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Indiana Project Screenings Show Need For More Mental Health Services In Youth Detention

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Indiana is at the forefront of providing mental health screening and services to juvenile offenders, but more efforts are needed to improve the services provided to detained youths, according to Indiana University School of Medicine research findings published in the October issue of the American Journal of Public Health.

"A Statewide Collaboration to Initiate Mental Health Screening and Assess Services for Indiana Detained Youths" reviewed 25,265 detention visits of 15,461 youths occurring in 2008 to 2011. The youths were incarcerated in 16 detention centers participating in the Indiana Juvenile Mental Health Screening Project, a statewide collaboration of the Indiana Criminal Justice Institute, the Indiana State Bar Association and other community members.  

The intent was to implement mental health screening; determine the percentage of youth detainees in need of services; assess the availability and extent of detention center mental health follow-up and referral services; and assess whether a disparity exists due to the size and geographic location of the detention center.

"The Indiana Project disclosed several important facts that validate arguments for the need for mental health screenings and services for youths in detention centers and after their release," said Matthew C. Aalsma, Ph.D., associate professor of pediatrics in the Section of Adolescent Medicine at the IU School of Medicine. "The study showed that youths in the juvenile justice system have very high rates of mental health issues and that the services available are disparate; improvements are needed to enable youths to receive services after discharge."

The screenings were initiated when a youth was placed in a detention center and a screening tool, the Massachusetts Youth Screening Instrument, was administered within 24 to 48 hours of the youth's arrival at the detention facility. MAYSI-2 assesses potential mental health problems in seven areas: alcohol or drug use, anger or irritability, depression or anxiety, somatic complaints, suicide ideation, thought disturbance, and traumatic experiences. The results are not intended as a diagnostic tool but rather to alert detention facility staff to the fact that a teen is exhibiting clinical symptoms that require follow-up mental health services.

The Indiana Project found that about 21 percent of youths screened positive for mental health issues requiring follow-up. Female detainees were more likely to screen positive than male detainees (32.9 percent vs. 17.8 percent) and were also more likely than male detainees to score within the caution or warning ranges (79.5 percent vs. 67.7 percent). Overall, 70 percent scored in the caution or warning ranges of at least two of the various assessment areas.

White and Hispanic male and female detainees scored higher on the alcohol and drug use scale than African American youths. Hispanic male and female youths scored lower than African American or white youths on the other screened areas, with the exception of somatic complains where African American females scored lower than other female detainees.

With the screenings completed, the researchers then assessed the level of follow-up mental health services. Overall, 61 percent of the detainees that screened positive received some type of follow-up service, but only 31 percent received services from a master's degree-level mental health clinician within 24 hours of intake. Size and location of the detention centers varied widely, which may contribute to the services available in some areas. The Indiana Project also found that race/ethnicity did not have an impact on utilization of services for youths who screened positive on the mental health screener, and the authors caution that this finding warrants further study.

"In a lot of ways, Indiana is at the forefront of juvenile justice reform. Only one other state -- Pennsylvania -- has implemented mental health screenings in detention centers," Dr. Aalsma said. "The Indiana Project provides an organized method to get juveniles into effective mental health and substance abuse care, which we could not do before 2008 when the project was organized. However, more services and consistency are needed to improve the mental health of Indiana's youth held in detention centers."

This story was originally published by the Indiana University School of Medicine on Oct. 22, 2014.