Improving the Health, Safety, and Well-Being of Young Adults: Workshop Summary (2013)

12

The Justice System

Millions of young adults are involved in the juvenile or adult justice systems in the United States each year, and this involvement can have dramatic impacts on their lives. Two speakers explored these and other impacts of the justice system on the lives of young adults.

TRAJECTORIES THROUGH THE JUVENILE AND ADULT JUSTICE SYSTEMS

The juvenile justice system is “basically a sorting system,” said Edward Mulvey, professor of psychiatry at the University of Pittsburgh School of Medicine and currently a visiting scholar at the Russell Sage Foundation in New York. It tries to identify the right people to get out of the system, “and if they don’t come back, that is a success.” The juvenile system has recently focused on a developmental framework. It has become more attuned to the needs of adolescents, how they are different from adults, what they might need at different times, and the importance of accountability for the juveniles in the system (NRC, 2012).

The juvenile system also has become more systematic in its identification of juveniles with mental health disorders and in its use of evidence-based practice. It uses more structured risk assessments to identify those at risk of reoffending and to divert groups into different trajectories (Mulvey, 2013). However, it also continues to rely heavily on placement of juveniles into institutions, Mulvey noted.

One of the toughest problems the system faces is the overrepresentation of juveniles of color in the system. This disproportionate representation of young people of color begins at arrest and detention and progresses throughout the entire system. “There has been a lot of work” on the problem, said Mulvey, “but it is a continuing issue.”

Turning to the adult system, the incarceration rate of inmates under state and federal jurisdiction has risen from about 100 per 100,000 population in the early 1970s to about 500 per 100,000 population today, with the incarceration rate for males an order of magnitude greater than for females (Carson and Sabol, 2012). The United States has about 2.3 million people locked up (Glaze and Parks, 2012). This is an “immense” number that imposes “immense” costs, Mulvey said.

Many of the people in the adult justice system are young adults (West, 2010). “Crime is the province of the young.” Social scientists know very little about why crime drops off so rapidly during the young adult years, though obvious factors include maturation and a decline in impulsivity. “We all have stories of people we knew or ourselves and how stupid we were when we were younger and how we got smarter. We have talked also about a lot of the regular life changes that occur—peers changing groups, moving, and that sort of thing.”

Mulvey is the principal investigator for Pathways to Desistance, a study of 1,354 serious adolescent offenders who have been followed for 7 years.¹

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¹ Additional information about the Pathways to Desistance Study is available at http://www.pathwaysstudy.pitt.edu.

Their average age was 16 when they entered the system, they all were found guilty of a serious offense (almost exclusively felonies) in Philadelphia or Phoenix, and they were 23 when the study quit collecting data. The study found, first, that most adolescents greatly reduce or stop criminal offending. With each subsequent release from the system, an offender is on the street longer with less likelihood of being rearrested. Their crimes also tend to become less serious over time.

Even at the “deep” end of the system where adolescents are committing felonies, they exhibit great variability. About 10 percent self-report serious and relatively stable rates of offending. About a fifth of the group begins by committing serious offenses, but drops to a low rate over the follow-up period (in their late teens and early 20s). Other groups start low and then rise or remain at a low level of offending through the period studied (Monahan et al., 2009; Mulvey et al., 2010b; Piquero et al., 2013). “These map on to the arrest data very neatly,” Mulvey said.

His group has found a strong association between crime and alcohol and other drug use. Those who drink more alcohol and use more drugs report higher levels of offending. Many of the subjects in their study had diagnosable substance use problems (Mulvey et al., 2010a).

By the time the subjects in the study turned 23, their status on several life course indicators had changed. More than 50 percent were parents, and 40 percent were living on their own. They were locked up less and were more likely to have been involved in a romantic relationship. Forty-five study subjects—3.3 percent of the total—died before age 23.

By combining the characteristics of study subjects through a technique called latent class analysis, Mulvey and his colleagues identified four groups:

1. “Stalled out” (28 percent of the sample). These adolescents had gotten out of high school or had their GED, but they had little else in terms of positive outcomes. They had spent more time in institutional care over the past year and were less likely to be working.
2. “Anchored by a child, but unstable” (10 percent of the sample). This group was more likely to be parenting, have a stable romantic partner and some steady work, but no stable living arrangement.
3. “Independent, but transient” (35 percent of the sample). This group was more likely to be working in the community, with a romantic partner and a child, but limited residential stability.
4. “Stable, with limited responsibilities” (27 percent of the sample). These individuals were working steadily and were stable in their living arrangements.

A large number of the study subjects reported that they either had biological children or were responsible for children—more than 70 percent of females by age 23 and nearly 60 percent of males. “These kids have kids at a reasonably high rate,” said Mulvey. Eighty-seven percent said they had spent time in an institutional placement either as a juvenile or an adult over the 7 years of the study. The average number of unique stays at juvenile facilities was 2.4, and the average at adult facilities was 4.9. “The complexity of these kids’ lives in terms of institutional care is overwhelming when you start to look at it.”

Of the 44 percent of adolescents in the study with a diagnosed substance use problem, 55 percent received substance use services in an adult setting, 61 percent in a juvenile setting, and only 30 percent in the community (Schubert and Mulvey, in press). However, the rate at which they got services was low, especially in the adult setting and in the community. “We know their substance use is related to offending,” said Mulvey, yet many never or rarely get care.

