1
|
Rungan S, Montgomery A, Smith-Merry J, Liu HM, Eastwood J. Retrospective audit of a school-based integrated health-care model in a specialised school for children with externalising behaviour. J Paediatr Child Health 2023; 59:1311-1318. [PMID: 37964701 DOI: 10.1111/jpc.16515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 01/17/2023] [Accepted: 10/27/2023] [Indexed: 11/16/2023]
Abstract
AIM Problematic externalising behaviours in adolescents are associated with high individual and societal burden. A school-based multidisciplinary health clinic, Ngaramadhi Space (NS), was developed at Yudi Gunyi School, a specialised behavioural school in Sydney, Australia, to improve access to holistic health-care and behavioural support. This evaluation aimed to describe the demographics, clinic attendance, health screening, recommendations made, and changes in Strengths and Difficulties Questionnaire (SDQ) scores of students attending the clinic. METHODS Retrospective evaluation of students including changes in SDQ scores using descriptive statistics (26 July 2016 to 14 May 2019; n = 79). RESULTS Prior to the assessment, few students engaged with a paediatrician or mental health professional (22.8%; 27.8%, respectively). Child protection services were involved with 76%. NS attendance was high (failure-to-attend = 7.6%; cancellations = 8.9%). New issues found at the assessment included: parental separation (31.6%); trauma history (27.8%); substance use (19%); emotional wellbeing concerns (16.5%), learning difficulties (12.7%), domestic violence (12.7%) and medical conditions (10.1%). SDQ teacher reports showed a significant decrease in total difficulties scores (M = 6.2, SD = 6.165, P < 0.05, eta squared = 1.013 (large effect)) and all subsets. No significant differences in parent and self-reported SDQ. CONCLUSIONS Students with problematic externalising behaviour have unmet health and social needs. The NS school-based integrated health-care model offers a novel, convenient and innovative way to engage these students. This approach has high initial attendance rates with teacher-reported SDQ results showing some behavioural improvement. Further qualitative studies are required.
Collapse
Affiliation(s)
- Santuri Rungan
- Croydon Community Health Centre, Sydney Local Health District, Melbourne, New South Wales, Australia
| | - Alicia Montgomery
- Croydon Community Health Centre, Sydney Local Health District, Melbourne, New South Wales, Australia
| | - Jennifer Smith-Merry
- Centre for Disability Research and Policy (CDRP), The University of Sydney, Sydney, New South Wales, Australia
| | - Huei Ming Liu
- Croydon Community Health Centre, Sydney Local Health District, Melbourne, New South Wales, Australia
| | - John Eastwood
- Croydon Community Health Centre, Sydney Local Health District, Melbourne, New South Wales, Australia
| |
Collapse
|
2
|
Rungan S, Gardner S, Liu HM, Woolfenden S, Smith-Merry J, Eastwood J. Ngaramadhi Space: An Integrated, Multisector Model of Care for Students Experiencing Problematic Externalising Behaviour. Int J Integr Care 2023; 23:19. [PMID: 38107833 PMCID: PMC10723013 DOI: 10.5334/ijic.7612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 03/30/2023] [Indexed: 12/19/2023] Open
Abstract
Introduction Behavioural and emotional disorders are a significant cause of morbidity for young people aged 10-19 years. School-based health care (SBHC) provides an innovative approach to addressing these issues within Australia. Description We describe an innovative and integrative SBHC model called Ngaramadhi Space (NS) based at a specialised behavioural school called Yudi Gunyi school (YGS) in metropolitan Sydney, Australia. NS was developed in partnership with the Aboriginal community to provide holistic, integrated, multidisciplinary child and family centred care to students experiencing problematic externalising behaviour. We contextualise the historical factors leading to the development of NS, highlighting the importance of effective partnerships between sectors, and providing the theoretical framework and key components underpinning the model of care. Discussion In Australia, schools are an under-utilised resource for the delivery of health and support alongside education. Collaboration between sectors can be challenging but allows a more coordinated approach to the management of complex social and health issues. By forming effective partnerships with schools and communities, the health sector has an opportunity to improve access to health and social care in a culturally safe and acceptable way. This is in line with national and international frameworks for improving health service delivery and addressing inequity. Conclusion The health sector can play a pivotal role in improving the wellbeing of children by forming effective partnerships with schools and communities. The NS model is a practice-based example of this.
