received a face-toface structured interview in a private area. The interviews 

typically took place within 2 days of intake and lasted 

approximately 2 to 3 hours. 

Juvenile Justice Bulletin 3 
 

 

 

 

Measures 

The authors identified youth’s psychiatric diagnosis and 

measured their functional impairment to determine their 

need for mental health services. They used the Diagnostic 

Interview Schedule for Children, version 2.3 (DISC–2.3), 

based on the American Psychiatric Association’s Diagnostic 

and Statistical Manual of Mental Disorders, Third Edition, 

Revised (DSM–III–R; 1987) criteria, to measure alcohol, 

drug, and mental disorders (Bravo et al., 1993; Shaffer 

et al., 1996). These included affective disorders (major 

depression, dysthymia, mania, hypomania), anxiety 

disorders (panic, generalized anxiety, separation anxiety, 

obsessive-compulsive, overanxious), behavior disorders 

(conduct, attention-deficit/hyperactivity, oppositional), 

psychosis, and substance use disorders (alcohol, marijuana, 

and other substances). The authors then used the 

Children’s Global Assessment Scale (Shaffer et al., 1983) 

to measure functional impairment. This instrument 

allows the interviewer to determine the lowest level of the 

interviewee’s functioning at home, at school and/or work, 

and in other social environments. Scores range from 1 

(most impaired) to 100 (healthiest). Scores of less than 61 

indicate that children require services (Bird et al., 1990). 

To assess service use and barriers to services, the authors 

used the Service Utilization and Risk Factors interview 

(Lahey et al., 1996). Interviewees were asked about 

services received for educational, behavioral, emotional, 

or substance use problems; types of services received 

(inpatient, outpatient, or residential); treatment providers; 

length of treatment; and their satisfaction with services. 

The authors asked youth who were currently in treatment, 

or who had a history of using mental health services, why 

they stopped treatment or whether various factors made 

them think about stopping treatment. Of the youth who 

had been referred but had not received treatment, the 

authors asked why they had not gone for help. Of those 

who had never been referred nor received services, the 

authors asked which factors would impede them from 

getting help if they needed it. The specific barriers assessed 

were a belief that the problem would go away or could 

be solved on one’s own, being unsure of the right person 

or place to get help, difficulty in obtaining help, concern 

about what others would think, and worry about cost. The 

authors also asked participants if there were “other” barriers 

beyond those specifically listed that they would like to 

volunteer. Barriers were not mutually exclusive; participants 

Barriers to Nonschool Service Use Among Detainees With Alcohol, Drug, or Mental Disorders 

Males (Percent) 

Barriers 

Total 

(n = 1,216) 

Total 

(n = 752)1 

Received Past 

Services 

(n = 403) 

Referred, Never 

Received 

(n = 128) 

Never Referred, 

Never Received 

(n = 202) 

Analysis 

Comparing Groups, 

p value 

Any barriers 84.6 84.2 84.0 92.7 81.8 0.71 

Belief that problem would go 

away or could be solved on 

own 

56.5 56.3 64.1 46.8 52.4 0.07 

Unsure of the right person or 

place to get help 31.7 31.0 24.4 47.5 34.9 <0.05; referred > 

received 

Too difficult to obtain help 19.1 19.4 19.7 15.0 20.8 0.72 

Concern about what others 

would think 16.4 16.3 10.0 12.4 28.4 

<0.01; never 

referred > received 

Worry about cost 13.2 13.3 6.4 10.0 23.7 <0.001; never 

referred > received 

Other3 26.5 25.3 37.2 27.8 6.8 

<0.001; received; 

referred > never 

received 

Notes: Data are weighted to reflect the actual population of the Cook County Juvenile Temporary Detention Center. Alcohol, drug, and mental disorders include 

major depression, mania, dysthymia, hypomania, obsessive-compulsive disorder, overanxious disorder, generalized anxiety disorder, separation anxiety disorder, 

panic disorder, psychosis, alcohol use disorder, marijuana use disorder, other substance use disorder, attention-deficit/hyperactivity disorder, conduct disorder, and 

oppositional defiant disorder. 

