The Prevalence of Behavioral Health Disorders, a Need to Reinstill Tolerance

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On Monday a lawsuit was filed against the Galveston County jail for the wrongful death of Jesse Jacobs, a 32 year old gay man, who died seven days into a thirty-day sentence after being denied his prescription medication. Mr. Jacobs had been on medication since his late teens for comorbid behavioral health conditions, including severe anxiety, attention deficit-hyperactivity disorder, and depression. While the police claimed his death to have been from “natural causes,” he had begun experiencing seizures after being denied his prescription Benzodiazepine. Abrupt cessation of such drugs can be lethal, as was sadly the case for Mr. Jacobs.

Our criminal justice system is poorly equipped to handle persons with behavioral health conditions (inclusive of both diagnosable mental health and substance use disorders) and yet, jails are a major mental healthcare provider in the United States. Unfortunately, our juvenile system doesn’t look much different than our adult system. The over-representation of youth with behavioral health disorders, many of whom have also experienced concomitant trauma, is a sad reality of our juvenile justice system.

The National Center for Mental Health and Juvenile Justice (NCMHJJ) estimates that 70% of juvenile offenders have a mental health disorder, compared to 20% of youth in the general population, and 46.2% have a substance use disorder, compared to 8% in the general population. On any given day, approximately 55,000 youth are detained in residential placement facilities within the juvenile justice system. This means that every day approximately 38,500 youth with a mental health disorder and slightly fewer with substance abuse issues are housed in juvenile facilities not conducive to their long-term treatment goals or success. As NCMHJJ recommends, they could be better served in community settings with access to evidence-based treatments.

In addition, court-involved youth are more likely to have had one or more adverse child experiences (ACES), or traumatic experiences that can then exacerbate or cause behavioral health conditions. NCMHJJ reports that approximately 90% of juvenile delinquents have been exposed to some of the common ACES of domestic violence, crime and gang violence, bullying, physical and sexual abuse, rape, and other abject experiences, and the majority of juveniles have experienced six or more such experiences. Essentially, those juveniles being charged with delinquency are themselves victims, and are coping, or not coping, with a behavioral health disorder, or serious trauma, or both. The interaction between trauma, mental health conditions, and substance use can be volatile, seemingly intractable, and if left untreated, can cause delinquency. One must then wonder if we are charging kids for their crimes or for having behavioral health disorders and for living in environments which sustain and even greatly aggravate them.

However, the criminalization of mental illness in the juvenile justice system receives relatively little attention. This could possibly be due to the fact that from its foundation the juvenile justice system was meant to be rehabilitative in nature. If children are then mandated to rehabilitative services by a probation officer or by a judge as part of the adjudication process, the purpose of the courts has been served. This thinking fails to fully consider the long term consequences of adjudication – disruption of education, poor graduation rates and employment outcomes, potential banishment from public housing, and consequences for adult sentencing, among many other collateral consequences. Even the youth who is diverted from incarceration by the probation officer misses out on valuable instructional time to attend court, is often still sent to an alternative school, and could still potentially be cycled back into the system for failure to uphold any provision of the intake agreement. These youth are still faced with many barriers to contributing meaningfully in society; the community loses out on potential talent, and its economic health is impacted. Treatment of behavioral health disorders through the juvenile justice system is not ethical, efficient, or cost-effective.

Public policy initiatives that increase access to behavioral health services for youth might ultimately prevent court involvement and provide yet another entry point for disassembling the school-to-prison pipeline. Connecticut has developed a novel initiative, the Connecticut School-Based Diversionary Initiative (CSBDI), which identifies youth at risk of justice-involvement when they act out at school and diverts some youth to community-based behavioral health services, reducing use of exclusionary disciplinary methods. In tandem, the initiative implements reforms to zero-tolerance disciplinary policies for participating schools. Of course, such an approach might not work in states lacking an adequate mental healthcare infrastructure and might not be politically viable in others. Creative and holistic approaches, such as the successful trauma-sensitive schools movement of Massachusetts and Washington State, are still being developed, tested, and implemented elsewhere.

Jesse Jacobs was not a juvenile at the time of his death, but he had been battling behavioral health conditions since his teens. He died serving what should have been a short sentence for driving under the influence. Denying him his medication showed a flagrant indifference for his mental health and his life. While public policy approaches for juveniles with behavioral health issues and trauma have mostly focused on how we handle such conditions as they arise in school, ultimately, law enforcement and society must also be asked to reframe criminal behavior as a cry for help and show empathy while holding persons accountable. Otherwise, more will die like Jesse.

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