What chance that they’d keep taking the tablets?

Most young offenders exhibit some form of impairment to their mental health, so might it be better to deal with their illnesses rather than punish their crimes?

The idea is far from new. Numerous pioneers and reformers have tried to steer the machinery of youth justice away from criminological responses and toward the treatment of psychopathology.

And as the limitations of the “tough on crime” policies that have characterized attitudes in several economically developed nations in recent decades become more glaringly apparent, so these older ideas may be ready for dusting down.

Multidisciplinary teams from several US universities have been revisiting some of the options as part of a mental health response to youth justice issues. Their work emerges from an American Academy of Child and Adolescent Psychiatry [1] workgroup on juvenile impulsivity and aggression, and the results are just published in the Journal of Clinical Psychiatry and in the latest edition of Child and Adolescent Mental Health.

Some aspects of the work are familiar. The prevention programs that might be employed under a mental health aegis are similar to those that are available, but currently patchily used, by jurisdictions adopting a criminal justice approach. The effect sizes, small to moderate, are the same from either perspective.

Many of the programs reviewed by the research team will be familiar to Prevention Action readers: for example, Incredible Years, High Scope/Perry Pre-school and others.

In other respects, the work treads new ground. Our understanding of child development, neuroscience and genetic inheritance has been steadily accelerating since the early twentieth century efforts to reform youth justice. Biological responses to mental health problems are beginning to emerge as a result.

For example, the research teams point to sound evidence as to the benefits of anticonvulsants and atypical antipsychotic medication in reducing aggression among boys with conduct disorders. Just as with social interventions, the drugs don’t work for everyone. They appear best suited to hotheads who are aggressive in an unthinking way.

Any such approach depends on the child or young person being prepared to take the medicine. The depressing undertone of the review is that a high proportion do not participate in the social programs to which they have been assigned. And youth justice workers, most of whom will have battled to overcome an understandable resistance to pharmaceutical interventions, will continue to be highly skeptical about young offenders’ ability to take their medication.

References
Karnik N and Steiner H, “Evidence for Interventions for Young Offenders”, Child and Adolescent Mental Health, 12, 4, 2007 pp154-159
O'Connor D, Carlson G, Chang K and colleagues, “Juvenile Maladaptive Aggression: A review of prevention, treatment, and service configuration and a proposed research agenda”, Journal of Clinical Psychiatry, 67, 5, 2006 pp808-820