Forensic Psychiatry, University of Lund, Lund, Sweden, firstname.lastname@example.org.
Many international studies show that adolescents in coercive institutional care display high prevalences of mental disorders, especially in the form of disruptive behavior disorders [including attention-deficit/hyperactivity disorder (AD/HD), oppositional defiant disorder, and conduct disorder], anxiety disorders, and mood disorders. High degrees of overlap across mental disorders have also been reported. In addition, institutionalized adolescents are often traumatized. Despite this well-documented psychiatric morbidity, the mental health care needs of detained adolescents are often overlooked. The main objective of this study is to assess prevalences of psychiatric disorders, results of intelligence tests, and previous contacts with child and adolescent psychiatric services among adolescents in institutional care. DSM-IV diagnoses, mental health contacts, substance abuse, neurocognitive abilities, and school performance were registered in 100 adolescents (92 boys, 8 girls) aged 12-19 years (mean age 16.0; SD ± 1.5) consecutively committed to Swedish juvenile institutions between 2004 and 2007. At least one psychiatric disorder was diagnosed in 73% of the subjects: 48% met DSM-IV diagnostic criteria for AD/HD, 17% for an autism spectrum disorder, and 10% for a mental retardation. The collapsed prevalence for psychiatric disorders requiring specialist attention was 63%. Our data indicate that systematic diagnostic procedures are crucial in the treatment planning for institutionalized adolescents. Adequate treatment strategies need to be designed and implemented to meet the extensive mental health care needs of this vulnerable population.
I admit, I don’t have the paper. I am assuming “coercive institutional care” means juvenile jail. 73% of those in such care had at least one psychiatric disorder. 17% were autistic. 10% had intellectual disability.
So many questions come up. The authors note the need to identify conditions and provide appropriate treatment. One also must ask if the high percentage of people with these conditions means that (a) there is a high percentage of perpetrators who have these conditions and/or (b) is there a higher conviction rate for people with these conditions.
I know I’m not phrasing this well, but this really bugs me.
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Coercive treatments make all mental health disorders worse. It is the cycle of violence. It also tends to make people more violent. That doesn't alway happen, but always mental health problems get worse. Especially in children.
David N. Brown:
I similar thought came to my mind. Actually, it seems conceivable that institutionalization could CAUSE a psychiatric disorder. I was particularly struck by the line about "disruptive behavior disorders". This called to mind my "Tasmanian devil" joke: "Put Tasmanian devil in barrel. Had grad student poke devil with a stick. Devil viciously bit grad student's finger off. Gave grad student longer stick. Conclusion: Tasmanian devil vicious when poked with a stick."
The prevalence of Psychiatric disorder in UK jails for both adult and adolescents is also high. I visit jails and from my own limited overview social dysfunction has a high association with mental health and cognitive disorders which have no other place to be treated.