The health of a group of young Australians in a New South Wales juvenile justice detention centre: a pilot study

Suicidal behaviour in Aboriginal and non-Aboriginal young men under custodial youth justice supervision: understanding the role of adverse childhood experiences

This study examined the association between adverse childhood experiences (ACEs) and suicidal behaviour in a sample of 1726 young men in an Australian youth justice detention population. Nine ACEs, including child abuse and parental risk factors, were examined. Analyses focused on whether ACEs were associated with suicidal ideation and attempts after controlling for other known correlates including substance use, aggression and out-of-home care exposure. Aboriginal and Torres Strait Islander young men were found to have a higher prevalence and a higher average score of ACEs, but differed very little in relation to reported suicidal behaviour. Higher ACEs scores and specific maltreatment types (i.e. physical and sexual abuse) were positively associated with suicidal behaviour. This relationship was attenuated after controlling for established correlates of suicidal behaviour. The findings underscored the importance of understanding ACEs as major risk factors for suicide in youth justice populations and the need for effective prevention measures.

A Systematic Review of the Antecedents and Prevalence of Suicide, Self-Harm and Suicide Ideation in Australian Aboriginal and Torres Strait Islander Youth

Suicide and self-harm represent serious global health problems and appear to be especially elevated amongst indigenous minority groups, and particularly amongst young people (aged 24 years or younger). This systematic review investigates for the first time the antecedents and prevalence of suicide, self-harm and suicide ideation among Australian Aboriginal and Torres Strait Islander youth. Web of Science, PubMed, PsychINFO, CINAHL databases and grey literature were searched from earliest records to April 2019 for eligible articles. Twenty-two empirical articles met the inclusion criteria. The data confirmed that indigenous youth in Australia have elevated rates of suicide, self-harm and suicidal ideation relative to the nonindigenous population. Risk factors included being incarcerated, substance use and greater social and emotional distress. Notably, though, information on predictors of suicide and self-harm remains scarce. The findings support and justify the increasing implementation of public health programs specifically aimed at tackling this crisis. Based on the review findings, we argued that Aboriginal communities are best positioned to identify and understand the antecedents of youth self-harm, suicide ideation and suicide, and to take the lead in the development of more effective mental health preventive strategies and public policies within their communities.

Health needs of Australian Indigenous young people entering detention

AIM

To determine whether there are different health needs associated with differences between Indigenous and non-Indigenous youth in detention in Brisbane, Queensland, Australia.

METHODS

All records of young people (aged 10 to 21 years) taken into detention in Brisbane Queensland over the period 1 July 2001 to 30 June 2009 were reviewed, and data were extracted documenting the mental health and related behaviours of those referred to the Mental Health, Alcohol, Tobacco and Other Drugs Service. International Statistical Classification of Diseases and Related Health Problems - Tenth Revision (ICD-10) criteria were applied to a clinical interview. ICD-10 diagnostic outcomes and reason for referral are presented by Indigenous status and age.

RESULTS

Young male (under 14 years of age) Indigenous respondents are substantially over-represented in youth in detention. Indigenous youth in detention are disproportionately referred and diagnosed with a substance use problem. Referral and diagnosis of substance use problems was not as commonly found for non-Indigenous youth.

CONCLUSIONS

Young Indigenous persons are substantially over-represented in those taken into detention in Queensland. This study shows significant differences in relation to mental health and substance use assessment outcomes for Indigenous and non-Indigenous young people in youth detention in Queensland. Further research focusing on service delivery for Indigenous young people should focus on their specific needs.

