Adolescent
Girls with Co-Occurring Disorders
in the Juvenile Justice System
The arrest rate for
violent crimes committed by adolescent females increased 55 percent between
1989 and 1993, compared to a 33 percent increase for males. (Poe-Yamagata
& Butts, 1996). During this same period, the number of court cases
involving female juveniles charged with delinquency increased by 31 percent
and female convictions related to gang activity, sexual misconduct and
drug offenses quadrupled between 1987 and 1992 (Calhoun, et al., 1993).
Risk Factors
- Abuse/Victimization:
Research suggests that sexual, emotional, and physical abuse may be
a significant underlying cause of high-risk behaviors leading to delinquency
in girls.
- Substance
Use/Abuse: FBI statistics in 1995 showed that twice as many
girls (5.6 percent) were arrested for liquor law violations, drunkenness
or driving under the influence than those arrested for drug abuse violations
in 1994.
- Difficulty
in School: A study based on self-report revealed that 27 percent
of girls in the juvenile justice system said they dropped out of school
because they were pregnant and 20 percent dropped out of school because
they were parents and needed to take care of children. A disproportionate
number of these girls have undiagnosed learning disabilities that put
them at risk for frustration, leaving school prematurely and engaging
in other risky behaviors (Girls Inc., 1996).
- Gang-related
Activities: Studies on gang member activities among female juveniles
showed that 32 percent admitted participating in violent offenses on
behalf of the gang, 43 percent to property offenses and 10 percent admitted
drug-related offenses (Girls Inc., 1997; Joe & Chesney-Lind,
1995).
Characteristics
A disproportionate
number of girls come in contact with the juvenile justice system as status
offenders, their crimes become more serious over time, and they are mostly
adolescents of color who are poor. Like their adult female counterparts,
girls are often arrested for non-violent crimes that are drug related
and are entering the system with serious mental health and medical issues
associated with substance use, high-risk sexual behavior and violence.
Prevalence Rates of Co-Occurring
Disorders
In 1989 approximately
1.27 million youths were referred to juvenile court. Of those, approximately
118,700 to 186,000 met the criteria for at least one mental disorder.
Further, they found that the estimated number of youths having a diagnosable
substance disorder ranged between 17,000 and 271,000 (Otto, Greenstein,
Johnson and Friedman, 1992).
A 1997 survey found
that 84 percent of the girls displayed the need for mental health assistance
compared to 27 percent of the boys and that this need had increased over
time. Conduct disorder was diagnosed most frequently (100 percent), followed
by substance abuse (87 percent), mood disorder (80 percent), anxiety disorder
(47 percent), ADHD (20 percent) and 20 percent evidenced euresis (Timmons-Mitchell,
et al., 1997).
Most studies show
a substantial prevalence of co-occurring addiction and mental disorders
among adolescents with approximately one-half of the adolescents receiving
mental health services reported as having a dual disorder. Among adolescents
with co-occurring addiction and mental disorders, conduct disorder and
depression are the most frequently reported mental disorders (Greenbaum
et al., 1996).
Adolescents with concomitant
mental health and substance abuse problems are seen as either "mad"
or "bad." The symptoms and behaviors of girls are often misinterpreted
as manipulative, defiant, antisocial, and delinquent. These girls may
act out their rage in gender-specific ways that do not qualify them for
services anywhere. Subsequently, they may be inappropriately placed in
restrictive settings of all kinds, if they are seen at all.
Measuring Mental Health
and Addiction Status
In their chapter,
Issues in Systems Interactions Affecting Mentally Disordered Juvenile
Offenders, Barnum and Keilitz (1992) ask the question "How do
we categorize the sort of disturbances involved in a girl running away
from a home and becoming involved in indiscriminate sexual activity after
a long history of being sexually abused?" They emphasize the importance
for mental health and justice institutions to appreciate the variety of
ways children react to the multiple stresses and the implications of those
reactions for responses in mental health classification, prognosis and
treatment.
Research suggests
that the needs of girls and perhaps even the etiologies of their involvement
in the justice system are drastically different than those of their male
counterparts. Thus, assessment of risk factors influencing the onset of
offenses, delinquency, and violent behavior in girls requires future attention.
Gender-specific programming initiatives need to be developed that take
into consideration all of the inter-related needs of girls and women in
correctional settings.
