Incarceration and the health of detained children
Authors: Lauren Brinkley-Rubinstein, Scott A Allen, Josiah D Rich
Journal: The Lancet Public Health (2020)

Historically, the incarceration of children has been used limitedly. The two reasons used to justify depriving youth of their freedom have been specific and serious threats to either public safety or to the young person's own wellbeing (such as suicidal ideations). Incarceration should only be a last resort, with the standard being to place children in the least restrictive environment, such as in the community, because of the high risks of physical and mental health harms associated with detention. Although a large body of literature has shown the harms of incarceration in adult populations, less is known about children and adolescents. In their Scoping Review in The Lancet Public Health, Rohan Borschmann and colleagues1Borschmann R Janca E Carter A et al.The health of adolescents in detention: a global scoping review.Lancet Public Health. 2020; (published online Jan 16)https://doi.org/10.1016/S2468-2667(19)30217-8Summary Full Text Full Text PDF PubMed Google Scholar synthesised the literature relevant to the health of incarcerated children. Mirroring findings for adult populations, the authors found that children in correctional facilities often have poor health and a disproportionate burden of disease. In particular, a substantial proportion of adolescents who are incarcerated have mental health issues, self-harm or suicidal behaviours, substance use disorders, neurodevelopmental disabilities, and an increased incidence of sexually transmitted infections. Less has been documented about the socioeconomic, minority, and disadvantaged statuses of incarcerated youth, but it is likely that those follow the same patterns found in adult populations, with higher incarceration rates for people of lower socioeconomic status and people of colour. The Scoping Review1Borschmann R Janca E Carter A et al.The health of adolescents in detention: a global scoping review.Lancet Public Health. 2020; (published online Jan 16)https://doi.org/10.1016/S2468-2667(19)30217-8Summary Full Text Full Text PDF PubMed Google Scholar also pointed to some major takeaways relevant to future research. For instance, most existing studies come from high-income countries, highlighting the need for more studies in jail and prison settings in low-income and middle-income countries. In addition, few validated tools are available to measure specific domains, including oral health and cardiopulmonary disease, and varied definitions are used to measure both health outcomes and incarceration. The findings of Borschmann and colleagues1Borschmann R Janca E Carter A et al.The health of adolescents in detention: a global scoping review.Lancet Public Health. 2020; (published online Jan 16)https://doi.org/10.1016/S2468-2667(19)30217-8Summary Full Text Full Text PDF PubMed Google Scholar underscore the negative impact that incarceration can have on children and lend a voice to a loudening call for decarceration. In the USA, where rates of incarceration are the highest in the world, some actions have been taken to decrease incarceration rates among the children. Over the past decade,2Commission on Youth, Public Safety, & JusticeFinal Report of the Governor's Commission on Youth, Public Safety and Justice: Recommendations for Juvenile Justice Reform in New York Sate.https://raisetheageny.org/wp-content/uploads/2018/12/ReportofCommissiononYouthPublicSafetyandJustice_0.pdfDate: April 2014Date accessed: December 12, 2019Google Scholar many states have introduced so-called raise-the-age legislation that limits the use of adult corrections for those under the age of 18 years. This legislation acknowledges that housing children in adult facilities increases their risk of abuse and exposure to violence, and leads to high rates of recidivism.2Commission on Youth, Public Safety, & JusticeFinal Report of the Governor's Commission on Youth, Public Safety and Justice: Recommendations for Juvenile Justice Reform in New York Sate.https://raisetheageny.org/wp-content/uploads/2018/12/ReportofCommissiononYouthPublicSafetyandJustice_0.pdfDate: April 2014Date accessed: December 12, 2019Google Scholar However, the increasing involvement of youth in the opioid epidemic threatens to offset those gains.3Centers for Disease Control and Prevention2018 annual surveillance report of drug-related risks and outcomes—United States. US Centers for Disease Control and Prevention, Atlanta, GA2018https://www.cdc.gov/drugoverdose/pdf/pubs/2018-cdc-drug-surveillance-report.pdfDate accessed: November 19, 2019Google Scholar Furthermore, there has been a concurrent rise in the number immigrant children held in Immigration and Customs Enforcement detention centres in the USA. This increase represents a troubling departure from the standard of only incarcerating those children who represent a serious and specific threat. Between October, 2018, and June, 2019, the US Border Patrol detained 234 443 adults, 390 308 family units, and 63 624 unaccompanied children.4US Customs and Border ProtectionSouthwest border migration FY 2019. Department of Homeland Security, 2019https://www.cbp.gov/newsroom/stats/sw-border-migrationDate accessed: