Article Title
2022, Vol. 21, No. 2, 107-119 | International Journal of Forensic Mental Health
Adolescents’ Quality of Life and Mental Health Needs during the Initial Phase in a Closed Institution
Authors
Nele Van Hecke; Department of Special Needs Education, Ghent University, Ghent, Belgium
Florien Meulewaeter; Department of Special Needs Education, Ghent University, Ghent, Belgium
Sara Rowaert; Department of Special Needs Education, Ghent University, Ghent, Belgium
Chijs van Nieuwenhuizen; Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
Abstract
This study investigated adolescents’ Quality of Life and mental health needs during the first weeks in a closed institution for mandatory care and treatment to inform (gender-specific) rehabilitation. Questionnaires concerning socio-demographic variables, Quality of Life and mental health needs were administered (n1⁄4182; 90 boys and 92 girls; mean age 1⁄4 16.2). Given the high prevalence of mental health needs in this study population and their significant negative correlation with QoL, we argue for a holistic view on rehabilitation and to broaden treatment aims in youth forensic care by including not only determinants of recidivism but also determinants of QoL.
Keywords
Quality of Life; mental health needs; adolescents; detention; rehabilitation
Summary of the Research
“The interest in Quality of Life (QoL) has expanded in recent decades, both as an outcome measure of program evaluation…as well as a strengths-based supports paradigm for individuals who find themselves in vulnerable situations…Adolescents in detention are at risk of experiencing high levels of mental health needs, internalizing and externalizing problems, exposure to traumatic experiences, and socio-economic problems…Being able to live a personally meaningful and fulfilling life is hypothesized to play a buffering role in relation to the risk of recidivism…adopting a focus on QoL may assist practitioners in developing personalized rehabilitation plans that are tailored to adolescents’ specific needs and aspirations…This study aims to explore adolescents’ QoL and mental health needs in the initial phase of detention, and whether and how this differs between male and female adolescents…191 adolescents, who were admitted to a closed institution, agreed to participate in the study…” (p. 107-108).
“…The study identified significant differences between boys and girls, and by that contributed to relevant knowledge on gender-specific characteristics…low QoL-scores for global wellbeing were revealed for the total group of adolescents during the initial phase of detention…Even though adolescents are relatively satisfied with separate life domains at the start of detention, their overall subjective feeling of wellbeing is low…As admission to a closed institution can be considered a stressful life event…it is likely to influence adolescents’ general feeling of wellbeing in the initial phase of detention, whereas one’s satisfaction on different life domains might be less susceptible to a general feeling of discomfort…” (p. 114).
“In this study, the highest domain-specific QoL-scores for the total group of adolescents were found on the domains ‘positive self-esteem’ and ‘framework,’ indicating that the adolescents feel good about themselves and have a sense of purpose and meaning in life…Significant differences between boys and girls were found on almost all life domains, with exception of the ‘framework’ scale. Strikingly, these differences are consistently displayed to the detriment of girls. In the same vein, girls reported significantly higher scores with regard to mental health needs, more specifically for the scales ‘depressed-anxious,’ ‘suicide ideation,’ and ‘somatic complaints.’ Girls’ lower levels of QoL and higher levels of (mostly internalizing) mental health needs show similarities with findings in the general population…and is reflective of findings in other studies that have identified girls as a particularly vulnerable group within the criminal justice system…” (p. 114).
“This was also reflected in the significant differences between boys and girls on some of the categorical variables. A significantly smaller proportion of girls (as compared to boys) lived with at least one of her parents before detention…Moreover, a significantly higher proportion of girls had already known previous periods of detention, had already been hospitalized for psychological problems in the past, and had visited a professional caregiver due to psychological problems in the past year…The fact that a higher proportion of girls had received treatment with regard to psychological problems in the past (year), is probably a reflection of the higher prevalence of mental health needs in the group of detained female adolescents…It might also be a consequence of a system in which girls are only referred to closed facilities in ‘the most extreme cases,’ when other – less invasive – measures appear insufficient…it might also be the case that boys’ mental health needs remain unrecognized more frequently due to disproportionate focus on problematic behavior, with the risk of remaining untreated” (p. 114).
“Correlations suggest that traumatic experiences show a significant negative association with QoL and a significant positive association with mental health needs for both boys and girls…A multivariate research design was applied to identify determinants of adolescents’ QoL in the initial phase of detention, as these may have the potential to guide treatment goals. In summary, mental health needs – mostly internalizing problems – as well as variables pertaining to contextual and structural disadvantage (e.g., financial problems and not being able to live with parents) were found to show negative association with adolescents’ QoL” (p. 114-115).
Translating Research into Practice
“…Clinicians play a critical role in promoting adolescents’ mental health and wellbeing…as they must view their situational holistically and invest efforts into a broad range of life domains (e.g., family relations). Findings point, among other things, to the importance of focusing on strengthening and enhancing the relation between adolescents and their context during their stay in a closed institution…adopting an integrative approach in which adolescents’ social context and structural difficulties are taken into account as well…Findings underscore that mental health screening and psychological assistance might be even more salient in working with girls in closed institutions, as well as strengthening girls’ relationships with their context and supporting them in overcoming structural barriers” (p. 115).
“When postulating treatment aims, focusing on adolescents’ QoL in order to capture their needs and to provide them with positive prospects should be valued. Hence, a combined focus on risk reduction and enhancement of QoL might in the long run be effective both in guiding adolescents away from a deviant pathway, but also in guiding them toward a meaningful and more fulfilling life…Knowing which determinants affect adolescents’ QoL (both in a positive or negative way) may help to define and prioritize treatment aims. A holistic approach to rehabilitation is therefore recommended, in which adolescents’ QoL is promoted, next to risk reduction. Furthermore, gender differences in mental health needs were highlighted, suggesting the need for gender-sensitive considerations…In addition to emphasizing the relevance of risk-need assessment in adolescents, study findings underscore a greater need for gender-specific risk-need assessment tools (Odgers et al., 2005), in line with recent findings among adult offenders (Goulette, 2020)” (p. 115).
Other Interesting Tidbits for Researchers and Clinicians
“Quality of life was assessed by means of the modified Dutch youth version of the Lancashire Quality of Life Profile (LQoLP-vl-jeugd; van Nieuwenhuizen et al., 2002b), a structured interview which is an adapted version of the Lancashire Quality of Life Profile (LQoLP; Oliver et al., 1997)…The LQoLp comprises both objective and subjective indicators of QoL and measures satisfaction on 10 different life domains, as well as adolescents’ global wellbeing. Adolescents’ subjective evaluation of the life domains ‘living situation…’ ‘leisure and social participation…’ ‘health…’ ‘finances…’ ‘family relations…’ and ‘safety…’ was rated by means of a 7-point Likert scale…The domains ‘positive self-esteem’ and ‘negative self-esteem…’ and ‘framework…’ and ‘fulfilment…’ were measured on a 3-point Likert scale…The ‘framework’ scale refers to having meaningful perspectives in life. The ‘fulfillment’ scale refers to feeling able to fulfill one’s life goals…” (p. 110).
