Lifelong mental health service use among 15-22 years old offenders: a document-based, mixed-methods descriptive study

• Published in: BMJ open Vol. 13; no. 3; p. e065593
• Main Authors: Huikko, Eeva, Aalto-Setälä, Terhi, Santalahti, Päivi, Lämsä, Riikka, Ahlgrén-Rimpiläinen, Aulikki
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 16.03.2023; BMJ Publishing Group
• Series: Original research
• Subjects: Adolescent; Adolescents; Adult; Attention deficit hyperactivity disorder; Child; Child & adolescent psychiatry; Child development; Child welfare; Childhood; Children; Comorbidity; Content analysis; Crime; Crime - psychology; Criminals - psychology; Drug abuse; Drug use; Family roles; Forensic psychiatry; Health insurance; Health services; Humans; Imprisonment; Juvenile offenders; Mental disorders; Mental Disorders - diagnosis; Mental Disorders - epidemiology; Mental Disorders - therapy; Mental Health; Mental health care; Mental Health Services; Mixed methods research; Morbidity; Patient Acceptance of Health Care; Peer relationships; Quantitative analysis; Substance abuse; Substance-Related Disorders - psychology; Symptoms; Teenagers; Trauma; Young Adult; Finland; mental health; child & adolescent psychiatry; qualitative research
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2022-065593

Among young offenders, psychiatric morbidity and comorbidity are common, but our knowledge about their use of mental health services during childhood and adolescence is scarce. We aimed to describe the lifelong use of mental health services of young offenders who have committed serious crimes. Using data on forensic psychiatric examinations of 42 Finnish offenders aged 15-22 years, we analysed the timing and typical patterns of their prior mental health service use with qualitative and quantitative content analysis and typification. Young offenders appeared in this study as children with plenty of perinatal and developmental risks, and risks related to their family situation and peer relations. Most subjects were described as having had emotional or behavioural symptoms, or both, since childhood. Involvement in mental health services was rare before the age of 7 years but increased markedly after that, staying on the same level during adolescence. Five categories of mental health service users were identified: (1) continuing service use around a decade (14.3%), (2) one brief fixed treatment (11.9%), (3) involuntary use of services (31.0%), (4) evasive use of services (21.4%) and (5) no mental health service use (21.4%). Young offenders had symptoms from early ages, but during childhood and adolescence, involvement in mental health services appeared for most as relatively short, repetitive or lacking. To help children at risk of criminal development, a multiprofessional approach, an early evidence-based intervention for behavioural symptoms and screening for learning problems, traumatic experiences and substance use are necessary. Results can help identify children and adolescents with a risk of criminal development, to develop mental health services and to plan further research.