An Intensive Mental Health Unit for Adolescents in the Correctional Setting

The need for psychiatric services for incarcerated adults with mental illness has received considerable attention in recent years. However, less emphasis has been given to adolescents with mental health problems who are committed to correctional facilities. Given that adolescents are particularly vulnerable to substance use, suicide, and emerging psychotic or mood disorders, the recognition and treatment of psychiatric disorders among youthful offenders represents a serious public health issue. In July 2000, a partnership between the Ohio State University (OSU) department of psychiatry and the Ohio Department of Youth Services (ODYS) was initiated to provide treatment for adjudicated youths with mental illness.

The goals of this partnership were to approximate services available in the community and to develop a specialized treatment unit for the most severely ill youths. The partnership was formed in recognition of the need for intensive mental health treatment for incarcerated youths and would allow for research initiatives to examine the relationships between adolescence, mental illness, and criminality. A relative lack of community alternatives and the volume of seriously mentally ill juvenile delinquents committed were also instrumental in the formation of the intensive mental health unit.

With the OSU-ODYS affiliation, an intensive mental health unit opened in September 2000 at a newly built maximum-security institution for males aged 13 to 20 years. The intent of this 12-bed unit was to provide specialized care to young inmates with a psychiatric diagnosis who were decompensating or otherwise unable to function in the general population. Often, these youths exhibited psychosis, violence, or self-injurious behavior or had a recent suicide attempt. Some of the youths who are referred to this unit might meet community standards for psychiatric hospitalization. However, finding a community hospital that is willing to treat adjudicated youths can be difficult. Some need specialized services to enhance functioning within the prison setting, and many may have lengthy commitments, depending on the criminal offense.

The unit is equipped with 24-hour nursing and psychiatric availability and one-to-one monitoring as necessary. The medical needs are coordinated by the on-site clinic, and specialized tests (such as EEGs, CTs, and MRIs) are available locally. The youths participate in individual and group programming on the unit in addition to institutional programming when clinically acceptable. Familial involvement, including family therapy, is available and encouraged. Students may receive individualized academic instruction or attend classes with other youths, depending on clinical status. A multidisciplinary approach is emphasized, and psychologists, psychiatrists, social workers, nurses, teachers, unit managers, and juvenile corrections officers—who are with the youths around the clock—collaborate to identify individual treatment needs.

Youths who are referred to the intensive mental health unit have had diagnoses including schizophrenia, mood disorders, posttraumatic stress disorder, conduct disorder, and attention-deficit hyperactivity disorder. A majority of the youths also have comorbid substance-related disorders, and some have intellectual impairment. The length of stay varies. Some youths have had extensive mental health treatment history, including repeated hospitalizations and medication trials. Others may be experiencing the onset of psychiatric symptoms for the first time.

To date, more than 100 youths have been treated on the intensive mental health unit. Upon stabilization, nearly all have been successfully transitioned to nonintensive mental health settings or general population within ODYS. These youths continue to receive ongoing support and treatment through multidisciplinary personnel for the duration of their commitment.

A small number of the most severely ill youths are deemed unsuitable for transfer from the intensive mental health unit. One individual with catatonia was subsequently transferred to a long-term psychiatric facility. Approximately four other youths remain on the intensive unit for the foreseeable future because of their inability to tolerate larger populations. These youths evidence appropriate functioning on the intensive mental health unit, but one displayed recurrent violence toward others and the other self-injurious behavior when in alternative settings. With individuals like these, allowing them to make the transition at a slower pace to institutional programming appears to be successful.

Both ODYS and OSU consider the partnership, now in its third year, to be a success. The academic affiliation provides ODYS with specialized psychiatric expertise and the opportunity to educate and train personnel who are less familiar with mental illness. The unique population of ODYS provides OSU with valuable research opportunities to further the understanding of mental illness and juvenile delinquency—two issues at the forefront of several societal and ethical crossroads.

Dr. Niedermier is assistant professor of psychiatry at The Ohio State University, 1670 Upham Drive, Columbus, Ohio 43210 (e-mail, [email protected]). Dr. Thomas is affiliated with the Department of Youth Services in Columbus.