Collapse
Affiliation(s)
- Santuri Rungan
- Sydney Local Health District, University of Sydney, Sydney Institute for Women, Children & their Families, AU
| | | | - Huei-Ming Liu
- The George Institute for Global Health, University of New South Wales, AU
| | - Susan Woolfenden
- Sydney Local Health District, University of Sydney, AU
- Sydney Institute Women, Children and their Families, University of New South Wales, AU
| | - Jennifer Smith-Merry
- Centre for Disability Research and Policy, Sydney School of Health Sciences, The University of Sydney, AU
| | - John Eastwood
- University of New South Wales, Sydney, AU
- Ingham Institute of Applied Medical Research, Liverpool, NSW, AU
- University of Sydney, Sydney Institute for Women, Children and their Families and Sydney Local Health District, AU
| |
Collapse
|
3
|
Marr C, Gaskin C, Kasinathan J, Kaye S, Singh Y, Dean K. The prevalence of mental illness in young people in custody over time: a comparison of three surveys in New South Wales. PSYCHIATRY, PSYCHOLOGY, AND LAW : AN INTERDISCIPLINARY JOURNAL OF THE AUSTRALIAN AND NEW ZEALAND ASSOCIATION OF PSYCHIATRY, PSYCHOLOGY AND LAW 2023; 31:235-253. [PMID: 38628250 PMCID: PMC11018085 DOI: 10.1080/13218719.2023.2192257] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 02/09/2023] [Indexed: 04/19/2024]
Abstract
Few studies have examined the prevalence of mental illness in young people over time within the same jurisdiction. In the current study, we compared data from three large surveys of youth in custody in New South Wales, conducted in 2003, 2009 and 2015. We examined rates of mental illness, self-harm and suicidal behaviours, substance use and childhood trauma and found little consistent change over time, though some fluctuations were observed regarding certain mental illnesses and substance use. We also descriptively compared findings with observed rates for the general population and found that young people in custody showed higher levels of all examined variables. In sum, these data suggest little improvement in the well-being of young people in custody in New South Wales over time. Better identification and treatment of these issues are vital if young people are to be prevented from becoming enmeshed in the criminal justice system.
Collapse
Affiliation(s)
- Carey Marr
- School of Clinical Medicine, Discipline of Psychiatry and Mental Health, University of New South Wales, Randwick, NSW, Australia
| | - Claire Gaskin
- School of Clinical Medicine, Discipline of Psychiatry and Mental Health, University of New South Wales, Randwick, NSW, Australia
- Justice Health and Forensic Mental Health Network, University of New South Wales, Randwick, NSW, Australia
| | - John Kasinathan
- School of Clinical Medicine, Discipline of Psychiatry and Mental Health, University of New South Wales, Randwick, NSW, Australia
- Justice Health and Forensic Mental Health Network, University of New South Wales, Randwick, NSW, Australia
| | - Sharlene Kaye
- Justice Health and Forensic Mental Health Network, University of New South Wales, Randwick, NSW, Australia
- National Drug and Alcohol Research Centre, University of New South Wales, Randwick, NSW, Australia
| | - Yolisha Singh
- School of Clinical Medicine, Discipline of Psychiatry and Mental Health, University of New South Wales, Randwick, NSW, Australia
- Justice Health and Forensic Mental Health Network, University of New South Wales, Randwick, NSW, Australia
| | - Kimberlie Dean
- School of Clinical Medicine, Discipline of Psychiatry and Mental Health, University of New South Wales, Randwick, NSW, Australia
- Justice Health and Forensic Mental Health Network, University of New South Wales, Randwick, NSW, Australia
| |
Collapse
|
4
|
Kuranga AT, Yussuf AD. Psychiatric morbidity amongst adolescents in a Nigerian juvenile correctional facility. S Afr J Psychiatr 2021; 27:1590. [PMID: 34522436 PMCID: PMC8424729 DOI: 10.4102/sajpsychiatry.v27i0.1590] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 05/20/2021] [Indexed: 11/21/2022] Open
Abstract
Background The high occurrence of psychiatric disorders amongst adolescents within the Juvenile Justice System (JJS) has been confirmed. Most of the available data are from developed countries and some of them focus on just a single psychiatric disorder which may not be representative of the situation in low-income countries, hence the need for more studies in developing countries, including Nigeria. Aim The study aimed to determine the prevalence of psychiatric disorders amongst adolescent residents of a correctional facility. Setting The study was carried out at a Borstal Institution in North-Central Nigeria. Methods A descriptive cross-sectional study design was used. One hundred and twenty adolescents were assessed using the socio-demographic pro forma questionnaire designed by the researcher and the Kiddies Schedule for Affective Disorders and Schizophrenia (KSADS-PL). Data were analysed using EPI-INFO 4.06 d version 6.04 software. Results A total of 62.5% of the male respondents were older than 15 years. The percentage of respondents with a psychiatric disorder was 82.5%. The rate of psychiatric disorders was high with disruptive behaviour disorders being the most common at 40.8%, others were substance use disorders (15.8%), anxiety disorders (14.2%), psychosis (6.7%) and mood disorders (5%). Conclusion This study has established a high prevalence rate of psychiatric disorders amongst incarcerated adolescents. This is in line with the findings of numerous studies worldwide. This study has identified the need to increase awareness and knowledge about the high morbidity of mental disorders in growing juvenile detainee populations. This will allow early identification of adolescents at risk of psychiatric disorders and ensure efficient resource distribution of both JJS service and mental healthcare. Effective and appropriate interventions have shown to improve overall health, quality of life and reduce the rate of recidivism amongst incarcerated juveniles.
