Original article
Complex Health Needs in the Youth Justice System: A Survey of Community-Based and Custodial Offenders

https://doi.org/10.1016/j.jadohealth.2013.10.003Get rights and content

Abstract

Purpose

Estimate the prevalence and annual frequency of health risk indicators in young people serving community-based orders (CBOs) and custodial orders in the state of Victoria, Australia.

Methods

Cross-sectional survey of 242 young people serving CBOs and 273 serving custodial orders in Victoria in 2002–2003. Validated measures included the Composite International Diagnostic Interview for substance dependence, Short Mood and Feelings Questionnaire for depression, and Psychosis Screening Questionnaire for psychosis symptoms. Prevalence estimates were adjusted for sampling bias and age- and sex-adjusted for between-group comparisons. Prevalence estimates were applied to 2010–2011 Victorian youth justice data to estimate annual frequencies at the state level.

Results

The prevalence of substance dependence, poor mental health, and risky sexual behavior was high in both groups. Age- and sex-adjusted prevalence estimates were generally higher among those serving custodial orders; however, extrapolating prevalence estimates to statewide youth justice data generally resulted in higher estimated annual frequencies among CBOs. For example, the estimated prevalence of any substance dependence was 66% (95% confidence interval [CI], 60–72) in those serving custodial orders and 34% (95% CI, 26–42) in CBOs, but the estimated frequency of substance dependence in CBOs in 2010–2011 was 970 (95% CI, 750–1,180), compared with 490 (95% CI, 450–530) in those serving a custodial order.

Conclusions

There is a compelling case for scaling up health services for young offenders in custody and in the community, and for routinely monitoring the health of young offenders serving custodial and community orders.

Section snippets

Participants

Between May 27, 2002, and October, 1, 2003, we interviewed sentenced young offenders in Victoria, with roughly even division of participants with a CBO and a custodial order. Those eligible to participate had received a court sentence, not continuous from a previous sentence, between May 21, 2002, and August, 31, 2003. Those admitted to custody on remand (pretrial detention) or in the community awaiting preparation of pre-sentence reports were ineligible but may have subsequently been sentenced

Results

The sample consisted of 515 participants aged 13–21 years, with 47.0% (n = 242) serving a CBO and 53.0% (n = 273) serving a custodial order at the time of interview. Based on Victorian Juvenile Justice data, we sampled 35% of all eligible Victorian young offenders during the study period, with a higher recruitment fraction in the custodial sample (68%) than in the CBO sample (23%). In the CBO group, participants were significantly more likely than non-participants to be female (21% versus 14%; p

Discussion

In a large sample of young offenders we identified a high prevalence of social disadvantage, substance dependence, and clinically significant symptoms of depressive and psychotic disorders. Many reported having a family member with a history of substance-related problems, mental illness, or incarceration. Experiences of sexual victimization and sexual risk behavior were common. Our findings add to a growing body of literature documenting high-level and complex health-related needs among young

Acknowledgments

The authors thank the study participants for sharing their stories, and the Juvenile Justice Branch of the Department of Human Services Victoria for assistance with data collection. An earlier version of this article was presented at the Sixth Academic and Health Policy Conference on Correctional Health, Chicago, Illinois, March 21–22, 2013.

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    Conflicts of Interest: None of the authors has any potential, perceived, or real conflict of interest to declare. None of the authors received an honorarium, grant, or other form of payment to produce the manuscript. The study sponsors had no role in study design; collection, analysis, and interpretation of data; or writing and submitting the manuscript for publication.

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