Abstract
Young people in correctional care facilities often have physical or psychological disorders that contribute to their behavioural problems. In the US, the need for medical services in youth facilities far exceeds current resources, especially for paediatric mental health and specialty services. There is obvious potential for telemedicine to improve access to care and thus the level of health care for juvenile detainees. A few studies have indicated that in specific instances telemedicine has improved access to care, referrals, contact between providers, and has also reduced unnecessary referrals. The question remains, however, whether this improved access and timeliness to care has any effect on the major goals of the incarceration: treatment, education and rehabilitation. Further investigation of this linkage is needed.
Introduction
Juvenile detention facilities face numerous obstacles in their role of educating, caring for and rehabilitating young offenders. Youths are placed in detention facilities for various reasons, including the severity of the crime, the danger to themselves or the community, the lack of appropriate social support or family environment, or the need for diagnostic evaluation. Any of these reasons for placement are likely to indicate a child with significant behavioural – and often medical – health-care needs. Young people in correctional care facilities have been shown to have a high prevalence of medical conditions such as neurological, respiratory, nutritional, orthopaedic, dermatological and dental disorders. 1–3 In addition, juvenile detainees often have physical or psychological disorders that contribute to their behavioural problems. In the US, the need for medical services in youth facilities far exceeds current resources, especially for paediatric mental health and specialty services.
There is therefore a need to provide access to types of specialists and care not available locally due to the remote location of some facilities and the fact that specialists are difficult to recruit to these residential placement centres. There is also a need to reduce delays in access to these specialists and to reduce costly trips and the security risks associated with taking patients to community-based providers outside the detention facility for treatment or diagnosis. 4 Epidemiological studies of the mental health-care needs of children in the US juvenile justice system, have found that two-thirds of men and three-quarters of women in juvenile detention have one or more psychiatric disorders. 5 The most common psychiatric diagnoses are substance abuse, conduct or oppositional/defiant disorder, and anxiety disorders. There is also substantial evidence that detained youths do not receive the mental health services that they need. In a recent study of the mental health services provided to juvenile detainees, Teplin et al. found that only 15% of detainees with a major mental disorder received treatment in the detention centre and only 8% received treatment in the community. 6
Access to and availability of all types of services is a major problem at many juvenile detention facilities. It is especially difficult in the area of health care, where costs have significantly exceeded increases in state budgets. 7 There is a dearth of behavioural and specialty health care, despite the tremendous needs evident in the population. A 1998 inventory of mental health services in juvenile justice facilities revealed that many facilities offered emergency mental health services for juveniles in crisis, routine mental health screening and medication therapy administration/management. However, only about half of facilities offered mental health evaluation or appraisal services (to make a diagnosis and formulate a care plan) and fewer than half offered mental health therapy or counselling by a licensed mental health professional. 8
Telemedicine is one method of improving the quality of health care by enabling patients and providers to overcome distance, time, opportunity and cost barriers to obtaining care. There are similar barriers in juvenile detention centres. Telemedicine-delivered health care has been shown to be successful, especially in adult prisons and youth facilities, and improvements to access and timeliness of care have been made in rural areas, such as those where many juvenile detention centres are located. 9–14
At present, research on the effect of telemedicine on access to care is insufficient, although a few studies have indicated that in specific instances telemedicine has improved access to care, referrals, contact between providers, and has also reduced unnecessary referrals. 15–19 There is obvious potential for telemedicine to improve access to care and thus the level of health care for juvenile detainees. The question remains, however, whether this improved access and timeliness to care has any effect on the major goals of the incarceration: treatment, education and rehabilitation. Telemedicine can provide the services that the facilities have been previously unable to provide locally. Telemedicine may also facilitate the effective provision of rehabilitative services to juvenile offenders by minimizing disruptions and maximizing the continuity of care. Further investigation of this linkage is needed to demonstrate that telemedicine is crucial to the provision of continuous, specialist and high quality health care, whether psychiatric or medical, for incarcerated youths.