Collapse
Affiliation(s)
- Amudalat T Kuranga
- Department of Behavioural Science, University of Ilorin Teaching Hospital, Kwara State, Nigeria
| | - Abdullahi D Yussuf
- Department of Behavioural Science, University of Ilorin Teaching Hospital, Kwara State, Nigeria
| |
Collapse
|
5
|
Pedruzzi RA, Hamilton O, Hodgson HHA, Connor E, Johnson E, Fitzpatrick J. Navigating complexity to support justice-involved youth with FASD and other neurodevelopmental disabilities: needs and challenges of a regional workforce. HEALTH & JUSTICE 2021; 9:8. [PMID: 33638742 PMCID: PMC7916306 DOI: 10.1186/s40352-021-00132-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 02/15/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Young people with Fetal Alcohol Spectrum Disorder (FASD) can face significant challenges in their lives, including overrepresentation in the justice system from a young age. Police questioning and court proceedings can be difficult for these young people to navigate. Practice and policy responses are necessary to identify these individuals, provide appropriate support/rehabilitation, and upskill the justice workforce. The aim of this research was to determine the unmet workforce development needs of a regional workforce providing care and support to youth involved with the justice system. Interviews were conducted with 29 participants from 14 organisations to understand the support provided to youth, existence and uptake of referral pathways, and unmet needs. RESULTS Results revealed a workforce that wants to see improvements to outcomes for young people with FASD and other neurodevelopmental disabilities who enter the youth justice system. However more support is required through training, ongoing funding, and assistance to develop FASD informed work practices. CONCLUSIONS The workforce supporting youth to navigate the justice system requires practical interventions to achieve best practice so that young people with FASD and other neurodevelopmental disabilities receive the support that they need. Following the interviews a model of care tool was developed and piloted in the sector. The tool includes current pathways through the justice system and provides resources to assist staff in achieving best practice care for young people with FASD and other neurodevelopmental disabilities.
