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Taking Issue   |    
Tough on Crime or Tougher on Those Who Need Care?
Bonnie T. Zima, M.D., M.P.H.
Psychiatric Services 2008; doi: 10.1176/appi.ps.59.9.955
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In the landmark 1967 decision, In re Gault, the Supreme Court required juvenile courts to respect the due process rights of juveniles and placed priority on a youth's right to receive fair treatment under the law. Yet the dissenting opinion delivered by Justice Potter Stewart expressed concern that the court's decision would "convert a juvenile proceeding into a criminal prosecution." He emphasized that the historical intent of juvenile court was to "correct a condition" and meet society's "responsibilities to the child." The parens patriae legal premise for the juvenile justice system has been further tested over the past 25 years with the passage of "tough on crime" legislation.

In this issue Washburn and colleagues, from the Northwestern Juvenile Project, report on a study that involved two groups of youths: those transferred to adult criminal court because of the nature of their crime and those processed in juvenile court. The level of need for psychiatric services did not differ between groups. In both groups nearly 70% met criteria for at least one psychiatric disorder and more than 50% met criteria for at least one substance use disorder. Similarly large percentages had two or more psychiatric disorders. However, youths from minority groups were significantly more likely to be tried as adults, even when the analyses controlled for felony-level violent crime. The sociodemographic factors found to be associated with transfer to adult court are the same factors found by other studies to be linked to lower odds of receiving psychiatric services, regardless of need. Thus the study by Washburn and colleagues raises the question of whether an unintended consequence of legislatively mandated transfer to adult court is to place these youths at even greater risk of receiving poor-quality psychiatric care or none at all. Another finding that raises concern is that among youths processed in adult criminal court, those who had any psychiatric or substance use disorder were more than twice as likely to receive a prison sentence as youths without a disorder. On the basis of these findings, the investigators outline a research agenda to better inform the selection of youths for whom trial in an adult criminal court may be more appropriate.

To address Justice Stewart's concern that the juvenile justice system has drifted from its original purpose, a conceptual shift in future research is warranted. Advocacy to improve mental health care for detained and incarcerated youths requires a stronger evidence base that will support the argument that delivery of psychiatric care promotes the juvenile justice system's priorities of providing rehabilitation (that is, restoring individuals to their former capacity) and reducing recidivism. To gently sway the pendulum back, we must work in partnership with juvenile justice system leaders to develop methodologies to link sensitive criminal and mental health service use databases and design studies that answer questions that may first be raised in court.

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Authors' reply. Br J Psychiatry 2013;202():468-9.