Substance use and the prediction of young offender recidivism

The problem considered is whether self-reported substance use can be used in the estimation of recidivism risk among youths placed in secure care. The Secure Care Psychosocial Screening (SECAPS) and offending records of 447 youths admitted to detention centres in South Australia were examined. The target outcome was any new offending within 6 months of release. Use of a psychoactive substance at the time of committing the most recent offence was not a significant predictor of subsequent offending, nor was acknowledging having a problem with drug or alcohol use. In relation to the recent use of alcohol, marijuana, hallucinogens, sedatives/hypnotics, narcotics, stimulants and inhalants, only the use of alcohol and inhalants appeared to have significant relationships with recidivism. While the relationships were too small to permit using these items on their own to estimate re-offending risk, recent alcohol and inhalant use could be included as part of a broader recidivism risk assessment. [Putniņs AL. Substance use and the prediction of young offender recidivism.

The physical health status of young Australian offenders

AIMS

To describe the socio-economic background and physical health status of young offenders in custody in New South Wales (Australia).

DESIGN

Cross-sectional survey of all young offenders held at nine juvenile detention centres across New South Wales (NSW) (eight male and one female) between January and March 2003.

METHODS

Demographic and health information was collected by nurse interviewers and psychologists using a face-to-face interview. Blood and urine samples were collected to screen for blood-borne viruses and sexually transmissible infections.

RESULTS

The final sample comprised 242 young people (223 males and 19 females). Overall, 90% of those assessed rated their general health as 'excellent', 'very good' or 'good'. Sixty-nine (30%) young offenders reported that they had been previously diagnosed with asthma. Two young women reported a past diagnosis of diabetes with the results of the random blood glucose testing indicating that a further six young people required testing for possible diabetes. None of those tested were positive for HIV, 9% tested positive for hepatitis C antibody, and 11% tested positive for hepatitis B core-antibody.

CONCLUSIONS

Our findings indicate that young offenders in New South Wales have backgrounds characterised by extreme disadvantage (poor educational attainment, unemployment, and care placements) and poor physical health. Parental incarceration was common to 43% of the sample. Our findings reinforce the concept that for marginalised groups, contact with the criminal justice system represents an important opportunity to detect illness, initiate treatment, and promote contact with health services.

Planning primary health-care services for South Australian young offenders: A preliminary study

Although many young offenders receive health care during periods of detention, addressing their health needs after release from secure care is a key strategy for successful rehabilitation and reintegration into the community. The purpose of this preliminary study was to examine current discharge planning practices for young offenders in Youth Training Centres in South Australia with a view to improving offenders' connection with primary health-care services on discharge. To determine the strengths and weaknesses of current discharge planning practices, this exploratory study involved in-depth review of literature and a semistructured focus group of stakeholders. Findings were discussed with an expert advisory group before final recommendations were made. This study identified a service model approach to discharge planning that recommended a nurse located within the Divisions of General Practice as the coordinator. The study found that trusted staff in detention centres, with an awareness of services available in the location of release, influence young offenders' decision-making in relation to health-care services. Awareness and recognition of young offenders' health beyond periods of juvenile detention and into their adult lives is valuable in that it has the potential to establish lifelong healthy behaviours. Bonding with young offenders and gaining their trust increases their likelihood of attending primary health-care services.

Sexually transmitted infection and blood-borne virus screening in juvenile correctional facilities: A review of the literature and recommendations for Australian centres

BACKGROUND

Juveniles in custody are disproportionately affected by sexually transmitted infections (STI) and blood-borne viruses (BBV) due to high rates of risk behaviours.

METHODS

A literature review was undertaken with the aim of providing evidence-based recommendations on STI/BBV screening in Australian juvenile correctional facilities. Relevant research was identified using Premedline and Medline databases, followed by a manual search of reference lists in relevant articles identified in the database search. A total of 36 relevant publications were identified and reviewed.

RESULTS

STI/BBV knowledge in incarcerated youth is poor and accompanied by high rates of sexual and blood-borne risk behaviours. The prevalence of these infections is considerable. High rates of asymptomatic gonococcal and chlamydial infections exist, which can be easily diagnosed on self-collected specimens using new nucleic acid amplification technology. HIV infections are rare although continued vigilance is needed in view of substantial risk factors for infection. Hepatitis C prevalence is high, although much lower than that of adult prisoners, signifying a possible window of opportunity for Hepatitis C prevention. Many remain at risk of Hepatitis B, and it is important to assess the need for vaccination in this group.