Collapse
Affiliation(s)
| | | | | | - Elizabeth Connor
- Telethon Kids Institute, PO Box 855, West Perth, Western Australia 6872 Australia
| | - Elvira Johnson
- Mercy Services, 32 Union St, Newcastle, NSW 2297 Australia
| | - James Fitzpatrick
- Telethon Kids Institute, PO Box 855, West Perth, Western Australia 6872 Australia
- School of Psychological Science, The University of Western Australia, Perth, 6009 Australia
| |
Collapse
|
6
|
Fougere A, Thomas S, Daffern M. A Study of the Multiple and Complex Needs of Australian Young Adult Offenders. AUSTRALIAN PSYCHOLOGIST 2020. [DOI: 10.1111/j.1742-9544.2012.00083.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Amber Fougere
- Centre for Forensic Behavioural Science, School of Psychology and Psychiatry, Monash University
| | - Stuart Thomas
- Centre for Forensic Behavioural Science, School of Psychology and Psychiatry, Monash University
| | - Michael Daffern
- Centre for Forensic Behavioural Science, School of Psychology and Psychiatry, Monash University
| |
Collapse
|
7
|
Hafekost K, Lawrence D, O'Leary C, Bower C, Semmens J, Zubrick SR. Maternal Alcohol Use Disorder and Risk of Child Contact with the Justice System in Western Australia: A Population Cohort Record Linkage Study. Alcohol Clin Exp Res 2017. [PMID: 28641361 PMCID: PMC5575459 DOI: 10.1111/acer.13426] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Early contact with the justice system is associated with a multitude of negative outcomes across the life course. This includes an increased risk of ongoing justice contact, social disadvantage and marginalization, and mental health and substance use issues. Children whose mothers have an alcohol use disorder may be at risk of early justice system contact, and we sought to quantify this relationship in a Western Australian cohort. METHODS This population cohort study made use of linked administrative data. Those in-scope for the study were women who had a birth recorded on the Midwives Notification System (1983 to 2007). The exposed cohort were mothers who had an alcohol-related diagnosis (ICD9/10), recorded on administrative data. This included mental and behavioral disorders which were alcohol related, diseases which could be entirely attributed to alcohol and other ICD alcohol codes. These women were considered to have an alcohol use disorder, which was a proxy for heavy drinking. The comparison cohort was frequency-matched sample with no alcohol-related diagnosis identified on administrative data sets. RESULTS After adjusting for potential confounders, children whose mothers had a maternal alcohol use disorder had a significantly increased odds of justice contact when compared to those whose mothers had no diagnosis (odds ratio [OR] = 1.79, 95% confidence interval [CI] = 1.60 to 1.99). Additional significant maternal factors associated with child justice contact included being Indigenous (OR = 5.14, 95% CI = 4.54 to 5.81), low maternal age, low socioeconomic status, being unmarried, and a history of a mental health problems. Significant child-level factors, which were associated with increased odds of justice contact, included being male, a mental health diagnosis, child protection contact, parity, and academic failure. CONCLUSIONS Children who were exposed to a maternal alcohol use disorder had significantly increased odds of contact with the justice system. Additional risk was associated with being Indigenous and with markers of social disadvantage. These results suggest that prevention and early intervention services should span across agencies in an effort to reduce risk.
Collapse
Affiliation(s)
- Katherine Hafekost
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - David Lawrence
- Graduate School of Education, The University of Western Australia, Perth, Western Australia, Australia
| | - Colleen O'Leary
- Office of the Chief Psychiatrist, Western Australian Department of Health, Perth, Western Australia, Australia
| | - Carol Bower
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - James Semmens
- Centre for Population Health Research, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Stephen R Zubrick
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia.,Graduate School of Education, The University of Western Australia, Perth, Western Australia, Australia
| |
Collapse
|
8
|
Lemos I, Faísca L. Psychosocial adversity, delinquent pathway and internalizing psychopathology in juvenile male offenders. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2015; 42-43:49-57. [PMID: 26299601 DOI: 10.1016/j.ijlp.2015.08.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The main aim of the present study was to investigate the presence of a set of risk factors relating to childhood life events and other psychosocial factors that may be associated with criminal indicators and with the prevalence of internalizing psychopathology in a sample of adolescent offenders. Fifty male adolescents in the custody of the Portuguese Juvenile Justice System participated in the study (M=15.8 years of age). The Adolescent Psychopathology Scale - Short Form (APS-SF) was administered in a structured interview format, and the sociodemographic, family and criminal data questionnaire was filled in by the justice professional after consulting the adolescent's file. Forty-six percent of all subjects had previous delinquent behavior. About 32% of the boys had committed violent offenses and 88% acted with peers. Also, the persistence of the delinquent behavior (50% of the offenders), coupled with the increase in the severity of the crimes committed (38% of the sample), suggests that these adolescents were at risk for serious and chronic delinquency at the time of the intervention. About 32% of the participants reported posttraumatic stress disorder symptoms, 20% had suicide ideation, and a lower percentage reported other internalizing problems. Institutionalization, maltreatment and conduct problems in childhood, and family risk factors (parental conflict, absence of a father figure, lack of parental control and family substance addiction) were related with the report of internalizing problems. Moreover, the increase in the severity of criminal offenses and living in a correctional facility were associated with higher levels of posttraumatic stress, interpersonal problems, anxiety and depression. This study draws attention to the importance of assessing indicators of psychopathology and of psychosocial risk in intervention programs with young offenders, but also to the need of family focused interventions in order to help prevent recidivism.
