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Using Systems of Care to Reduce Incarceration of Youth with Serious Mental Illness

American Journal of Community Psychology

Abstract

Youth with serious mental illness come into contact with juvenile justice more than 3 times as often as other youth, obliging communities to expend substantial resources on adjudicating and incarcerating many who, with proper treatment, could remain in the community for a fraction of the cost. Incarceration is relatively ineffective at remediating behaviors associated with untreated serious mental illness and may worsen some youths’ symptoms and long-term prognoses. Systems of care represent a useful model for creating systems change to reduce incarceration of these youth. This paper identifies the systemic factors that contribute to the inappropriate incarceration of youth with serious mental illness, including those who have committed non-violent offenses or were detained due to lack of available treatment. It describes the progress of on-going efforts to address this problem including wraparound and diversion programs and others utilizing elements of systems of care. The utility of systems of care principles for increasing access to community-based mental health care for youth with serious mental illness is illustrated and a number of recommendations for developing collaborations with juvenile justice to further reduce the inappropriate incarceration of these youth are offered.

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Notes

  1. There are three definitions of serious mental illness most often used for clinical and policy purposes with regard to youth (Narrow et al. 1998). Public Law 102–321, the Alcohol, Drug Abuse, and Mental Health Administration (ADAMHA) Reorganization Act of 1992 defined serious mental illness as a 12-month disorder, other than a substance use disorder, that meets DSM-IV criteria that causes "serious impairment" which a SAMHSA advisory group defined as equal to a Global Assessment of Functioning (GAF) score of 60 or less (Epstein et al. 2004). The US Senate Committeeon Appropriations in the 1993 appropriations bill for the Departmentof Health and Human Services defined severe mental illness as those disorders with psychotic symptoms including“schizophrenia, schizoaffective disorder, manicdepressive disorder, autism, as well as severe forms of other disorders such as major depression, panic disorder, and obsessivecompulsive disorder." Public Law 94–142, the Individuals with Disabilities Education Act (IDEA), originally passed in 1975, developed a definition of emotional disturbance for use in educational settings, but which has been criticized for its vagueness and outmoded terminology (Narrow et al. 1998).

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Acknowledgments

The author wishes to gratefully acknowledge that portions of the research for this article were supported by the Robert Wood Johnson’s Health Policy Fellowship program.

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Erickson, C.D. Using Systems of Care to Reduce Incarceration of Youth with Serious Mental Illness. Am J Community Psychol 49, 404–416 (2012). https://doi.org/10.1007/s10464-011-9484-4

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