摘要：Objectives. We determined whether or not juvenile detainees with major mental disorders received treatment, and the variables that predicted who received services. Methods. Our sample was 1829 randomly selected juvenile detainees taking part in the Northwestern Juvenile Project. To determine need for mental health services, independent interviewers administered the Diagnostic Interview Schedule for Children and rated functional impairment using the Child Global Assessment Scale. Records on service provision were obtained from the juvenile justice and public health systems. Results. Among detainees who had major mental disorders and associated functional impairments, 15.4% received treatment in the detention center and 8.1% received treatment in the community by the time of case disposition or 6 months, whichever came first. Significantly more girls than boys were detected and treated. Receiving treatment was predicted by clinical variables (having a major mental disorder or reported treatment history or suicidal behavior) and demographic variables. Conclusions. The challenge to public health is to provide accessible, innovative, and effective treatments to juvenile detainees, a population that is often beyond the reach of traditional services. The most recent annual estimates from the US Department of Justice show that there were 2.2 million juvenile arrests in 2003 1 and approximately 1.1 million individuals referred to juvenile courts (Melissa Sickmund, PhD, National Center for Juvenile Justice, e-mail communication, July 21, 2005). More than 104000 juveniles are held in juvenile placement facilities on a given day. 2 Over 60% are racial/ethnic minorities. 2 Epidemiological studies estimate that between two thirds and three quarters of detained youths have 1 or more psychiatric disorders. 3 , 4 More than 15% of detained youths have major mental disorders (e.g., affective disorders, psychosis) and associated functional impairments. 3 , 4 By law, youths with serious mental disorders must receive mental health treatment while incarcerated. 5 – 7 Federal courts have affirmed that detainees with serious mental disorders have a right to receive needed treatment as part of the state’s obligation to provide needed medical care under the US Constitution’s Eighth Amendment (barring cruel and unusual punishment) and Fourteenth Amendment (right to substantive due process for youths in the juvenile justice system) (e.g., Estelle v Gamble , 1976 8 ; Ruiz v Estelle , 1980 9 ; Madrid v Gomez , 1995 10 ; Bowring v Godwin , 1977 11 ). Despite the legal mandate, recent reports issued by the surgeon general 12 and the President’s New Freedom Commission on Mental Health 5 , 13 suggest that juvenile detainees are a profoundly underserved population. There are few empirical studies of the treatment provided to juvenile detainees. Although many studies have investigated detainees’ history of treatment, 14 – 21 their current need for mental health treatment, 3 , 15 , 16 , 18 , 19 , 22 – 25 and the availability of treatment, 26 this is the first large-scale prospective study to examine whether detained youths who need mental health treatment receive it (in either the detention center or the community) before disposition of their cases. We investigated 2 questions: (1) What proportions of juvenile detainees with major mental disorders are detected and treated? (2) Which variables predict who receives services?