Collapse
Affiliation(s)
- Ida Lemos
- Research Center for Spatial and Organizational Dynamics, University of Algarve, Portugal.
| | - Luis Faísca
- Cognitive Neuroscience Research Group, Centre for Biomedical Research, CBMR, University of Algarve, Portugal
| |
Collapse
|
9
|
Gretton HM, Clift RJW. The mental health needs of incarcerated youth in British Columbia, Canada. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2011; 34:109-115. [PMID: 21458071 DOI: 10.1016/j.ijlp.2011.02.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The purpose of the study was to identify the current prevalence of mental disorders and mental health needs among incarcerated male and female youths in Canada, and to present these data in the context of rates found in other jurisdictions. One hundred forty male and 65 female incarcerated young offenders in British Columbia were screened with the Massachusetts Youth Screening Instrument Version 2 (MAYSI-2); provisional psychiatric diagnoses were assessed with the Diagnostic Interview Schedule for Children Version IV (DISC-IV); abuse history and aggressive symptoms of Conduct Disorder (CD) were coded from file information. Nearly all youths (91.9% of males and 100% of females) met the criteria for at least one mental disorder. Substance abuse and dependence disorders were highly prevalent (85.5% of males and 100% of females). Aggressive forms of CD were common (72.9% of males and 84.3% of females), as were exposure to physical abuse (60.8% of males and 54.3% of females) and sexual abuse (21.2% of males and 42.4% of females). Female youths had significantly higher odds of presenting with: (1) substance abuse/dependence disorders; (2) current suicide ideation; (3) sexual abuse; (4) PTSD; (5) symptoms of depression and anxiety; (6) Oppositional Defiant Disorder; and (7) multiple mental disorder diagnoses. Male youths had significantly higher odds of presenting with aggressive symptoms of CD. Overall, rates of mental disorder among this sample of serious and violent young offenders were higher than rates previously reported for incarcerated youths - both in Canada and in other jurisdictions.
Collapse
Affiliation(s)
- Heather M Gretton
- Program Evaluation and Research, Youth Forensic Psychiatric Services, Burnaby, British Columbia, Canada.
| | | |
Collapse
|
10
|
Sawyer MG, Guidolin M, Schulz K, McGinnes B, Baghurst P, Zubrick SR. Mental health problems among young people on remand: has anything changed since 1989? Aust N Z J Public Health 2010; 34:594-7. [DOI: 10.1111/j.1753-6405.2010.00628.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
|
11
|
Osman A, Gutierrez PM, Bagge CL, Fang Q, Emmerich A. Reynolds adolescent depression scale-second edition: a reliable and useful instrument. J Clin Psychol 2010; 66:1324-45. [DOI: 10.1002/jclp.20727] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
|
12
|
Sørland TO, Kjelsberg E. [Mental health among teenage boys remanded to prisoner]. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2010; 129:2472-5. [PMID: 19997134 DOI: 10.4045/tidsskr.08.0236] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Incarceration of young people should be avoided according to Norwegian policy. Even so, young people reside in our prisons at all times. Our aim was to investigate their mental health. MATERIAL AND METHODS Among 42 teenage boys (below 20 years of age) remanded to prison, 40 consented to participate in the study. Socio-demographic data were collected and a structured diagnostic instrument (K-SADS) was used to assess their mental health. RESULTS Only four participants had no mental disorder. The 36 who had mental disorders had a mean of 2.5 diagnoses. The most common diagnosis was substance abuse/dependence (n = 31). 30 of the adolescents had serious conduct disorders and nine of them fulfilled the ICD-10 criteria for a dissocial personality disorder. Anxiety and/or depressive disorders (n = 14) and hyperkinetic disorders (n = 12) were also frequent. Many of the adolescents had unmet treatment needs in addition to large social problems, such as disrupted education and unemployment. Three of four adolescents had an immigrant background. INTERPRETATION Teenage boys remanded to prison have a variety of complex problems. They have an extensive need for psychiatric treatment, drug treatment, education and employment. This calls for multidisciplinary coordinated interventions to avoid further negative development of chronic maladjustment with substance abuse, mental problems and crime.
