Addressing the unmet health needs of justice system-involved youth
Authors: Arash Anoshiravani
Journal: The Lancet Public Health (2020)

Detained 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 services1Centers for Disease Control and PreventionSocial determinants of health: know what affects health.https://www.cdc.gov/socialdeterminants/index.htmDate accessed: November 6, 2019Google Scholar are crucial factors in how and why many young people become involved in the criminal justice system. In The Lancet Public Health, Rohan Borschmann and colleagues2Borschmann 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 report the results of their Scoping Review of almost four decades of literature documenting the health of youth in detention. They report that detained adolescents commonly experience poor health across a range of physical and mental health domains, including mental disorders, self-harm and suicidal behaviour, substance use disorders, neurodevelopment disabilities, blood-borne viruses and sexually transmitted infections (STIs), and sexual and reproductive health.2Borschmann 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 The authors also document the disparities between detained youth and their non-detained peers matched on age and sex, highlighting the higher prevalence of various health conditions and the increased morbidity and mortality risks for justice system-involved youth. Importantly, the Scoping Review shows that the issues that characterise the lives of adolescents involved in the justice system (ie, disadvantage, instability, abuse, neglect, poor education, and poverty) are not solely problems in high-income countries. Although most publications included in the review were from high-income nations, the existing high-quality studies from low-income and middle-income countries suggest that structural societal inequities (including those related to economics, race or ethnicity, or social policy) influence the poor life and health outcomes of these youth worldwide. With regard to improving the health outcomes of this vulnerable population, the solutions are not simple. The most accessible first step involves expecting more of the systems and adults entrusted with the care of this population during detention. Screening for unmet health needs—whether they be inadequate childhood vaccination, poor oral health, possible STIs, or underlying mental, behavioural, or developmental health conditions—and providing high-quality care in a timely, respectful, and adolescent-friendly manner should be the responsibility of health officials who work in such facilities. The regrettable detention of a young person is a rare opportunity to address unmet health and life needs and to proactively re-establish connections with community-based resources before and upon release. Fulfilling the original rehabilitative promise of juvenile justice is challenging governmental and non-governmental agencies to find new ways to transition their services and to commit more resources upstream of juvenile detention. Almost all detained youth return to their communities eventually, and reform strategies now aim to keep these youth in their own homes, schools, and neighbourhoods, whenever public safety allows. In the USA, overall arrest and detention rates have decreased in the past decade,3Puzzancherra C Juvenile arrests. Office of Juvenile Justice and Delinquency Prevention, US Department of Justice, 2017https://ojjdp.ojp.gov/sites/g/files/xyckuh176/files/pubs/252713.pdfDate accessed: November 10, 2019Google Scholar and even more so in counties and states that have embraced key juvenile justice reform principles such as diversion from detention and community-based supervision and programming.4California Department of JusticeJuvenile court and probation from 2009 to 2018.https://openjustice.doj.ca.gov/data-stories/2018/juvenile-court-and-probation-2009-2018Date accessed: November 10, 2019Google Scholar, 5Florida Department of Juvenile JusticeDelinquency profile.http://www.djj.state.fl.us/research/reports/reports-and-data/interactive-data-reports/delinquency-profile/delinquency-profile-dashboardDate: 2019Date accessed: November 10, 2019Google Scholar, 6Illinois Department of Juvenile JusticeAnnual report.https://www2.illinois.gov/idjj/SiteAssets/Pages/Data-and-Reports/IDJJ%20Annual%20Report%202018.pdfDate: 2018Date accessed: November 10, 2019Google Scholar At present, the evidence base is weak for how best to replace detention-based health care for justice system-involved youth with easily accessible, adolescent-friendly, culturally appropriate, and trauma-informed integrated physical, reproductive, mental, and dental health care in the schools, community centres, and even streets in which these youth might spend their time. Effectively addressing the toxic stress and the intergenerational effects of trauma, poverty, and entrenched disadvantage will require a reimagining of paediatric and adolescent primary care, while focusing on earlier interventions for younger high-risk children, especially in highly impacted communities. As Borschmann and colleagues have shown,2Borschmann 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 youth who become involved in justice systems are an especially vulnerable group globally. This population deserves a highly skilled and dedicated team—including teachers, lawyers, social workers, physicians, nurses, probation officers, judges, mentors, coaches, spiritual leaders, policy makers, and mental health clinicians—that works across disciplines and in close partnership to effectively address their health needs. I declare no competing interests. Incarceration and the health of detained childrenHistorically, 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. Full-Text PDF Open AccessThe 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 Access