1 Nineteen males did not receive all or part of the services section from the Service Utilization and Risk Factors interview; they were excluded from these analyses. 

2 Five female participants were missing data from the services section of the Service Utilization and Risk Factors interview and were excluded from these analyses. 

3 Participants were asked if there were other barriers to services that were not already listed. 

4 Juvenile Justice Bulletin 
 

 

could choose more than one. The results are summarized 

below; for more detailed information, see the table. 

Results 

Among participants with any alcohol, drug, or mental 

disorder, most reported at least one barrier to services 

received outside school. Most commonly, youth believed 

that the problem would go away or that they could solve 

the problem without help. The second most common 

barrier was that youth were not sure who to contact 

or where to go for help. Nearly one-fifth of the sample 

reported difficulty obtaining help. The authors found no 

significant differences in these barriers in relation to race, 

ethnicity, or gender. 

More than one-fourth (27 percent) of the sample with 

alcohol, drug, or mental disorders volunteered “other” 

barriers to services, most commonly, denial that the problem 

exists, disinterest in treatment, and dissatisfaction with their 

therapist or treatment. The prevalence of these “other” 

barriers varied by gender and race/ethnicity. Among all 

participating youth with a disorder, significantly more 

males than females volunteered that they did not have a 

problem (31.8 percent versus 19.1 percent). Significantly 

more females than males volunteered that they were afraid 

of labeling or other negative consequences of treatment 

(17.3 percent versus 3.8 percent). Significantly more African 

American and Hispanic youth than non-Hispanic white 

youth volunteered that they did not have a problem (31.9 

percent and 35.9 percent versus 11.7 percent). Finally, 

significantly more non-Hispanic white youth than Hispanic 

youth volunteered that they feared labeling or other 

consequences of treatment (7.7 percent versus 1.5 percent). 

The authors then examined whether a history of service 

use influenced detainees’ perceptions of barriers to 

services if they had an alcohol, drug, or mental disorder. 

History of service use varied by gender and race/ 

ethnicity. Significantly more females (70.0 percent) than 

males (49.1 percent) had received services outside school 

(e.g., medication, residential treatment, and professional 

outpatient services) before detention. Most non-Hispanic 

white males had received out-of-school services before 

detention (83.1 percent), in contrast to less than half 

of African American (48.4 percent) and Hispanic (40.0 

percent) males. Among females, significantly more 

Barriers to Nonschool Service Use Among Detainees With Alcohol, Drug, or Mental Disorders (continued) 

Females (Percent) 

Barriers 

Total 

(n = 464)2 

Received Past 

Services 

(n = 329) 

Referred, Never 

Received 

(n = 58) 

Never Referred, 

Never Received 

(n = 72) 

Analysis 

Comparing 

Groups, p value 

Any barriers 88.7 90.2 93.1 77.7 <0.01; received; 

referred > never referred 

Belief that problem would go 

away or could be solved on 

own 

59.3 64.4 60.2 39.3 <0.01; received; 

referred > never referred 

Unsure of the right person or 

place to get help 40.4 40.8 41.7 37.5 0.86 

Too difficult to obtain help 16.5 13.5 23.5 22.5 0.057 

Concern about what others 

would think 17.8 17.2 9.2 26.0 0.054 

Worry about cost 12.1 6.1 22.2 28.9 

<0.001; referred; 

never referred > 

received services 

Other3 39.5 48.3 26.8 11.0 

<0.001; received; 

referred > never referred; 

received > referred 

Juvenile Justice Bulletin 5 
 

non-Hispanic whites received services outside school (87.0 

percent) than African Americans (64.7 percent). 

The table shows that significantly more females who 

had received services before detention, or who had been 

referred for services but had never received them, believed 

that their problems would go away than females who 

had never been referred nor received services. Compared 

with males who had received services, significantly more 

males who had never received services worried about the 

cost of services. Similarly, compared with females who 

had received services, significantly more females who had 

never received services or who had been referred but had 

not received services worried about the cost of services. 

