JUSTICE-INVOLVED YOUTH PERCEPTIONS OF MENTAL HEALTH CARE SERVICES IN INSTITUTIONAL SETTINGS

Abstract

Justice-involved youth have been shown to have higher rates of mental health concerns and trauma exposure than youth in the general population (e.g., Wood et al., 2002). An increased understanding of these mental health concerns is crucial as incarcerated youth already have worse long-term health outcomes (Barnert et al., 2017). However, while the mental health needs in terms of specific mental health diagnoses of justice-involved youth are well-documented (e.g., Teplin et al., 2002), there is a lack of research on the mental health services that are provided to justice-involved youth in institutional settings. Further, there is no known research on youth perceptions of the mental health services they received while incarcerated, which could be used to inform future research and practice to improve services. Thus, this study aimed to fill this gap by examining through a mixed-methods approach how justice-involved youth perceive the mental health care they received while incarcerated, as well as by exploring themes of areas of improvement that youth indicate as recommendations for better mental health support in youth justice institutional settings. Two-hundred and one (201) individuals who were formerly incarcerated as youth (age 24 or younger) participated in this study. Overall, participants indicated slightly greater than average satisfaction with the mental health care they received. Kruskal-Wallis tests were used to examine differences in satisfaction between groups. Significant differences in satisfaction among facility types that youth were incarcerated in and among racial groups were found. There were no significant differences based on gender or ethnicity. Multiple regression analyses were performed to examine the relationship between Type-T (risk-taking/thrill-seeking) personality and satisfaction of mental health services while incarcerated, while controlling for covariates (gender, race, ethnicity, facility type, mental health diagnoses, and mental health services). Type-T was not found to be a significant predictor of satisfaction. Some mental health diagnoses (e.g., post-traumatic stress disorder, autism spectrum disorder, schizophrenia/psychotic disorder, substance use disorder), some racial groups (e.g., Arab American/Middle Eastern compared to White), and some facility types (e.g., juvenile detention compared to prisons) were found to be significant predictors of satisfaction. Thematic analysis was also performed on qualitative information obtained from both the surveys and interviews. Themes identified for positive aspects of mental health care experiences include Impact of Services, Relationships, Access, Service Quality, and No Positives. Themes identified for negative aspects of mental health care experiences include Access, Service Quality, Lack of Comfort, Ineffectiveness, Low Social Support, Physical Environment, All Negative, and No Negatives. Themes identified for recommendations include Access, Service Quality, Physical Setting and Environment, and Social Support. Results from this study have the potential to be used to inform experimental evaluations of changes to mental health services for incarcerated youth based on the strengths, identified needs, and recommendations of current mental health care from this study. Such studies could be aimed at improving services for incarcerated youth and developing best practices for mental health services for this population.