December 12, 2019Google Scholar Access to detention facilities is very limited and the operations and processes in place, for health care or otherwise, have not been detailed or disclosed. Clear, though, is that children detained in these facilities are not receiving adequate health care. Some reports have chronicled the unsafe and unsanitary conditions to which many children are exposed.5Spiegel P Kass N Rubenstein L Can physicians work in US immigration detention facilities while upholding their Hippocratic oath?.JAMA. 2019; 322: 1445-1446Crossref PubMed Scopus (5) Google Scholar Children in these facilities often have insufficient access to food, live in overcrowded cells, are exposed to untreated contagious illnesses, and have inadequate clothing.6Office of Inspector GeneralManagement alert – DHS needs to address dangerous overcrowding and prolonged detention of children and adults in the Rio Grande Valley (redacted). US Department of Homeland Security.https://www.oig.dhs.gov/sites/default/files/assets/2019-07/OIG-19-51-Jul19_.pdfDate: July 2, 2019Date accessed: December 12, 2019Google Scholar Incarceration itself is a known determinant of health, but an emerging body of research shows that the carceral context, including the various types of deprivation, punishment, and social conditions.7Brinkley-Rubinstein L Incarceration as a catalyst for worsening health.Health Justice. 2013; 1: 3Crossref Google Scholar The carceral contexts that these children are exposed to are most probably causing irrevocable harm. Incarceration of children should be a last resort. Norway serves as an example for rehabilitative frameworks that are more appropriate for adolescents. Norway has 10% of the incarceration rate of the USA, and, perhaps more impressively, only 20% of people with a previous conviction recidivate (compared with more than 75% in the USA).8Graunbøl HM Kielstrup B Muiluvuori M-L Gudmundsdottir H et al.Retur: en nordisk undersøgelse af recidiv blant klienter i kriminalforsorgen. Kriminalomsorgens utdanningssenter, Oslo2010Google Scholar, 9United States Sentencing CommissionRecidivism among Federal offenders: a comprehensive overview.https://www.ussc.gov/sites/default/files/pdf/research-and-publications/research-publications/2016/recidivism_overview.pdfDate: March, 2016Date accessed: December 12, 2019Google Scholar Key to these successes is the country's orientation not to punishment but to restorative justice, with a main aim of identifying and repairing harm caused by crime. Restorative justice programmes have been implemented and show promise in possibly reducing future behaviour that increases risk of incarceration among children.10Office of Juvenile Justice and Delinquency PreventionEffectiveness of restorative justice programs. Office of Justice Programs, US Department of Justice, July, 2017https://www.ncjrs.gov/pdffiles1/ojjdp/grants/250995.pdfDate accessed: December 12, 2019Google Scholar However, more research is necessary to optimise the efficacy of these programmes.11Latimer J Dowden C Muise D The effectiveness of restorative justice practices: a meta-analysis.Prison J. 2005; 85: 127-144Crossref Scopus (249) Google Scholar Many such programmes, though, exist alongside tradition juvenile justice institutions that are oriented to punishment. A major and important step is to eradicate juvenile justice programmes using a punishment framework and replace them with evidence-based rehabilitative programmes focused on restorative justice. SAA is a consultant with the Office of Civil Rights and Civil Liberties, US Department of Homeland Security. The views expressed in this article do not represent the views of the US government. JDR's work on this Comment is supported by National Institutes of Health grant P20GM125507 . LB-R declares no competing interests. The health of adolescents in detention: a global scoping reviewAdolescents detained within the criminal justice system are affected by complex health problems, health-risk behaviours, and high rates of premature death. We did a global synthesis of the evidence regarding the health of this population. We searched Embase, PsycINFO, Education Resources Information Center, PubMed, Web of Science, CINCH, Global Health, the Cochrane Database of Systematic Reviews, the Campbell Library, the National Criminal Justice Reference System Abstract Database, and Google Scholar for peer-reviewed journal articles, including reviews, that reported the prevalence of at least one health outcome (physical, mental, sexual, infectious, and neurocognitive) in adolescents (aged <20 years) in detention, and were published between Jan 1, 1980, and June 30, 2018. Full-Text PDF Open AccessAddressing the unmet health needs of justice system-involved youthDetained youth throughout the world represent a vulnerable group, for whom social determinants often have a detrimental impact on their lives and health. Insufficient access to food and stable housing, quality educational and economic opportunities, secure family and community environments, adequate recreation and transportation infrastructure, and community-based social and health-care services1 are crucial factors in how and why many young people become involved in the criminal justice system. Full-Text PDF Open Access