The Pandemic Exacerbated Mental Health Issues among Incarcerated Youth. How Can We Reverse the Trend?

By Arielle Jackson, Reprinted from the Urban Institute

Research suggests as many as 70 percent of justice-involved youth have a diagnosable mental health disorder, such as attention deficit hyperactivity disorder, behavior problems, anxiety disorders, and depressive disorders. Entering juvenile carceral facilities can exacerbate existing mental health problems. But the juvenile system rarely addresses, or insufficiently addresses, mental health issues.

The COVID-19 pandemic has exacerbated this problem. During the pandemic, many youth detention facilities have significantly reduced their mental health services, which has limited residents’ access to counselors and treatment programs. Some youth experiencing a mental health issue could only speak with mental health professionals through their cell door for a couple minutes per day. And 23-hour periods of isolation to prevent the spread of the coronavirus and halted family visitation worsened young people’s mental health.

This pandemic-exacerbated mental health crisis could widen existing racial and ethnic disparities. Because of systemic racism embedded in the criminal legal system’s policies and practices, Black people are overrepresented in the criminal legal system, and Black youth are similarly overrepresented in the juvenile system. In 2020, 41 percent of young people in placement were Black, despite Black youth comprising only 15 percent of all youth in the United States.

To ensure the COVID-19 pandemic does not widen racial and ethnic disparities in mental health among incarcerated youth, and to improve mental health outcomes long after the pandemic, gaining an accurate picture of the problem will be key. Building this evidence base will not happen overnight, so increasing access to equitable mental health services can offer young people much-needed relief in the meantime.

What do we know?

The pandemic shed a light on the prevalence of mental health disorders among incarcerated youth and how little we know about them. What we do know is that mental health services are not equally accessible.

About 66 percent of youth in detention or correctional settings have at least one diagnosable disorder (PDF) compared with 9 to 22 percent of the general youth population, yet only 15 percent of young people (PDF) diagnosed with psychiatric disorders and functional impartment received treatment while in detention.

And these services are not equitably distributed. One study (PDF) found that in Maryland’s juvenile system, 43 percent of white youth who met diagnostic criteria received mental health services, but only 12 percent of the Black youths who met these criteria received services.

How can we address the gaps in information and access to services?

Emphasizing decarceration and providing mental health treatments within communities is one way to reduce the number of youth in facilities–during and after the pandemic. Urban Institute research has demonstrated that when services are provided in their community, youth often have better outcomes and reduced contact with the juvenile system. It can also advance equity and inclusion in the juvenile justice system.

But if young people do become incarcerated, youth facilities, researchers, and policymakers can consider the following evidence-based strategies to improve system-involved youth’s well-being during and beyond the pandemic.

1. Reimplement family visitation at youth facilities.
   Family visitation has the potential to reduce young people’s anxiety and depression. Without it, youth may continue to experience social isolation because of the pandemic.
2. Increase the number of available, on-site physicians, counselors, and therapists.
   Receiving appropriate medication and immediate medical support during times of crisis can help minimize negative effects caused by consistent cell isolation for youth who remain in out-of-home placements . Giving young people access to full Medicaid benefits, regardless of placement location (at home or incarcerated) would also help advance this strategy because some of these services are built into the program.
3. Provide quality mental health services in conjunction with a young person’s sentence to mitigate the risk of developing posttraumatic stress disorder, depression, and self-harm.
       This could help reduce factors associated with lack of services and behaviors after release, such as trauma experienced while incarcerated. However, for this to be effective, they must be accessible, evidence based, and culturally and linguistically effective.
4. Ensure mental health services are accessible to all youth to avoid widening disparities.
       Young people should have equitable access to services, no matter their race or ethnicity.
5. Improve data collection.
       Better understanding the scope of the mental health crisis will ensure it can be better addressed. We also need a better understanding of the short- and long-term effects of COVID-19 on young people’s mental health so we can implement effective practices and policies.
6. Consider sharing mental health data.
   As of 2015, only 24 states had formal requirements for mental health screening in detention centers. Longitudinal data could provide insight as to how and why mental health is changing over time, during and beyond COVID-19. The pandemic affirms the necessity for advancing data collection and presents a unique opportunity to explore this underresearched area. State and local policymakers can seize this opportunity to strengthen data sharing.

In order to narrow racial disparities in mental health care receipt and outcomes among incarcerated youth, it will be important that detention facilities, researchers, and policymakers apply a racial equity lens when designing, implementing and evaluating these strategies. This involves establishing cultural competency on the intersection between race and mental health among people who run mental health programs, research these programs, and create policies that influence these programs. Youth themselves should be integral to the process and provide feedback.

The available evidence suggests the pandemic has worsened the already steep mental health challenges facing incarcerated young people. To improve mental health outcomes during and after the pandemic, youth and their well-being must be prioritized. A better understanding of the crisis and successful interventions and high-quality mental health care could make a big difference in helping youth address their mental health issues and lead successful lives.

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