Significantly more males who had never received services 

reported that they were concerned about what others 

might think of them receiving treatment compared with 

males who had received services. Significantly more males 

who had been referred but had never received services 

reported uncertainty about how to get help than males 

who had received services. 

The authors also asked detainees with alcohol, drug, 

or mental disorders about their history of service use 

to examine the prevalence of other barriers to services. 

Among those who reported a barrier to treatment not 

listed in the survey, significantly more youth who had 

never received services before detention denied having a 

problem than those who had received past services (never 

referred, never received = 53.7 percent; referred, never 

received = 71.2 percent; received = 18.1 percent). 

Discussion 

Youth may decide not to seek services for mental health 

problems for many reasons. This study shows that most 

detained youth with alcohol, drug, or mental disorders 

report at least one perceived barrier to services. Most 

frequently, youth believe that problems will go away 

without outside help. This is the most common barrier 

regardless of gender, race/ethnicity, or (among females) 

previous experience with mental health services. Similarly, 

youth in the general population who have self-identified 

mental health needs (Samargia, Saewyc, and Elliott, 2006) 

and youth receiving substance use services (Johnson et al., 

2001) often believe that their problems do not require 

treatment. Parents of children with mental illness also 

frequently report this barrier (Flisher et al., 1997), which 

indicates the possibility of an intergenerational pathway for 

this belief. 

Despite meeting the criteria for a mental disorder, many 

youth stated that they did not have a mental health 

problem. Detained youth who do not recognize their 

mental health problems or feel that they can solve such 

problems independently are unlikely to cooperate with 

referrals. Youth must first understand that they need 

mental health services before they will seek them out (Kim 

and Fendrich, 2002; Lopez, 2003) and stay in treatment 

(Ortega and Alegria, 2005). 

The common barriers that juvenile detainees in this study 

reported may reflect perceptions about the state of the 

mental health service system in the United States. Most 

youth said they know how to access services; however, a 

substantial minority (about one-third) did not, and nearly 

one in five felt that it was too difficult to access services. 

National reports substantiate difficulties in accessing 

services (U.S. Department of Health and Human Services, 

1999, 2000). Fragmented systems of care likely contribute 

to confusion about where to seek needed services 

(Goldstrom et al., 2000; U.S. Department of Health and 

Human Services, 1999). They are often not based on 

continuity of care or long-term needs (Goldstrom et al., 

2000). Moreover, the separation of service sectors for 

mental health and substance use from general healthcare 

providers limits the sharing of patient information to 

coordinate care between providers and often results in 

multiple “handoffs” of patients for different services 

(Institute of Medicine, 2006). 

African American and Hispanic detainees had received 

significantly fewer services in the past than non-Hispanic 

6 Juvenile Justice Bulletin 
“Detained youth who do not recognize their mental 

health problems or feel that they can solve such problems 

independently are unlikely to cooperate with referrals.” 

white youth, which follows similar patterns in the general 

population and in public sectors of care (Angold et al., 

2002; Cuffe et al., 2005; Garland et al., 2005; Hazen et 

al., 2004; Lopez-Williams et al., 2006). Male detainees 

also had received significantly fewer services in the past 

compared with female detainees. 

Despite disparities in service use, detainees’ attitudes 

toward services were remarkably similar across gender and 

race. These findings suggest that individual perceptions 

and attitudes toward mental health services do not 

explain the disparities in service use. Instead, racial and 

ethnic disparities in service use may stem from external 

factors such as poverty, lack of sufficient minority service 

providers, and sociocultural barriers (U.S. Department of 

Health and Human Services, 2001). Disparities in service 

use between males and females may be due to greater 

help-seeking behaviors among females than among males 

(Garland and Zigler, 1994) and the higher likelihood that 

females will be referred to mental health services (LopezWilliams et al., 2006). 

Nearly three-fourths of youth had received services 

(including those received in school) before being detained. 

