A youth with untreated ADHD struggles with impulse control, acts without thinking, and ends up charged with assault. A teenager self-medicates trauma with substances and faces drug possession charges. Someone experiencing a mental health crisis responds to police commands erratically and is arrested for resisting rather than connected to care. A young person whose behavior stems from developmental disorders they have never been diagnosed with cycles through detention repeatedly without anyone recognizing the underlying condition. The overlap between mental health issues and justice system involvement among youth is so substantial that some describe juvenile facilities as de facto mental health institutions. Whether this represents a failure to treat vulnerable youth appropriately or an inevitable intersection between behavioral health and behavior requiring accountability divides practitioners, families, and policymakers.
The Case for Treatment Over Punishment
Advocates argue that criminalizing mental health symptoms represents fundamental system failure. Research shows that the majority of youth in juvenile justice have diagnosable mental health conditions, trauma histories, or substance use disorders. ADHD, conduct disorders, depression, anxiety, and post-traumatic stress appear at rates far exceeding the general youth population. For many, offending behavior is directly linked to untreated conditions: impulsivity from ADHD, aggression from trauma responses, theft to fund substance use, acting out from unaddressed abuse. From this view, these youth need treatment, not punishment. Detention exacerbates mental health problems rather than addressing them. Trauma-informed approaches that recognize how adverse childhood experiences shape behavior produce better outcomes than traditional discipline. Diverting youth to mental health treatment, ensuring all detained youth receive proper screening and care, training justice personnel to recognize mental health crises, and investing in community mental health services that prevent justice involvement would address root causes rather than punishing symptoms.
The Case for Accountability Alongside Treatment
Others argue that mental health conditions, while important context, do not eliminate personal responsibility or excuse harmful behavior. Many youth with ADHD, trauma, or substance use do not commit crimes. Mental health challenges create vulnerabilities but not determinism. From this perspective, treating mental health and holding youth accountable are not mutually exclusive. Courts can mandate treatment as part of disposition. Facilities can provide mental health services while maintaining security and structure. Substance use may explain theft but does not make the victim whole or negate that theft is wrong. Moreover, using mental health as primary explanation for offending risks pathologizing entire populations. Not every youth who commits a crime is mentally ill, and assuming they are may ignore other factors like choice, values, or environmental influences. The solution is ensuring justice systems can identify and address mental health needs when present, not transforming youth justice into mental health treatment or eliminating accountability when youth have diagnosable conditions.
The Screening and Treatment Gap
Even when systems recognize that mental health matters, capacity to respond is limited. Many jurisdictions lack standardized mental health screening at intake. Diagnoses require evaluations by clinicians who may not be available for weeks or months. Treatment requires specialized staff, medication management, and therapeutic programming that most facilities cannot provide. Community mental health services for youth have long waitlists, limited capacity for crisis intervention, and rarely accept youth with justice involvement. The result is youth cycling through systems that identify problems but cannot address them, or never identifying problems in the first place. Meanwhile, families desperate for help sometimes view the justice system as the only way to access mental health services their insurance will not cover or that do not exist in their communities.
The Question
If the majority of youth in the justice system have mental health needs, does that mean the system is criminalizing illness, or does it mean these youth need both treatment and accountability for behavior that harmed others? Can justice systems adequately provide mental health treatment, or does expecting them to function as healthcare providers guarantee inadequate care for everyone? And when mental health services in communities are insufficient, forcing families to choose between no treatment or justice system involvement to access care, whose failure does that represent and who bears responsibility for creating alternatives?