which focused mainly on mental health service costs in health care settings. The findings of Costello, Copeland, and colleagues (2007) are consistent with other empirical studies showing that MEB disorders are associated with increased use of services in nonmedical settings, such as foster care (Harman, Childs, and Kelleher, 2000), special education (Bussing, Zima, et al., 1998), and juvenile justice (Teplin, Abram, et al., 2002).

Youth with MEB disorders who become involved with the juvenile justice system also often incur costs related to law enforcement and court expenses, detention, placement and incarceration, and other forms of treatment that are publicly provided (National Center on Addiction and Substance Abuse, 2004). In addition, violent crimes can result in victim costs, such as medical care, treatment through public programs, and property damages to victims. The costs associated with all juvenile (under age 18) arrests in 2004 were estimated at about $14.4 billion (National Center on Addiction and Substance Abuse, 2004), and the costs of medical care, treatment through public programs, and property damages to victims of juvenile violence were estimated at about $95 million (Miller, Sheppard, et al., 2001). Although not all of these crimes were committed by young people with MEB disorders, overall costs of these disorders would be higher if the cost of relevant juvenile crimes were included with service use estimates. In addition, these health problems lead to significantly increased use of informal (unpaid) care by family members and others. For example, family members with a child with mental health care needs are more likely than family members whose children do not have these needs to reduce their working hours or stop working to care for their child (Busch and Barry, 2007).

Using data from the Fast Track project, Foster, Jones, and colleagues (2005) estimated that each youth with conduct disorder incurs public costs of more than $70,000 over a seven-year period, with costs incurred by the juvenile justice, education, and general health care systems in addition to the mental health system. Similarly, a study in the United Kingdom (Scott, Knapp, et al., 2001) documented societal costs from childhood conduct disorder that extended into adulthood. Children who had diagnosed conduct disorder at age 10 incurred public service costs by age 28 that were 10 times higher than those considered to have no problems and 3.5 times higher than those with conduct problems but not diagnosed with conduct disorder. This suggests that preventive interventions aimed at addressing behavioral problems before they reach the threshold for a diagnosis could yield significant savings.



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