Some adolescent girls
with co-occurring disorders and histories of abuse committed to long term
psychiatric institutionalization have provided useful insight into the
effects of traditional crisis intervention procedures. During the first
Massachusetts statewide conference sponsored by the Department of Mental
Health on Strategies for the Reduction of Restraint and Seclusion, adolescent
girls shared their experiences in a workshop. They stated that the following
interventions at times of crisis caused them to further escalate, which
compounded pre-existing shame often leading to increased self-injurious
behavior and restraint:
- Presence of male
security;
- Being surrounded
by men when hearing voices, having flashbacks, (can mirror gang-related
physical and sexual perpetration, cultic abuse);
- Being strapped
to beds where many experienced the original sexual abuse;
- Being strapped
to beds spread-eagle style, which increases vulnerability and is insensitive
to the ways girls and women are violated;
- Having medication
forcibly injected into their bodies, which re-stimulates the feelings
of loss of control over their bodies during episodes of sexual abuse;
- Seclusion: effect
of disappearing, not being visible to anyone, reminiscent of neglect;
- Suicide precautions
that force disrobing (re-stimulating humiliating exposure to male perpetrators);
- Constant observation
– watching girls through windows, while toileting, showering, disrobing
– reenacts intrusive voyeurism of perpetrators;
- Being transported
in restraint and/or handcuffs to and from facilities (usually emergency
rooms to psychiatric facilities or from psychiatric facilities to court);
- Forced physical
exams: involves disrobing and sometimes restraint while intrusive physical
procedures are carried out;
- Body searches:
invasive body searches can replicate rape for many girls.
Future Challenges
Advancements in assessment,
early intervention, innovative programming and cross-system collaboration
need to be developed and implemented for girls at risk for juvenile justice
involvement.
The following questions
address the focus of efforts to identify some essential next steps:
- What is the first
step in designing developmentally-sensitive, gender-specific programming
that includes educational, health, psychiatric and substance abuse treatment
in communities?
- How do we examine
the characteristics of adolescent female offenders and delinquency within
the context of "normative" female development?
- How do we identify
programs for adolescent girls that apply strength-based approaches in
screening and assessment, intervention and programming for girls at
risk?
- What kinds of early
intervention, diversion and training prevent decompensation, suicidal
ideation and recidivism for girls?
Cooperative efforts
can begin to reverse decades of neglect by bringing the needs of adolescent
girls with co-occurring disorders involved in the juvenile justice system
into focus across multiple systems. By generating new ideas through dialogue,
identifying existing innovative models, and sharing knowledge regarding
best practices, we can create a new future for these girls and those who
provide for them.
References
Barnum, R. and Keilitz,
I. (1992). Issues in systems interactions affecting mentally disordered
juvenile offenders. In J. J. Cocozza (Ed.), Responding to the Mental
Health Needs of Youth in the Juvenile Justice System. Seattle, WA:
The National Coalition for the Mentally Ill in the Criminal Justice System,
pp. 49-91.
Calhoun, G., Jurgens,
J. and Chen, F. (1993). The neophyte female delinquent: A review of the
literature. Adolescence, 28, 461-471.
Girls Incorporated.
(1996). Prevention and parity: girls in juvenile justice report.
Girls Incorporated national Resource Center & Office of Juvenile Justice
and Delinquency Prevention, Indianapolis, IN.
Greenbaum, P. E.,
Johnson, L. F., Petrila, A. (1996). Co-occurring addictive and mental
disorders among adolescents: Prevalence research and future directions.
American Journal of Orthopsychiatry, 66(1), 52-60.
Joe, K. A., &
Chesney-Lind, M. (1995). Just every mother’s angel: An analysis of
gender and ethnic variations in youth gang membership. Gender and Society,
9, 408-431.
Otto, R. K., Greenstein,
J. J., Johnson, M. K., Friedman, R. M. (1992). Prevalence of mental disorders
among youth in the juvenile justice system. In J. J. Cocozza (Ed.), Responding
to the Mental Health Needs of Youth in Juvenile Justice System. Seattle
WA: The National Coalition for the Mentally Ill in the Criminal Justice
System.
Poe-Yamagata, E.
& Butts, J. (1996). Female offenders in the juvenile justice system:
statistics summary. NCJ 160941. Office of Juvenile Justice and Delinquency
Prevention. Washington, D.C.: U.S.A. Department of Justice.
Timmons-Mitchell,
J., Brown, C., Shultz, S. C., Webster, S. E., Underwood, L. A., Semple,
W. E. (1997). Final Report: Results of a Three Year Collaborative Effort
to Assess the Mental Health Needs of Youth in the Juvenile Justice System
in Ohio. Columbus, OH: Ohio Department of Youth Services.
Adolescent
Girls with Co-Occurring Disorders in the Juvenile Justice System
was prepared for the GAINS Center by Laura Prescott and published in December
1997. The report is available from The GAINS Center, Policy Research,
Inc. 345 Delaware Avenue, Delmar, NY 12054. E-mail gains@prainc.com. Website http://www.prainc.com.
This summary is provided by the Texas Youth Commission. For more information about programs and research relating to children, youth, and family issues, contact us by e-mail at prevention@tyc.state.tx.us or by telephone at (512) 424-6336.
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Prevention Summary
Texas Youth Commission