What Is Justice? Incarceration of Mentally Ill Youth in the United States

The University of California, Berkeley recently released a report discussing the incarceration of youth with mental illness. Mental Health Issues in California’s Juvenile Justice System (.pdf) examines juvenile detention in California and the ways that it is falling woefully short in terms of providing adequate mental health services to incarcerated juveniles. Unsurprisingly, it is getting very limited attention in the media because it contains a trifecta of things society doesn’t want to address: rising incarceration rates, youth, and mental illness.

We cannot examine this study without considering the larger context of juvenile incarceration in the United States as a whole. The US incarcerates more youth than any other country in the world, in a prison-industrial complex that happens to be a major moneymaker for thousands of private prisons run with minimal accountability. The ‘justice’ system in the United States is deeply flawed, with stark racial and class disparities, including for incarcerated youth. Numerous regions claim to be ‘tough on youth crime’ and as with other ‘tough on crime’ initiatives, nonwhite juveniles are far more likely to be arrested, prosecuted, and imprisoned. White juveniles, when they do enter the legal system, are offered far more alternatives.

‘Tough on youth crime’ results in life in prison for teens. Like other residents of the prison system, incarcerated youth are at risk for sexual assault, rape, and physical violence. They lack access to adequate health care. Despite the fact that we have a legal and ethical responsibility to provide health services to the people we incarcerate ‘for the public good,’ prisoners are routinely denied access to their medications (content warning, this prisoner died of complications from an eating disorder), life saving medical treatments, and even the most basic of health care.

Juveniles are held in overcrowded prison environments that expose them to the risk of violence, infectious disease, and stress-related mental illness. Thanks to prison crowding and ‘tough on crime’ laws, some juveniles end up being held in adult facilities. Youths housed with adults are at increased risk of assault. They are also more likely to attempt suicide. Our prisons, for the most part, are no place for human beings, no matter what those human beings may have done, and the disparities in our justice system mean that there is no guarantee that we are incarcerating the right person for the crime.

We have too many juveniles in prison. The justice system in the United States imprisons too many people in general, with few explorations of alternatives to incarceration. ‘Justice’ plays out along racial and class boundaries and this is impossible to ignore. We cannot talk about the problems with prisoner care without talking about why and how people are incarcerated in the first place, and exploring the social attitudes that play a huge role in the construction of our justice system.

There are several problems going on with the incarceration of mentally ill youth. The first is that because community support services are limited, many youth who do not belong in prison at all are being incarcerated for ‘behaviour problems.’ Mentally ill children are not provided with support and end up being institutionalised on involuntary psychiatric holds, while their parents are told that if they want help, they should call the police (content warning, problematic framing). As a society, the United States is using the juvenile justice system as a mental health treatment program.

Who is least likely to have access to services, support, and the funds to provide adequate mental health treatment? People in poverty and nonwhite folks. Parents with disabilities caring for their mentally ill children. A vicious cycle is created where people with nowhere to turn go to the option of last resort and it ends with youth in prison because they are mentally ill. Not because they have committed crimes. Because they have mental illnesses (h/t MsFeasance for this link!). The Berkeley report shows, though, that once those youth arrive in prison, they are not provided with the mental health services that they need.

Incarcerated mentally ill youth often do not receive mental health treatment in prison. Screening of incarcerated youth is inadequate and spotty. Diagnoses are missed or disputed. Youth who have diagnoses aren’t provided with medications, therapy, and other treatments. Other youth are psychiatrised and subjected to abusive ‘treatment.’ Meanwhile, California is slashing its budget and although prison spending is one of the few areas of the budget that is increasing, that spending isn’t improving health care in prisons. It’s going to the construction of new facilities and into the pockets of prison administrators and private companies that make prison contracting a big business.

The report puts forward a number of suggestions for improving mental health services within the prison system, including establishing diversion programs to provide juvenile offenders with community-based treatment options. It also recommends taking some steps to keep mentally ill youth out of prison in the first place, by improving support and outreach so that the prison system stops being used as a dumping ground. In order to get mentally ill youth out of prisons, we need to change our attitudes as a society about mental illness and about incarceration; jails and prisons need to stop being regarded as holding facilities for people who are socially undesirable.

Lack of access to treatment and services for incarcerated youth is a symptom of a larger problem. It’s a symptom of the way mental illness in general is addressed by our society, of how we think about funding and budgeting priorities, of how we think about youth themselves.

3 Comments

  1. Well researched piece. One thing that would alleviate many of the problems would be real mental health parity (universal health care would be better, but I don’t see that happening soon). To get coverage for child with a mental illness, parents have to fight the system tooth and nail. My dad fought to get all the coverage he could for me and did well. But then, he is an educated professional with knowledge of how the system works. He could negotiate it much better than people without his level of privilege and education. My parents also had the means to pay up front for many of the treatments, then fight the insurance company for reimbursement, an option not available to all. Currently, mental health parity laws are weak and insurance companies can dodge them with ease. Keeping kids with mental illness out of prison is vital and forcing insurance companies to treat mental illness exactly as they would physical illness is crucial.*

    *Not that their treatment of physical illness is always great, but it is, in my experience, easier to obtain coverage for an ovarian cyst or broken leg than for depression or an eating disorder.

  2. Thanks for this piece, s.e. Unfortunately, the situation used to be similar in the Netherlands, where at least 1,500 children and youths were imprisoned without ever having committed a crime, and many more who have committed crimes, are lacking mental health services to treat their illnesses. A bill was passed last year to prohibit the incarceration of youth who didn’t commit crimes, and it is said the problem is solved now.

  3. This is a situation with which I have first hand experience. I worked in a public mental health hospital for kids and teens; it was the only public placement in the state except for juvenile detention. Many of my kids were back and forth between the two, and evidently in juvie because of their mental health issues. The whole business of putting kids in prison is just appalling; only a handful ever committed crimes worthy of prison (to my view; these were murder and rape and a few serious assault/attempted murder cases). Most were there for the crime of being psychotic while black and poor. Their parents couldn’t get them treatment, and once they were convicted the state paid for treatment, so they came to us (the only facility that would accept them) and stayed for months.