Mental health-related hospitalisations associated with patterns of child protection and youth justice involvement during adolescence: A retrospective cohort study using linked administrative data from the Northern Territory of Australia

• Published in: Children and youth services review Vol. 145; p. 106771
• Main Authors: Leckning, Bernard, Condon, John R, Das, Sumon K, He, Vincent, Hirvonen, Tanja, Guthridge, Steven
• Format: Journal Article
• Language: English
• Published: Elsevier Ltd 01.02.2023
• Subjects: Child maltreatment; Indigenous; Mental health; Service utilisation; Youth offending; Youth offending; Service utilisation; Indigenous; Child maltreatment; Mental health
• ISSN: 0190-7409; 1873-7765
• DOI: 10.1016/j.childyouth.2022.106771

•The risk of mental health hospitalisations in adolescence increases with child protection and youth justice involvement.•Out-of-home care (OOHC) and detention were linked to the highest risk of mental health hospitalisations.•A higher frequency of mental-health hospitalisations was associated with OOHC during adolescence.•Trauma-informed approaches and co-ordination of services between child protection and youth justice systems are needed.•The over-representation of Aboriginal adolescents in this study reinforces the need for culturally responsive approaches. Adolescents involved with child protection and youth justice systems carry a greater burden of mental health problems, but little is known about how this risk differs by patterns of involvement, especially amongst Aboriginal children who are over-represented in these systems. Describe patterns of child protection and youth justice involvement among Aboriginal and non-Aboriginal adolescents in the Northern Territory (NT) of Australia associated with a higher prevalence and incidence of mental health-related hospitalisations. A retrospective cohort study was developed using a whole-population repository of linked administrative data. The cohort consisted of 14,972 adolescents who turned 10 between 2004 and 2009, inclusive. Odds (OR) and incidence rate ratios (IRR), estimated using zero inflated negative binomial regression, were used to determine if there was a higher prevalence and incidence, respectively, of mental health-related hospitalisations associated with different levels of child protection and youth justice involvement. An increasing gradient of prevalence and incidence of mental health-related hospitalisations was observed with increasing levels of child protection and youth justice involvement. Adolescents who experienced out-of-home-care (OOHC) (OR = 12.06; 95 % CI = 5.64–25.53) and detention (OR = 11.82; 95 % CI = 3.06–45.15) experienced the highest prevalence of mental health-related hospitalisations. After adjustment, only OOHC was associated with a higher incidence of hospitalisations (IRR = 2.67; 95 % CI = 1.73–4.11). Substance misuse was the most common diagnosis among adolescents with child protection or youth justice involvement who were hospitalised. Implications: The findings suggest adolescents with child protection and youth justice involvement are at greater risk of hospitalisation for mental health issues. Trauma-informed services in the child protection and youth justice systems require better coordination and integration to assess and respond to complex mental health issues, especially for those who have been placed in OOHC and/or detention. The over-representation of Aboriginal adolescents exposed to child protection, youth justice, and mental health-related hospital admissions reinforces the need for such services to also be culturally safe and responsive.