Discontinuities in and Perceptions of Mental Health Service Path of Violent Young Offenders: A Qualitative Descriptive Study.

Studies on mental health service use among juvenile violent offenders prior to their acts of violence are sparse. Mostly, their service use seems to be short-term, although there may have been several service periods. Little is known about how they have perceived those services. Using a qualitative content analysis on data from forensic psychiatric examination statements, we studied discontinuities in the use of mental health services of 15-22-year-old violent Finnish offenders and descriptions of their perceptions of those services. There were several types of discontinuities: limited youth engagement and subsequent dropping out from services, or partial or total refusal of the proposed examinations or treatments. Most discontinuations were instigated by the youth themselves, followed by the parents and the service system. The subjects had perceived mental health services to be not beneficial for the most part, although some experienced benefits from medication. When treating children and adolescents with behavioral symptoms clinicians should identify the early signs of the process of disengagement from treatment and pay attention to the perceptions of the treatment of both the youth and their parents. Also, more research is needed on the user experience of mental health services among violent offenders, as well as factors relating to discontinuities along their mental health service path.

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

OBJECTIVES: 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. DESIGN AND STUDY SETTING: 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. RESULTS: 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%). CONCLUSIONS: 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.