Mental health screening cutting off prevention blood supply?

Until recently screening young offenders for mental health issues was unusual in the US. Thomas Grisso - Professor of Psychiatry at the University of Massachusetts - has been one of the researchers at the forefront of a shift that has seen such assessments go from rare to routine.

Nevertheless, in a presentation to the Association for Child and Adolescent Mental Health’s (ACAMH) in London earlier this month, he highlighted the discrepancy between the wide support enjoyed by the policy, and the lack of empirical evidence showing that it benefits young offenders.

Grisso explained that the impulse for the promotion of mental health screening did not initially come from researchers - it was political.

A rise in delinquency in the 80s and 90s created what he called “a not very friendly juvenile justice system”. The system spent a long time preoccupied with punishment, but by the end of the century, both politicians and professionals working with young offenders were beginning to take young people's needs more seriously.

The first step was ensuring that children had access to services appropriate to their problems. To do this an effective screening tool was needed.

To fill this gap, Grisso recalled, his team developed MAYSI (the Massachusetts Youth Screening Instrument), a reliable, standardized screening tool.

MAYSI and other similar measures provided a cheap way to improve the referral process and match individuals needs to available services. With everyone receiving the right treatment, logically this should lead to better environments inside detention centers, and possibly better outcomes for inmates.

But it is not that simple, Grisso explained. He acknowledged that there was very little hard evidence to support these supposed improvements. Using such tools might even have some unintentional negative consequences.

By improving mental health services for young offenders, services in the community might be “let off the hook,” he said.

The disparity resulting from improving juvenile justice resources without making any equivalent investment in community mental health could result in “net-widening" – drawing children into the system as a way of securing them better care.

“This would be in complete contrast to our philosophy of preventing children entering this system,” he argued.

The number of articles in the press about mothers complaining that they had to get their children arrested before they could access the services they needed was already a worry.

But despite the uncertain results from mental health screening, Grisso persists in promoting it. Equipped with an arsenal of anecdotes supporting it, he is now busy collecting the hard evidence he hopes will back them up.

His team has already looked at two detention centers in Pennsylvania where reports of problem behavior have decreased since the implementation of MAYSI.

They are currently working on two more robust studies, examining different aspects of screening. The first will examine the link between mental health referrals, service use and problem behavior, before and after the introduction of screening tools.

The second will look at the effect of "net widening" by studying the relationship between mental health services in the community and the proportion of children in detention centers with mental health problems.

The net effect of screening measures for young offenders, both inside detention center and in the community at large, are still unsure. Work by Grisso and his team will help to fill in the blanks.