Juveniles involved in the justice system do tend to go on to the adult system, but not uniformly so. They went through different paths, with a large amount of activity consisting of transitions at the level of jail and probation. The challenge, said Mulvey, is dealing with recurrent reentry into the community as a young adult. Currently, community-based services for serious offenders who have been found guilty of committing a felony are scarce. “These are the kids that most people don’t want in their services,” Mulvey said.

Family involvement is an unexplored asset for this group, Mulvey said. When adolescents leave institutions, about 80 percent of them go home to a biological mother. Many “are still connected to their families,” even though they are often having families themselves.

More work is needed on pathways out of the justice systems during adolescence and young adulthood, said Mulvey. How can these systems assess the ongoing risk an individual poses for continued criminality and then intervene to reduce that risk? The role of psychosocial development is also a major unanswered question, as is the continuity and discontinuity of care afforded to young offenders as they transition in and out of institutions.

HEALTH AND SAFETY IN THE JUSTICE SYSTEM

Health care policy in the justice system is informed by few data about the characteristics or needs of prisoners, said Robert Greifinger, adjunct professor of health and criminal justice and Distinguished Research Fellow at John Jay College of Criminal Justice in New York City. Prisoners, whether young or old, tend to be treated the same way, regardless of developmental needs in younger inmates and cognitive and sensory deficits in

older inmates. Individuals are incarcerated for retribution, not rehabilitation, so “there is not a lot of thought about what we need to do to make a difference” in the health of inmates, said Greifinger. In his presentation, Greifinger described his views on the major health and safety concerns impacting young adults in the justice system.

Health care in prisons is driven by the constitutional right to medical care under the Eighth Amendment of the U.S. Constitution, which prohibits cruel and unusual punishment. For detainees in jails, the Fourteenth Amendment of the Constitution provides equal protection for detainees as it does for prisoners. This constitutional right requires timely access to care, access to an appropriate level of care, and treatment as prescribed by a physician, said Greifinger. If that does not happen, it constitutes deliberate indifference to serious medical needs and is grounds for litigation.

About 15 percent of adult prisoners overall have a serious mental illness, even using very strict criteria (Greifinger, 2013; Steadman et al., 2009). A high proportion of women and a lower percentage of men have posttraumatic stress disorder. Eighty percent of the adolescents in juvenile detention centers are medicated for mental illness, and many may be overmedicated. Alcohol and drug use and addictive disorders are common (Greifinger, 2013). Suicides are common in prisons and jails, though age-adjusted suicide data are not available, Greifinger said.

Prisoners who display symptoms of mental illness, such as agitation, may be placed in segregation as punishment for acting out, rather than receive an evaluation and medical treatment for the mental health condition causing the behavior. According to Greifinger, “the overuse of segregation in prisons as punishment for minor infractions is becoming a major issue of attention right now.” One rule infraction, such as a fight, can put an 18-or 19-year-old in segregation for 6 to 12 months—23 hours per day in the cell, with no social contact, rarely a book, and limitations on visitations, said Greifinger. The prison environment is “isolating and alienating” for incarcerated young adults.

Violence and victimization occur in prisons, as does adverse mentoring from other inmates. Nutrition and exercise for prisoners are not “as good as they would be for energetic young folks in the community,” said Greifinger.

Convicted first felony offenders are often poor, undereducated, and black or Hispanic, said Greifinger. Many prisoners have unstable relationships in the community and with families. They then enter into a highly disciplined environment with a command and control organizational structure that lacks any hope for achievement, promotion, or job skills. “The only thing to look forward to for a young person behind bars is getting out,” said Greifinger.

Most incarcerated people come from just a few communities in each

city, which decimates the social capital of those communities. Low-income people are less likely to be married when they have their first child, in part “because a lot of the men are locked up.” About 8 percent of incoming women are pregnant, and most women who come to state prison have at least one child, as do many of the men. The limited data available shows there is a negative impact on children of incarcerated parents. “We need to think about the impact on kids of parental incarceration.”

Finally, reentry can be a great challenge. Ex-prisoners often have trouble finding jobs and can face stigma associated with being labeled as criminals. Their health care typically has little continuity as they exit the system, though the Patient Protection and Affordable Care Act could lead to the better coordination and transfer of medical information.

Greifinger identified several research and policy challenges. Much more data are needed on young adults behind bars. What are their rates of sexually transmitted infections, risk behaviors, and mental illness? Their suicide rates, nutrition, immunity, and chronic diseases all need to be monitored. Data are needed on the effectiveness of risk reduction, the minimization of harm, and the continuity of care on release.

In addition, public policies are needed that will reduce the rate of incarceration, Greifinger said. The mass incarceration of Americans is detrimental to the public health of young people in the United States. “It is so important that we can’t avoid it.” Greifinger added, “the low-hanging fruit … would be the provision of better mental health care in the community and better options for prevention, identification, and treatment of drug abuse.” If that is done first, said Greifinger, it is likely the demand for prison beds will “go down dramatically.”

During the discussion session, Richard Bonnie noted that this is a complicated issue and highlighted several factors that may contribute to the high incarceration rate in the United States, including economic interests inherent in the justice system, the justice system’s objectives of retribution and deterrence, the role incarceration may play in lowering the crime rate, and the dispersion of costs across many entities.