Mental health rehabilitation of detained juveniles: using time wisely.

The rehabilitation potential of mentally ill juvenile offenders should be at the forefront of the forensic mental health debate, because these youths mature into adults who may continue to have mental disorders and to offend. In view of this concern, the importance of using juvenile detention facilities as vehicles for youth reform cannot be overstated. Juvenile justice reform is a relatively recent concept in the United States. In the late 19th century, social activists theorized that poverty and social conditions resulted in juvenile offending. The reformers favored the English common law philosophy of parens patriae, which permitted the state to function as a parent would in the life of all children within its borders. Youths were not believed responsible for individual offenses that were attributable to poor supervision, support, and discipline. Although several jurisdictions responded to a growing need for youth supervision and guidance by separating juvenile proceedings and youth offenders from adults in the late 1800s, the practice expanded after the Illinois Legislature codified it in the Juvenile Court Act of 1899. This legislation established a framework for juvenile justice systems. The Act made clear distinctions between neglected and delinquent offenders, authorized a separate court system for juveniles between the ages of 7 and 16 years, established a structure of special procedures for juvenile hearings, and provided for a juvenile probation system. It was not the intention of the juvenile courts to usurp the autonomy of parents, but instead to reinforce the sense of responsibility of the child and the parent. To support this goal, the Act provided for psychosocial assessment teams that evaluated children and informed the court about what was needed to rehabilitate each youth. These child guidance assessment teams were the kernel from which the subspecialty of child psychiatry evolved. During the first half of the 20th century, inadequate funding and other structural and philosophical barriers hampered the efforts of the juvenile justice system to reform young offenders. Regrettably, since then, the rehabilitative model of juvenile justice has gradually been shifted to focus on retribution and punishment. In response to this change, the U.S. Supreme Court has afforded juveniles increased due process rights during court proceedings. The Court also raised the required legal standard in delinquency hearings from best interests to the standard of beyond a reasonable doubt that applies in criminal hearings. The Court has confirmed rights for youths who are at risk of having their cases transferred to criminal court, including the right to a defense, access to salient records, and a judicial explanation of findings when the case is transferred. In 2005, the U.S. Supreme Court banned executions of inmates who committed offenses before the age of 18 years. Society’s response to increased liberty interests and rights for juveniles in court has included legislating more severe consequences for juvenile offenders, including but not limited to charging younger juveniles as adults for a greater variety of offenses. There Dr. Wills is Assistant Professor of Psychiatry, Case Western Reserve University, Cleveland, OH. Address correspondence to: Cheryl D. Wills, MD, 10540 Euclid Avenue, WLK 5080, Cleveland, OH 44106. E-mail: [email protected].