Do Detention Facilities Provide Adequate Mental Health Services for Teens?

Recent studies have estimated that as many as 65 percent of teens who are held in custody in detention centers have a diagnosable psychiatric or substance abuse disorder. Despite National Commission on Correctional Health Care (NCCHC) standards, many detainees are not getting the mental health care they need.

What does the NCCHC recommend? There are seven minimal requirements for mental health services in correctional settings:

1. Each detainee should be screened directly upon admission for current medication and for the existence of psychiatric problems.
2. Qualified mental health staff must develop a treatment plan and communicate this to detention staff; this plan should be documented and reviewed regularly.
3. Current psychiatric medication should be continued.
4. Any acute psychiatric problems should be attended to immediately, either within the detention facility or at an appropriate outside setting, such as a hospital.
5. Medications prescribed for mental health should be used for psychiatric conditions, not merely to control behavior.
6. There should be appropriate suicide prevention measures in place.
7. Care should include links and referrals to mental health care facilities in the community (especially important for follow-up care).

Why aren't these important standards for mental health care being upheld? First, there is no required accreditation of detention facilities, so compliance with good standards of mental health care is voluntary. Second, many facilities have limited resources, and those in charge of mental health treatment, including assessment of problems and delivery of prescription medications, are often guards or other staff who are not trained in the provision of mental health care. And finally, length of stay in detention facilities is often short and/or unpredictable, which provides limited opportunity for assessment, treatment, and arrangement of aftercare.

Even when mental health services are available to detainees, the definition of these services is not standardized, which means that mental health "treatment" may simply involve an on-call psychiatrist or other mental health professional if acute treatment is needed. Substance abuse treatment often is more regular, such as a 12-step program in conjunction with individual or group therapy, but there is still no standardized model for care.

While continued research will begin to address the mental health needs of teens in detention facilities, the message for parents is to seek appropriate mental health or substance abuse care for a teen prior to the child becoming a part of the juvenile justice system. There are many effective therapeutic treatment programs available, including wilderness therapy and even therapeutic boarding schools.