Every day in the U.S., one in five children are struggling with significant mental health issues. These diagnoses take many different forms— attention deficit disorder, depression and anxiety are among the most common— but all of them, left untreated, have the potential to cripple the opportunities of childhood. By only age eight, 14% of youth will have developed a mental, behavioral or developmental disorder; just over half of these children will receive the treatment they need. But unaddressed mental health issues increase the likelihood that treatable diseases will become chronic, leading to cycles of mental health struggles throughout adulthood; in fact, untreated mental health problems cost Americans billions each year in lost earnings. Even before reaching adulthood, youth with a mental health condition are at higher risks of developing co-occurring disorders, like substance abuse issues, and dropping out of school— grievously, suicide is the third-leading cause of death among Americans aged 10-14.
A Concentrated Problem
Within the juvenile justice community, youth are particularly vulnerable to mental health challenges. While about 20% of American children struggle with a mental health issue, research suggests that 50-75% of youth in the juvenile justice system meet the criteria for at least one mental health disorder. This can become a vicious cycle for involvement in the justice system—mental health struggles can contribute to co-occurring disorders, like substance abuse, that increase the likelihood of reappearance in court and sentencing. Among diagnosed youth in the juvenile justice population, the most common disorders are depression, ADHD/ADD, and PTSD, as well as a swath of conduct and behavioral disorders—yet finding treatment within the juvenile justice system can be frustratingly difficult.
Throughout the 1990s, public mental health services designed for young Americans were shrinking, both in funds and in the number of service providers. As a response, states across the country began viewing their juvenile justice systems as opportunities to provide treatment, rather than mere punishment, to youth in need. This led to juvenile detention facilities focusing on the provision of counseling, group therapy, and other services to incarcerated youth. Yet this strategy proved largely ineffective. In multiple studies, the U.S. Department of Justice reviewed juvenile justice facilities and found that mental healthcare access was either inadequate or entirely absent. This is the result of overburdened facilities, insufficient resources, lack of staff training, and understaffing of qualified therapists and mental health professionals. If vulnerable youth can’t receive effective treatment in juvenile justice facilities, what are the other options for young people struggling with mental disorders?
There are many different types of mental health interventions for both youth and adults alike. When a person is posing an immediate threat to themselves or to others, they are often placed in psychiatric hospitalization—this includes close monitoring of the individual, restricted movement in and out of the facility, and sometimes medication. But this option can be extremely traumatic for children—even feeling like punishment for their mental health diagnosis—and should be reserved for the most serious of cases. A common option for juvenile judges faced with a child experiencing mental health complications is inpatient or residential treatment. These out-of-home placements are designed to provide 24/7 treatment for youth, including individual counseling and group therapy. Though inpatient services can sometimes be effective, forcible separation from one’s family to live in a treatment home can be an emotionally and mentally traumatic experience for a child. Living without parents or caretakers can induce anxiety, depression, anger, and even trauma-related disorders within the youth, hindering their treatment process. The next logical intervention, then, would be outpatient treatment—youth visit therapists’ offices or clinics on a regular basis to receive treatment, though remain living in their homes. However, travel costs and feasibility can be prohibitive to clinic visits for some youth—in fact, children from families living below 100% of the federal poverty line are much more likely to experience mental health complications, and this can narrow the window of accessible treatments.
Mental Health Treatment That Works
Rather than treatment as usual, with all of its various drawbacks and complications, a different type of effective, evidence-based mental health intervention has gained traction: holistic mental health treatment. Holistic treatment means “taking into account mental and social factors, rather than just the symptoms of the disease”— so holistic mental health isn’t merely an attempt to alleviate the fatigue, anger, and anxiety that often come along with mental and emotional struggles, but to address the roots of the disorders themselves. This type of intervention involves treating the whole person and their ecosystem— that includes looking not only at the individual, but at the effects of family, school, peers, and community on the life of a young person. Holistic therapy postulates that the way these systems connect can be the key to creating an effective, individualized treatment plan.
Multisystemic Therapy (MST) incorporates the philosophy of holistic treatment into the creation of personalized interventions for youth involved in the juvenile justice system. The 3 to 5 month-long comprehensive program is an evidence-based intervention designed to address mental health issues, substance abuse, family coherence, community engagement, and other aspects of a young person’s ecosystem. To avoid the barriers of outpatient services, like travel costs and discomfort in a clinical environment, MST providers travel to the home of the juvenile, creating program plans not only for the youth but for the entire family. These plans focus on creating a strong support system for youth—strengthening family bonds, empowering caretakers, assessing the impact of peer, school, and community relationships, and developing treatment strategies alongside the family. Due to this focus on the young person and their entire environment, MST has been successful in supporting youth in the juvenile justice system with mental illnesses. The Suicide Prevention Resource Center rated MST as “a program with evidence of effectiveness”, pointing to its success in alleviating mental health symptoms and improving family relations. In fact, at the end of treatment, 91% of MST youth live at home, avoiding traumatic out-of-home placements like detention facilities or inpatient clinics. MST recognizes that youth are more than symptoms or disorders— every juvenile has important connections to their family, their school, their peers, and their community—and to effectively treat mental illness, strong support from these groups is the key.