Collapse
Affiliation(s)
- Tore Olav Sørland
- Kompetansesenter for sikkerhets-, fengsels- og rettspsykiatri for Helseregion Sør-Øst, Oslo universitetssykehus, Ullevål Gaustad, Bygg 7 0407 Oslo, Norway
| | | |
Collapse
|
13
|
Stathis SL, Letters P, Doolan I, Whittingham D. Developing an integrated substance use and mental health service in the specialised setting of a youth detention centre. Drug Alcohol Rev 2009; 25:149-55. [PMID: 16627304 DOI: 10.1080/09595230500537613] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
This article describes the frequency of co-morbid substance use and mental health problems of young people within the youth justice system and demonstrates that mental health and drug and alcohol services can be integrated and work effectively. The establishment of an integrated Mental Health Alcohol Tobacco and Other Drugs Service (MHATODS) to juveniles in detention represents a shift away from the traditional paradigm of separate services frequently found throughout Australia. The development of referral procedures and adolescent-focused treatment programmes that are tailored to the specific needs of this disadvantaged population are discussed. A wide-ranging literature review illustrates the consequences of the high prevalence of co-morbid substance use and mental health problems in juveniles within the youth justice system. A retrospective and descriptive account is given of the expansion of the MHATODS, including the recruitment of an Indigenous health worker, the incorporation of an automatic referral process for young people with substance use problems and the development of a brief four-session drug and alcohol counselling programme and a group relapse prevention programme. The proportion of Indigenous clients referred to MHATODS is now equitable to referrals of non-Indigenous youth. The introduction of an automatic voluntary referral process resulted in an increase in referrals for drug and alcohol assessment and counselling from 17% to 64% of total referrals. Of those young people commencing the drug and alcohol programme, 32% completed all sessions. While young people reportedly enjoyed the group programme, feedback from participants indicated that they felt vulnerable in a group setting. MHATODS recognises the limitations of the prevailing paradigm of separate service delivery for mental health and drug and alcohol treatment, and has developed an integrated treatment service for juveniles in detention. The service has expanded its referral base for substance use problems by employing an Indigenous health worker, and initiating an automatic referral process for young people admitted into detention who have a history of significant substance use. Early evidence indicates increased utilisation of drug and alcohol services by young people in detention.
Collapse
Affiliation(s)
- Stephen L Stathis
- Child and Family Therapy Unit, Royal Children's Hospital, Herston, Australia.
| | | | | | | |
Collapse
|
14
|
Kenny DT, Lennings CJ, Munn OA. Risk Factors for Self-Harm and Suicide in Incarcerated Young Offenders: Implications for Policy and Practice. JOURNAL OF FORENSIC PSYCHOLOGY PRACTICE 2008. [DOI: 10.1080/15228930802199317] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
15
|
Mental disorders among adolescents in juvenile detention and correctional facilities: a systematic review and metaregression analysis of 25 surveys. J Am Acad Child Adolesc Psychiatry 2008; 47:1010-9. [PMID: 18664994 DOI: 10.1097/chi.obo13e31817eecf3] [Citation(s) in RCA: 181] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To systematically review and perform a meta-analysis of the research literature on the prevalence of mental disorders in adolescents in juvenile detention and correctional facilities. METHOD Surveys of psychiatric morbidity based on interviews of unselected populations of detained children and adolescents were identified by computer-assisted searches, scanning of reference lists, hand-searching of journals, and correspondence with authors of relevant reports. The sex-specific prevalence of mental disorders (psychotic illness, major depression, attention-deficit/hyperactivity disorder [ADHD], and conduct disorder) together with potentially moderating study characteristics were abstracted from publications. Statistical analysis involved metaregression to identify possible causes of differences in disorder prevalence across surveys. RESULTS Twenty-five surveys involving 13,778 boys and 2,972 girls (mean age 15.6 years, range 10-19 years) met inclusion criteria. Among boys, 3.3% (95% confidence interval [CI] 3.0%-3.6%) were diagnosed with psychotic illness, 10.6% (7.3%-13.9%) with major depression, 11.7% (4.1%-19.2%) with ADHD, and 52.8% (40.9%-64.7%) with conduct disorder. Among girls, 2.7% (2.0%-3.4%) were diagnosed with psychotic illness, 29.2% (21.9%-36.5%) with major depression, 18.5% (9.3%-27.7%) with ADHD, and 52.8% (32.4%-73.2%) with conduct disorder. Metaregression suggested that surveys using the Diagnostic Interview Schedule for Children yielded lower prevalence estimates for depression, ADHD, and conduct disorder, whereas studies with psychiatrists acting as interviewers had lower prevalence estimates only of depression. CONCLUSIONS Adolescents in detention and correctional facilities were about 10 times more likely to suffer from psychosis than the general adolescent population. Girls were more often diagnosed with major depression than were boys, contrary to findings from adult prisoners and general population surveys. The findings have implications for the provision of psychiatric services for adolescents in detention.