These rates are significantly higher among detained youth 

than among youth in the community (Kataoka, Zhang, 

and Wells, 2002; Leaf et al., 1996; Zahner and Daskalakis, 

1997) and are comparable with rates of service use among 

youth in public service sectors (Garland et al., 2005; 

Hazen et al., 2004; Pumariega et al., 1999; Rosenblatt, 

Rosenblatt, and Biggs, 2000). 

Moreover, youth who had never received services were 

more likely to be concerned about what others may think 

of them, uncertain about where to seek services, and 

unsure whether they could afford services than youth who 

had received services. These barriers are also common 

among untreated youth (Flisher et al., 1997) and adults 

(Wang, 2006) with mental health disorders in the general 

population. Youth who had received services in the past 

were more skeptical about using services in the future than 

those who had never received services. Youth who received 

services prior to detention were more likely than untreated 

youth to believe that problems would go away on their 

own. To best understand how to successfully deliver 

treatment, service providers should examine how past 

experiences influence youth’s willingness to accept referrals 

to treatment. 

Study Limitations 

The study’s findings are drawn from a single site and 

therefore may pertain only to youth in urban detention 

centers with a similar demographic composition. In 

addition, service rates might differ if diagnoses were based 

on DSM–IV (American Psychiatric Association, 1994) 

instead of DSM–III–R (1987) criteria. 

Because it was not feasible to interview caretakers, the 

study’s data are subject to the reliability and validity of 

the youth’s self-reporting. Although the self-reporting 

instrument used may have included services that official 

records (e.g., nonreimbursed, informal services) did not 

capture, the turmoil of a recent detention, memory loss, 

different rates of service use over time, or omissions (Burns, 

Angold, and Costello, 1992) may affect self-report of use. 

The authors asked adolescents who had neither received 

nor been referred to services in the past to “imagine” 

perceived barriers if they did have a problem. This type 

of abstraction may not correspond to how the adolescent 

would behave if confronted with an actual problem. Also, 

the Service Utilization and Risk Factors interview only asks 

about five barriers to services. Many of the participants 

reported additional barriers to treatment. 

Finally, the authors were not able to assess the quality 

or appropriateness of services, so this study could not 

determine whether past treatment was appropriate for 

participants’ needs. 

Conclusion 

Findings from the study highlight areas for future 

research and point out ways in which clinical services and 

educational outreach might be improved. 

Juvenile Justice Bulletin 7 
 

 

Future Research 

The authors recommend three areas for future research: 

•	 Investigate the characteristics of mental health 

services that high-risk youth receive and why they 

are satisfied with these services. Why does past service 

use predict poor attitudes toward treatment among 

high-risk youth? How do characteristics of services— 

length of treatment, type of treatment, caregiver 

characteristics—affect perceptions of services? 

•	 Investigate gender and racial/ethnic differences in 

service use. Disparities in service use are well known; 

however, the mechanisms by which service use varies 

by gender or race/ethnicity are less clear. The present 

study suggests that disparities are unlikely to originate 

from differences in perceived barriers to service use 

among youth. 

•	 Study the role of social networks in youth’s 

attitudes toward services. As youth rarely are capable 

of seeking services on their own and may be resistant 

to seeking help (Boldero and Fallon, 1995; Samargia, 

Saewyc, and Elliott, 2006), researchers must work to 

understand the influence of social networks on service 

use. Social interactions may be the most important 

mechanism through which people recognize their 

problems and seek mental health services (Pescosolido, 

Gardner, and Lubell, 1998). Understanding how parents, 

extended family members, and other influential members 

of social networks facilitate or limit treatment-seeking 

behaviors will help service providers tailor outreach 

services to make them more acceptable to youth. 

Implications for Clinical Services 

The study’s findings have implications for clinical services. 

First, mental health staff must engage youth in the referral 

process. Findings from this study highlight the importance 

of understanding youth’s past experiences with mental 

health services before referring them to new services. 

