Mental Health’s Role in Juvenile Justice Rehabilitation

Sarah McCormick, University of Toronto
Michele Peterson-Badali, University of Toronto
Tracey A. Skilling, Centre for Addiction and Mental Health, Toronto, Canada and University of Toronto

Understanding the role that mental health issues play in justice-involved youth poses challenges for research, policy, and practice. While mental health problems are generally not risk factors for criminal behavior according to the risk-needs-responsivity (RNR) framework of correctional psychology practice, prevalence rates are very high and RNR principles suggest that mental health as a responsivity variable may moderate the success of interventions targeted to criminogenic needs. In this study we investigated the relationships among mental health status, criminogenic needs treatment, and recidivism in a sample of 232 youth referred for court-ordered assessments and followed through their community supervision sentence (probation). Youth with mental health needs were no more likely than youth without these needs to reoffend, regardless of whether those needs were treated. Youth who received mental health treatment also more frequently had their criminogenic needs matched across several domains, suggesting an association between mental health treatment and intermediate treatment targets. However, mental health did not moderate the effect of criminogenic needs treatment: youth who had a greater proportion of criminogenic needs targeted through appropriate services were less likely to reoffend, regardless of mental health status. Findings are consistent with the RNR stance that, within a correctional context in which the primary goal of intervention is preventing recidivism, treatment for mental health needs should be in addition to criminogenic needs treatment, not in replacement of it. They also point to the need for continued research to understand precisely how mental health treatment interacts with intervention targeting criminogenic needs.

Mental health, psychopathology, youth, risk-need responsivity, recidivism

“Despite a higher likelihood of having mental health problems, justice-involved youth are less likely than nonoffending youth to have had these problems identified previously or to have received services. Mental health problems also pose considerable challenges to frontline staff (e.g., probation officers); mental health issues may be perceived as a barrier to youths’ engagement with rehabilitative programming, with treatment of mental health needs often taking precedence over other issues, including those known to be directly related to risk to reoffend.” (p. 55)

“In the adult literature, mental health symptomatology has emerged as a weak predictor of reoffending for offenders in general but also for most offenders with mental illness; the strongest predictors of recidivism are criminogenic needs shared by those with and without mental disorder. To our knowledge, only one study of youth focused explicitly on the role of mental health in reoffending has also considered criminogenic needs, so it remains unclear whether mental health status relates to reoffending.” (p. 56)

“Within the corrections and criminal justice context, studies of offender populations that have identified mental health as a risk factor for subsequent criminal behavior have been challenged by research on forensic risk prediction that firmly asserts that mental health is not a risk factor for recidivism when examined alongside empirically validated risk factors—termed “criminogenic needs” in the risk-need- responsivity (RNR) literature.” (p. 56)

“In the current study we investigated the role of mental health needs and mental health treatment among youth in the context of criminogenic needs treatment. In keeping with the RNR framework, we defined mental health needs as those that are not captured within the RNR risk/needs tools. We also sought to differentiate between mental health symptomatology as an initial status variable—the presence or absence of mental health needs—and mental health treatment as a dynamic variable—whether or not youth received treatment for their mental health needs. Mental health treatment alone has rarely been found to reduce recidivism. However, it remains unclear whether the treatment of mental health problems, in addition to treatment targeting criminogenic needs, may improve reoffending outcomes.” (p. 56)

Methods

“The sample consisted of 232 youth referred by youth court judge between January 2002 and January 2010 to a mental health agency in a large urban center in Canada for an assessment to inform sentencing, and who provided consent for use of their information for research. The sample was predominantly male (n=187; 80.6%) and was ethnically diverse: 35.6% Black, 34.8% White, 9.8% Asian, and 19.7% other ethnicities. Youth ranged in age from 12 to 20 years, (M=16.12, SD=1.63). The youths’ most serious charges precipitating referral for assessment included violent offenses (e.g., assault, robbery; 59.1%), sexual offenses (16.8%) and nonviolent, nonsexual offenses (e.g., breach of probation, theft, drug-related offenses; 19.4%); offense information was missing for 4.7% of the sample.” (p. 57)

Results

“In preparation for addressing our primary study questions, we divided the sample into two groups: those who had mental health needs identified by clinicians (57.8%; n=134) and those with no identified mental health needs (42.2%; n =98); as noted above, “mental health needs” included diagnoses and subthreshold issues relating to mood, anxiety, thought disorders, trauma, and noncriminogenic personality features. We further divided the “identified mental health needs” group into “treated” and “untreated” mental health needs subgroups and compared the three groups to determine whether they differed in terms of demographic variables, offense characteristics, overall risk, identified criminogenic needs, and receipt of service for their identified needs.” (p. 58)

“Youth with mental health needs tended to have more criminogenic needs identified by clinicians than those without mental health needs and youth with untreated mental health needs had higher total risk scores than youth without mental health needs. These findings suggest that youth with mental health problems are characterized by greater criminogenic risk than those without, which is consistent with findings from the adult literature. This relationship between mental health needs and criminogenic needs suggests that, while a common set of risk factors may be sufficient for predicting reoffending, individuals with mental illness may present with more of these risk factors. When examined in terms of specific criminogenic need domains, youth identified with mental health needs were comparable with other youth in the areas of criminal history, family, peers, and attitudes, but they had higher risk/ need scores in education/employment, substance abuse, leisure, and personality/behavior.” (p. 62)

“The “good news” in our findings is that treatment of mental health needs was associated with increased likelihood that criminogenic needs would be addressed; in turn, intervention addressing youths’ criminogenic needs was associated with reduced likelihood of reoffending. The “bad news” is that—although, as expected, youths’ identified criminogenic needs increased with risk level—contrary to the risk principle, the number of needs addressed during probation did not change as risk increased.” (p. 63)

“Together, these findings suggest several implications for service. First is the need for services to be provided in a manner consistent with the risk principle: High-risk youth have more criminogenic needs and these needs should be addressed regardless of mental health status. Further, the present results do not support treatment of noncriminogenic mental health needs alone as an effective way to reduce reoffending; service providers must also attend to criminogenic needs in order to meet the goal of reduced involvement in the justice system. The finding that youth with treated mental health needs also had more of their criminogenic needs treated suggests that these youth may experience a better standard of care. It may be that youth have better outcomes with wraparound services than with referral to several siloed programs. Alternatively, youth receiving mental health treatment may have had an additional source of intervention targeting domains such as education, family functioning, and behavior, which may be targets for improved functioning from both mental health and criminogenic needs perspectives, and which correspond to the domains in which we found that more youth had both needs met.” (p. 64)

“The conclusion that treatment of mental health problems was not associated with reoffending may be conservative given the findings on intermediate treatment targets; the great majority of youth across most criminogenic need domains had either both or neither of their criminogenic and mental health needs matched, while comparatively few had only one or the other need matched. Accordingly, while there was not a complete separation in the data, there was limited power to differentiate between groups to detect an effect between youth with only criminogenic needs matched and youth with both types of needs matched. Until the reasons for the association with intermediate treatment targets are better understood we may be limited in the analysis of mental health treatment as a moderator of criminogenic needs treatment.” (p. 64)

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