Collapse
|
16
|
Stathis S, Letters P, Doolan I, Fleming R, Heath K, Arnett A, Cory S. Use of the Massachusetts Youth Screening Instrument to assess mental health problems in young people within an Australian youth detention centre. J Paediatr Child Health 2008; 44:438-43. [PMID: 18564078 DOI: 10.1111/j.1440-1754.2008.01324.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM To screen for mental health problems in an Australian adolescent forensic population, evaluate the Massachusetts Youth Screening Instrument Version 2 (MAYSI-2) in providing a preliminary assessment of those needs, and to explore the level of mental health problems in vulnerable populations within detention. METHODS Over a 6-month period, all young people admitted into detention were referred for screening by the MAYSI-2, a 7-scaled instrument developed to identify young people within the youth justice system at greatest risk for serious mental, emotional or behavioural disorders. RESULTS High levels of mental health problems and trauma were reported, with 75.0% of males and 90.0% of females, and 81.2% of Indigenous and 75.0% of non-Indigenous youth screening above the clinical cut-off for at least one scale. Males screened highest on the Alcohol and Drug Use (58.9%), Angry-Irritable (28.2%) and Somatic Complaints (28.2%). Females screened highest on the Alcohol and Drug Use (67.5%), Somatic Complaints (45.0%), Depressed-Anxious (42.5%) and Suicide Ideation (30.0%) scales, with significantly higher rates than males on the Depressed-Anxious, Somatic Complaints and Suicide Ideation scales. No significant differences in screening rates were reported between Indigenous and non-Indigenous youth. CONCLUSIONS This study confirmed the high rates of mental health problems in adolescents within youth detention. Appropriate use of screening tools improves our understanding and targets treatment of mental health problems in this cohort. We have reservations in recommending the MAYSI-2 as a valid screening tool for Indigenous young people in youth detention and recommend the development of a more appropriate screening tool.
Collapse
Affiliation(s)
- Stephen Stathis
- University of Queensland and Child and Family Therapy Unit, Royal Children's Hospital, Herston, Australia.
| | | | | | | | | | | | | |
Collapse
|
17
|
Kenny DT, Press AL. Violence classifications and their impact on observed relationships with key factors in young offenders. ACTA ACUST UNITED AC 2006. [DOI: 10.1037/1076-8971.12.1.86] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
18
|
Stathis S, Martin G, McKenna JG. A preliminary case series on the use of quetiapine for posttraumatic stress disorder in juveniles within a youth detention center. J Clin Psychopharmacol 2005; 25:539-44. [PMID: 16282834 DOI: 10.1097/01.jcp.0000186901.79861.e2] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Juveniles within the youth justice system have high rates of psychiatric morbidity, including posttraumatic stress disorder (PTSD). This case series describes 6 young people aged 15 to 17 years within a youth detention center who met the criteria for PTSD and reported an improvement in symptoms after 6 weeks of treatment with low-dose quetiapine. The primary outcome measure used was the Traumatic Symptom Checklist in Children. The dose of quetiapine ranged from 50 to 200 mg/d; T scores for PTSD symptoms decreased from 75 (SD, +/-5.2; range, 68-82) to 54 (SD, +/-7.4; range, 43-62) (P < 0.01). Significant improvements in symptoms of dissociation (P < 0.01), anxiety (P < 0.01), depression (P < 0.01), and anger (P < 0.05) were also noted over the 6-week evaluation period. Low-dose quetiapine was tolerated well, with no persisting side effects or adverse events. Nighttime sedation was reported, although this was viewed as beneficial. All young people opted to continue with treatment after the assessment period. This preliminary case series suggests that juveniles in detention who have PTSD may benefit from treatment with quetiapine. Caution is needed in interpreting these findings. Both larger open-label and blinded trials are warranted to define the use of quetiapine in the treatment of PTSD in the adolescent forensic population.
