What Are the Health Needs of Incarcerated Youth?

Patient Presentation
A 15-year-old male came to clinic for his health supervision visit. He was doing well and there were no concerns. His mother had a red mark on her cheek that the pediatrician noticed and asked about. The mother and son both started to grin somewhat. “We’ll I was the innocent bystander in a fight between two teenagers at the juvenile detention center I teach at. They started to go at it and when the probation officers came in to break it up, I got caught off balance trying to move away and tripped over a desk and hit the edge. I didn’t actually get hit but it looks like I was. Actually it could have happened in any high school, its just seems worse because I work at the ‘juvie jail,'” she explained. She went on, “I really like working there because the kids have so many needs. Their stories can be really, really sad and we see lots of mental health, physical and social issues. The classroom at least is a consistent place for all of them.” Later, the pediatrician looked up what are some of the health care needs of incarcerated youth.

Discussion
In the US during 2011, ~60,000 youth were incarcerated at some time in a correctional facility. Boys are detained more than girls (86% vs 14% respectively in the US, 95% male in the United Kingdom in 2014) but girls have more health issues. There are racial and ethnic differences with 38-40% of detainees being black, 23% being Hispanic/Latino and 32% being white, and 5% other. For detained youth, 5% are for violent crimes, 22% for non-violent property crimes and the majority of the rest are for non-violent offices such as substance use. The average length of detainment is 3-4 months and unfortunately the rates of recidivism are higher for youth than for adults; for youth, 75% are rearrested within 3 years. Detained youth have a higher risk of mortality at 4x the general population; girls have an 8x higher rate.

A comprehensive view of their health care needs to be provided to the youth, upon their arrival, during detention, transitioning out of and after detention. For formerly detained youth, primary care physicians can help with continuing primary care including immunizations and screenings for sexual and mental health issues, determining if consultative care is needed and referring as necessary for pediatric specialty care, mental health or substance abuse treatment, working with local school districts to assist with educational/academic needs, working with social services to help with overall family needs, and providing information to the probation officers and other legal system representativse as appropriate.

Within the detention system, girls are less common and therefore represent a special population. LGBTQ (Lesbian, Gay, Bisexual, transgender or questioning) youth were 15% of the detained population (11% for boys, and 27% for girls). Youth involved in sex-trafficking are also viewed as a special population.

Learning Point
Many health problems are seen at higher rates in detained youth. The priority primary health needs include dental, infectious illness, reproductive health needs and trauma-related injuries. In the United Kingdom the most common physical health needs were: vision (13%), oral health (12%), skin problems (12%), asthma (11%), weight problems (11%) and genito-urinary problems (10%). In the United Kingdom mental health prevalence rates showed personality disorder (~84%), drug dependency (~57%), depression (~50%), neuroses (52%) and psychosis (8%).

Health problems of detained youth include:

• Mental – 66% of boys and 75% of girls have at least 1 mental health need, many are undiagnosed
  • Behavior
  • Conduct disorder
  • Post traumatic stress disorder
  • Mood disorders including anxiety and depression and suicidality
    • Suicidality is very common with 52% of youth reporting recent suicidality and 1/3 with an attempt.
  • Neurodevelopment
    • Attention/ADHD
    • Learning disabilities including specific learning disabilities such as dyslexia
  • Substance use and abuse – alcohol and marijuana use are especially high among detained youth (74 and 84% respectively). Girls are more likely to use other substances.
    • Alcohol
    • Cocaine or crack
    • Crystal methamphetamine
    • Ecstasy
    • Marijuana or hashish
• Physical
  • Acute self-limited illness, e.g. upper respiratory infections, dermatological problems
  • Chronic problems
    • Asthma
    • Diabetes
    • Seizures
    • Sickle cell disease
  • Dental
    • Dental decay
    • Abscess of the jaw
    • Gum disease
  • Pain – females tend to report more musculoskeletal pain
    • Abdominal pain
    • Backache
    • Headache
  • Sexual – detained youth have higher rates of sexual activity and lower rates of contraception
    • Sexually transmitted infections
      • Chlamydia, gonorrhea, HIV and Hepatitis C, syphilis
    • Pregnancy
      • “…1 in 5 detained youth either [are] having a child or expecting a child.” Fourteen percent of boys and 9% of girls already have a child.
  • Trauma-related injury
  • Vision