High Incidence Of Mental Disorders Revealed In Young Offender Institutions

Main Category: Psychology / Psychiatry
Also Included In: Mental Health;  Schizophrenia;  Bipolar
Article Date: 04 Sep 2008 - 2:00 PDT

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Adolescent girls in young offender institutions are particularly vulnerable to depression, a large-scale study led by Oxford University has shown. The researchers have found incidences of mental health problems in both boys and girls are many times greater in juvenile detention centres than in the general population.

The high prevalence of mental disorders highlights the need for improved psychiatric care in juvenile justice and detention centres, say the researchers.

Oxford University researchers in the Department of Psychiatry and the Department of Public Health and Primary Care, together with the Karolinska Institutet in Sweden, have carried out a large-scale review and analysis of data from 25 different psychiatric surveys involving 16,750 young people in juvenile detention facilities around the world. The results are published in the Journal of the American Academy of Child and Adolescent Psychiatry.

"By putting all this data together, we can say with some confidence that the adequate provision of psychiatric care for adolescents in detention should be a key priority for prison services worldwide," says Dr Seena Fazel of the Department of Psychiatry at the University of Oxford.

For the first time, the researchers have shown adolescent girls in detention are at particular risk of depression. 29% of girls aged 10-19 were diagnosed with major depression, considerably higher than the 12% of adult women in prison reported to suffer from depression and four to five times higher than in the general youth population. 10.6% of boys suffer from major depression.

Cases of psychosis in boys and girls - severe mental illness involving loss of connection with reality - are also much more common in young offender institutions than would be expected, with rates around ten times higher than in the general population.

One in ten boys and one in five girls in young offender institutions have attention-deficit/hyperactivity disorder (ADHD). Rates of conduct disorder - a psychiatric diagnosis describing a pattern of disruptive and antisocial behaviour, for example where children consistently break rules, get into fights and play truant - are 10-20 times higher in girls in detention and five to ten times higher in boys than found in adolescents generally. "Currently, the care provided for incarcerated young people is patchy," says Dr Fazel. "This should be a starting point to examine where there is insufficient screening for mental ill-health, where secure facilities lack qualified staff or appropriate treatment, and where sentencing does not account for mental disorders."

"As well as assessing suicide risk and substance abuse, prisons should consider specific screening for mood disorders especially in girls," he adds. "Justice systems for juveniles offer the opportunity to pick up mental disorders and make a significant impact on public health. This is a chance to catch many vulnerable people who otherwise fall through the cracks."

"With conditions such as depression and psychosis, it is important to pick them up early. The longer you leave it, the worse the conditions become," explains Dr Fazel. "These disorders may also increase risk of drug and alcohol misuse, and perhaps indirectly, reoffending rates."

"In individual reports and small-scale studies there is considerable variation in the results purely by chance," explains Dr Fazel. "We've combined data from a number of published journal papers as well as reports by justice departments and other groups in what is called a meta-analysis. This large-scale synthesis of all the available data should help correct for any variations caused by chance or different survey methods and help prison health services by providing much more precise estimates."

- 'Mental disorders among adolescents in juvenile detention and correctional facilities: a systematic review and metaregression analysis of 25 surveys' by Seena Fazel, Helen Doll, and Niklas Långström is published in the September issue of the Journal of the American Academy of Child and Adolescent Psychiatry.

- The paper reports a systematic review of 25 psychiatric surveys of a total of 16,750 incarcerated adolescents aged 10-19 years old, including 13,778 boys and 2,972 girls. - In boys, 3.3% (3.0-3.6%) had psychotic illness, 10.6% (7.3-13.9%) had major depression, 11.7% (4.1-19.2%) had attention-deficit/hyperactivity disorder (ADHD), and 52.8% (40.9-64.7%) were diagnosed with conduct disorder.

- In girls, 2.7% (2.0-3.4%) had psychotic illness, 29.2% (21.9-36.5%) had major depression, 18.5% (9.3-27.7%) had attention-deficit/hyperactivity disorder (ADHD), and 52.8% (32.4-73.2%) were diagnosed with conduct disorder.

- Five per cent of all those detained in custody in Western countries are younger than 19 years of age, including about 100,000 in the US and 3000 in England and Wales. These young offenders are usually detained in separate institutions, correctional facilities, or prisons. Mental disorders have been estimated to affect 40-70 per cent of adolescents who come into contact with the justice system, with reports suggesting a high prevalence of undiagnosed and untreated mental health problems. This new Oxford University-led review gives a more precise picture of the prevalence of mental disorders in juvenile detention centres.

Oxford University's Medical Sciences Division is one of the largest biomedical research centres in Europe. It represents almost one-third of Oxford University's income and expenditure, and two-thirds of its external research income. Oxford's world-renowned global health programme is a leader in the fight against infectious diseases (such as malaria, HIV/AIDS, tuberculosis and avian flu) and other prevalent diseases (such as cancer, stroke, heart disease and diabetes). Key to its success is a long-standing network of dedicated Wellcome Trust-funded research units in Asia (Thailand, Laos and Vietnam) and Kenya, and work at the MRC Unit in The Gambia. Long-term studies of patients around the world are supported by basic science at Oxford and have led to many exciting developments, including potential vaccines for tuberculosis, malaria and HIV, which are in clinical trials.

Oxford University's Medical Sciences Division