CONCLUSION

Screening for STI/BBV in incarcerated juveniles is of major public health importance and all individuals should be offered screening in conjunction with risk-reduction education during their admission to juvenile detention centres.

A preliminary case series on the use of quetiapine for posttraumatic stress disorder in juveniles within a youth detention center

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.

Correlates and predictors of self-reported suicide attempts among incarcerated youths

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.

Predicting death in young offenders: a retrospective cohort study

OBJECTIVE

To examine predictors of death in young offenders who have received a custodial sentence using data routinely collected by juvenile justice services.

DESIGN

A retrospective cohort of 2849 (2625 male) 11-20-year-olds receiving their first custodial sentence between 1 January 1988 and 31 December 1999 was identified.

MAIN OUTCOME MEASURES

Deaths, date and primary cause of death ascertained from study commencement to 1 March 2003 by data-matching with the National Death Index; measures comprising year of and age at admission, sex, offence profile, any drug offence, multiple admissions and ethnic and Indigenous status, obtained from departmental records.

RESULTS

The overall mortality rate was 7.2 deaths per 1000 person-years of observation. Younger admission age (hazard ratio [HR], 1.4; 95% CI, 1.0-1.9), repeat admissions (HR, 1.8; 95% CI, 1.1-2.9) and drug offences (HR, 1.5; 95% CI, 1.0-2.1) predicted early death. The role of ethnicity/Aboriginality could only be assessed in cohort entrants from 1996 to 1999. The Asian subcohort showed higher risk of death from drug-related causes (HR, 2.5; 95% CI, 1.1-5.5), more drug offences (relative risk ratio [RRR], 13; 95% CI, 8.5-20.0) and older admission age (oldest group v youngest: RRR, 9.3; 95% CI, 1.3-68.0) than non-Indigenous Australians. Although higher mortality was not identified in Indigenous Australians, this group was more likely to be admitted younger (oldest v youngest: RRR, 0.31; 95% CI, 0.15-0.63) and experience repeat admissions (RRR, 1.6; 95% CI, 1.0-2.4).

CONCLUSIONS

Young offenders have a much higher death rate than other young Victorians. Early detention, multiple detentions and drug-related offences are indicators of high mortality risk. For these offenders, targeted healthcare while in custody and further mental healthcare and social support after release appear essential if we are to reduce the mortality rate in this group.

A transdisciplinary approach to adolescent forensic mental health

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.

Mortality in young offenders: retrospective cohort study

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.

Somatic morbidity and criminality: the Northern Finland 1966 Birth Cohort Study

OBJECTIVE

The aim of this study was to investigate the association between adverse physical disorders and violent/non-violent criminal behaviour.

DESIGN

The study material consisted of the large, prospectively followed, unselected and genetically homogeneous Northern Finland 1966 Birth Cohort, the Finnish Hospital Discharge Registers and the National Crime Register (n=10934).

MAIN RESULTS

The results of the logistic regression analyses showed that male offenders had statistically significantly more injuries (adj. OR=1.81, 95% CI=1.51-2.17), when compared with males without a criminal history. Violent male offenders exhibited greater morbidity to the diseases of the respiratory system (adj. OR=1.64, 95% CI=1.03-2.60) when compared with non-violent criminals. Female offenders suffered more commonly from poisonings (adj. OR=3.84, 95% CI=1.69-8.72), injuries (adj. OR=2.79, 95% CI=1.67-4.66), infections (adj. OR=1.87, 95% CI=1.16-2.99) and indefinite symptoms (adj. OR=2.02, 95% CI=1.20-3.40) than non-offending females.

CONCLUSIONS

At epidemiological level, criminal behaviour seems to be associated especially with an increased risk of injuries for both sexes. The observed increase of the diseases of the respiratory system among violent but not among non-violent males calls for further investigations.