Type of Mental Health Service Use and Reduced Recidivism Among Justice-Involved Adolescents

Background and Purpose: The justice system is often seen as a depository for youth without access to mental health services. Nearly two-thirds of males and three-quarters of females meet diagnostic criteria for one or more psychiatric disorders at intake to the juvenile justice system, and the prevalence of mental health diagnoses increases as youths are processed further in the system. Prior studies have shown service referral rates below 10 percent, indicating that many youth do not receive needed mental health services. The purpose of this study was to identify mental health service use as a promotive factor for justice-involved adolescents. Specifically, the current study investigated the role of inpatient, outpatient, and school-based mental health services on rates of recidivism among a sample of serious juvenile offenders. We hypothesized that mental health service use is associated with reduced recidivism.

Methods: This study used data from the Northwestern Juvenile Project, the first large-scale longitudinal survey of mental health and substance misuse outcomes in a representative sample of adolescent detainees. The sample consisted of 738 individuals who completed surveys at baseline, follow-up 1 (3 years after baseline), and follow-up 2 (3.5 years after baseline), of whom 74% received any mental health services between baseline and follow-up 1. Bivariate and multivariate analyses were conducted to test the hypothesis that mental health services received between baseline and follow-up 1 were associated with lower rates of re-arrest at Follow-up 2. Services included inpatient (residential placements), outpatient (community), and school-based services, each dichotomized for no services/any services in each category. OLS and logistic regression models were fit with re-arrest operationalized both as a continuous variable (i.e., number of arrests, arrest variety) and a dichotomous variable (i.e., any arrest).

Results: The study population was 89% male, 79% Black, 14% Hispanic, 7% White, averaging 18.2 years old at follow-up 1. Bivariate analyses using OLS and logistic regression showed that of the services assessed, only outpatient services received from baseline to follow-up 1 were associated with recidivism at follow-up 2. Specifically, individuals who received outpatient services between baseline and follow-up 1 had significantly lower odds of re-arrest between follow-up 1 and follow-up 2 (OR = 0.38, p < .05). This statistically significant association remained when controlling for race, gender, length of time incarcerated, mental health diagnoses, and when re-arrest was modeled as a continuous variable.

Conclusions and Implications: As the assumed goal of the juvenile justice system is rehabilitation, it is important to identify what works in reducing recidivism for justice-involved youth. Outpatient mental health service use between baseline and follow-up 1 significantly reduced recidivism at follow-up 2. These findings are important as they demonstrate the importance of offering community based mental health services to justice-involved youth in order to reduce further delinquency. Additional research is needed to explain the mechanisms of how type of mental health service use works as a promotive factor to reduce recidivism for justice involved adolescents.