Background Adolescents involved in the juvenile justice system have high rates of psychiatric disorder and social vulnerability. Those in custodial or semi-custodial detention may be particularly vulnerable to psychiatric emergencies, but the clinical factors associated with these crises remain insufficiently understood.Objective To characterise the sociodemographic and clinical profiles of detained adolescents attending a psychiatric emergency service and compare them with those of community-living adolescents.Methods In this retrospective cross-sectional study, we reviewed the medical records of all patients presenting to a public child and adolescent psychiatry emergency service in Brazil over 1 year. Detained adolescents aged 12-17 years were compared with community-living adolescents regarding sociodemographic characteristics, psychiatric diagnoses and presenting complaints.Results Of 1206 adolescents, 160 (13%) were detained. Compared with community-living adolescents, detained adolescents were more likely to be male (86%: 53%), older (mean [SD] 15.9 [1.1]: 14.9 [1.6] years) and to identify as Black (13%: 8%). Stress-related/adjustment disorders (30%:10%), conduct disorder (27%:10%) and substance use disorders (26%:20%), were more frequent among detained adolescents, whereas depression was less frequent (26%:35%). Emergency consultations involving detained adolescents were more likely to include insomnia (43%: 19%) and suicide attempts (26%: 18%), whereas behavioural presentations such as agitation, aggressiveness, irritability, disobedience and attention difficulties were comparatively less frequent.Conclusion Emergency psychiatric presentations among detained adolescents were more strongly associated with stress-related disorders, suicidal behaviour, sleep disturbance and substance-related problems than with behavioural disturbance alone. These findings have implications for emergency psychiatric assessment within juvenile justice settings.
Background Research has shown that young people with elevated callous-unemotional traits are also likely to be morally disengaged and may justify their offending behaviour. Moral disengagement may, thus, explain the cognitive processes leading to their offending. Moral disengagement, however, is a multifaceted construct, and research has yet to examine the role of its distinct components in the callous-unemotional traits/offending pathway.Aims This study aims to explore associations between callous-unemotional traits and components of moral disengagement in young offenders by testing a mediation model to determine whether the effect of callous-unemotional traits on delinquency operates through each element of moral disengagement.Methods Data were from an existing longitudinal study of 1124 14-18-year-old serious offenders-the US-based Pathways to Desistance Study. In this study, callous-unemotional traits were measured using the Youth Psychopathic Traits Inventory, and elements of moral disengagement were measured using the Mechanisms of Moral Disengagement scale. Callous-unemotional traits, the mechanisms of moral disengagement and self-reported offending behaviours were measured consecutively at 6-month intervals. Longitudinal mediation analysis was conducted to determine whether each specific element of moral disengagement mediated any association between callous-unemotional traits and self-reported delinquency.Results Bivariate analysis and comparison of correlation coefficients confirmed that callous-unemotional traits were associated with serious delinquency and also with elements of moral judgement and euphemistic language. Longitudinal mediation analyses suggested that all but two (diffusion of responsibility and displacement of responsibility) elements of moral disengagement individually and collectively mediated the relationship between callous-unemotional traits and delinquency; the higher the callous-unemotional trait score, the higher also was moral disengagement, in turn, associated with more delinquency.Conclusion The findings replicate prior research suggesting that a key mechanism in the link between callous-unemotional traits and delinquency lies in moral disengagement but go further in specifying the components of moral disengagement likely to be most relevant. This has implications for more accurately targeted interventions for reducing reoffending among young people with elevated callous-unemotional traits and possibly also for the primary prevention of offending by them. Specifically, interventions aimed at supporting change in thought processes around moral engagement among young people with elevated callous-unemotional traits may be as important for reducing the risk of offending as helping those young people to recognise emotions in others and respond more appropriately.
BACKGROUND:Mental health courts divert individuals with serious mental illness away from imprisonment into community-based treatment and supervision. Early research indicates that such treatment contracts can reduce recidivism and provide various other benefits. Aspects of eligibility for this diversion option are still under-researched. AIMS:To explore the nature of alleged offences against people accepted into mental health courts (on mental health court dockets), and their demographic and mental health context and their perceived relevance to eligibility for such diversion. METHODS:We used a sequential mixed-methods design in which semi-structured interviews were conducted after completion of quantitative data collection from the State of Virginia's behavioural and therapeutic court docket cases in 2022-2023. The State provides open online data on demographics and the nature of alleged offences for all mental health court-adjudicated cases. The qualitative part of the study involved semi-structured interviews with behavioural health docket coordinators across Virginia about their perceptions of how the nature of alleged criminal offences affects potential mental health court participation and the dynamics with other disciplines in the system that may be relevant to decision-making here. RESULTS:The most commonly alleged offence was assault-on-law-enforcement officers, an offence that, if convicted, carries a mandatory prison sentence. This was disproportionately charged against Black men. Qualitative findings revealed that the coordinators viewed assault-on-law-enforcement officers as likely to have occurred when defendants were in a state of mental health crisis, with resultant perceptions of law enforcement as a threat, and thus, usually, a mental health solution was likely to be in the best interests of all parties. There was local variation in processing, but a sense that local prosecutors hold disproportionate power, and defence lawyers are constrained by ideological advice rather than knowledge of optimal outcomes for their client. CONCLUSIONS:The punitive 6-month mandatory minimum jail term that must follow a conviction for an assault-on-law-enforcement officer may put both justice and safety at risk. Black men are disproportionately likely to be subject to such allegations, suggesting that disadvantage at every level of health and justice has reached this point. When mental disorder is manifestly a relevant factor in alleged offending, it makes sense to order disposals that will maximise restoration of health and social functioning in order to safeguard such officers, the wider community and the alleged offender. At present, the structured diversion option is only open in Virginia when a mental health court is willing to accept violent felony charges. We recommend wider dissemination of data on mental health court outcomes, including longer-term outcomes, to law enforcers and politicians with a view to change in the relevant law.