These past experiences may contribute to youth’s negative 

perceptions of future services and decrease their willingness 

to seek help in the future. Candid exploration of past 

experiences allows youth to express negative perceptions and 

choose service options that will maximize their likelihood of 

engaging in treatment. 

Second, the mental health and juvenile justice systems 

must provide educational outreach. To close the gap 

between service need and service delivery, these systems 

must collaborate to educate high-risk youth and their 

families about the nature of mental health problems, the 

myths of such problems and the stigma they carry, and 

available treatment options. Furthermore, education can 

improve juvenile detainees’ understanding of how to 

navigate the complex mental health system. 

Despite the pervasive need for mental health services, 

findings from this study suggest that detained youth do 

not perceive the mental health system as an important or 

accessible resource. Improving service delivery to these 

high-risk youth must include finding ways to inspire their 

confidence. 

For More Information 

This bulletin was adapted from Abram, K.M., Paskar, 

L.D., Washburn, J.J., and Teplin, L.A. 2008. Perceived 

barriers to mental health services among youths in 

detention. Journal of the American Academy of Child and 

Adolescent Psychiatry 47(3):301–308. 

Endnote 

1. The racial/ethnic and gender disparities in perceived 

barriers were only among those youth who volunteered 

a barrier that was not listed in the survey; unfortunately, 

these disparities cannot be interpreted more broadly 

because not all participants were asked about these 

barriers. 

References 

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American Association of Correctional Psychology. 2000. 

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facilities, and agencies. Criminal Justice and Behavior 

27(4):433–494. 

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due to greater help-seeking behaviors among females than among males and 

the higher likelihood that females will be referred to mental health services.” 

8 Juvenile Justice Bulletin 
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Acknowledgments 

Karen M. Abram, Ph.D., is Associate Professor and Associate Director, Health Disparities and Public Policy, in the Department 

of Psychiatry and Behavioral Sciences at the Feinberg School of Medicine, Northwestern University, Chicago, IL. 

Leah D. Paskar, Ph.D., is a psychologist at the Jesse Brown VA Medical Center, Chicago, IL. 

Jason J. Washburn, Ph.D., ABPP, is Assistant Professor and Director of Education and Clinical Training in the Division of 

Psychology, Department of Psychiatry and Behavioral Sciences, at the Feinberg School of Medicine. He is also Director of the 

Center for Evidence-Based Practice at Alexian Brothers Behavioral Health Hospital, Hoffman Estates, IL. 

Linda A. Teplin, Ph.D., is the Owen L. Coon Professor and Vice Chair for Research in the Department of Psychiatry and 

Behavioral Sciences at the Feinberg School of Medicine as well as Director of the Department’s Program in Health Disparities 

and Public Policy. 

Naomi A. Zwecker, Ph.D., is a psychologist at the Houston OCD Program, Houston, TX. 

Nicole M. Azores-Gococo, M.S., is a graduate student in the Division of Clinical Psychology of the Department of Psychiatry 

and Behavioral Sciences at the Feinberg School of Medicine. 

The authors thank Ann Hohmann, Ph.D., Kimberly Hoagwood, Ph.D., and Heather Ringeisen, Ph.D., for indispensable advice, 

and Grayson Norquist, M.D., and Delores Parron, Ph.D., for their support. Celia Fisher, Ph.D., guided our human subject 

procedures. We thank project staff, especially Amy Mericle, Ph.D., Linda Carey, M.A., and our field interviewers. Without the 

cooperation of the Cook County and State of Illinois systems, this study would not have been possible. Finally, we thank the 

participants for their time and willingness to participate. 
NCJ 248522

The research described in this bulletin was 

supported under grant numbers 1999–JE–FX–1001, 

2005–JL–FX–0288, and 2008–JF–FX–0068 from 

the Office of Juvenile Justice and Delinquency 

Prevention (OJJDP), U.S. Department of Justice. 

Points of view or opinions expressed in this 

document are those of the authors and do not 

necessarily represent the official position or policies 

of OJJDP or the U.S. Department of Justice.

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