Collapse
Affiliation(s)
- Stephen Stathis
- Child and Youth Mental Health Service, Royal Children's Hospital, Brisbane, Queensland, Australia.
| | | | | |
Collapse
|
19
|
Putnins AL. Correlates and predictors of self-reported suicide attempts among incarcerated youths. INTERNATIONAL JOURNAL OF OFFENDER THERAPY AND COMPARATIVE CRIMINOLOGY 2005; 49:143-157. [PMID: 15746266 DOI: 10.1177/0306624x04269412] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
The correlates and predictors of suicidal behaviors among 900 young offenders in detention centers in South Australia are investigated. That young offenders are a high-risk population is confirmed, with a quarter of the youths reporting recent suicidal ideation and more than a quarter reporting having made a suicide attempt. Past suicide attempts are significantly predictive of future suicide attempts. Other variables both concurrently and prospectively associated with suicidal behaviors (even after controlling for prior suicide attempt status) are substance use, prolonged dysphoric mood, attention deficit hyperactivity disorder signs, and having a bad temper. These variables not only have predictive value but should also be considered as appropriate targets when intervening to reduce suicide risk. It is suggested that impulsiveness is an underlying common factor.
Collapse
Affiliation(s)
- Aldis L Putnins
- Department for Families and Communities-South Australia, and University of South Australia, 2 Norton Summit Rd., Magill, SA 5072, Australia.
| |
Collapse
|
20
|
Abstract
OBJECTIVE To examine new strategies which may be implemented to address the significant mental health and substance abuse problems of young people within the juvenile justice system. METHOD Wide-ranging literature review of mental health problems within the juvenile justice population is given, illustrating the high prevalence of mental health problems within this cohort of young people. Reference is made to the differing demographics and agendas of the American justice system compared to that found in Australia. RESULTS It is suggested that new initiatives stemming from quality Australian studies are required in order to facilitate reform within adolescent forensic mental health. Psychiatrists need to be at the forefront of innovative policy delivery within the juvenile justice system. CONCLUSIONS A transdisciplinary approach is required to meet the changing needs of young people within the juvenile justice system. Such a system of care recognizes that these young people and their families have multiple needs that cross traditional boundaries and a collaborative approach across agencies is essential at both the policy and practical level. Psychiatrists have an important role to play in the development of these services. A systemic process to address such needs is offered.
Collapse
Affiliation(s)
- Stephen Stathis
- Child and Youth Mental Health Service, Royal Children's Hospital, Brisbane, Queensland, Australia.
| | | |
Collapse
|
21
|
Abstract
OBJECTIVES To describe a new programme, the Mental Health Alcohol Tobacco and Other Drugs Service (MHATODS) at the Brisbane Youth Detention Centre, which aims to provide young people in detention with the same quality of mental health and substance dependency services that would normally be available to them in the community. CONCLUSIONS Young people in detention suffer from considerable mental health and substance abuse problems. MHATODS seeks to address the specific needs of this group of young people. Its innovative structure recognizes the limitations of the prevailing paradigm of separate service delivery for mental health and drug and alcohol treatment, and has created an integrated treatment service for young people in detention.
Collapse
Affiliation(s)
- Paul Letters
- Mental Health Alcohol, Tobacco, and Other Drugs Service, Brisbane, Queensland, Australia.
| | | |
Collapse
|
22
|
Abstract
OBJECTIVES To estimate overall and cause specific standardised mortality ratios in young offenders. DESIGN Comparison of mortality data in cohort of young offenders. SETTINGS State of Victoria, Australia. SUBJECTS Cohort of young offenders aged 10-20 years with a first custodial sentence from 1 January 1988 to 31 December 1999. MAIN OUTCOME MEASURES Deaths ascertained by matching with the national death index, a database containing records of all deaths in Australia since 1980. Death rates in the reference Victorian population used to calculate standardised mortality ratios. RESULTS The offender cohort comprised 2621 men and 228 women with 11 333 person years of observation. The median age of first detention was 17.9 years for men and 18.4 years for women. Median follow up was 3.3 years for men and 1.4 years for women. Overall standardised mortality ratio adjusted for age (expressed as a ratio) was 9.4 (95% confidence interval 7.4 to 11.9) for men and 41.3 (20.2 to 84.7) for women. Cause specific standardised mortality ratios for men were 25.7 (17.9 to 36.9) for drug related causes, 9.2 (5.8 to 15) for suicide, and 5.7 (3.6 to 9.2) for non-intentional injury. A quarter of drug related deaths in men aged 15-19 years were in offenders. CONCLUSIONS Social policies for young offenders should address both the prevalent drug and mental health problems as well the high levels of social disadvantage.
Collapse
Affiliation(s)
- Carolyn Coffey
- Centre for Adolescent Health, Murdoch Childrens Research Institute, Parkville, Victoria 3052, Australia.
| | | | | | | | | |
Collapse
|