First community mental health contact after youth justice supervision among adolescents in New South Wales, Australia: timing, setting, and association with reincarceration in a population-based data-linkage study

Mental disorders are highly prevalent among justice-involved adolescents, and continuity of mental health care is vulnerable across transitions between custody, community supervision, and release. We described the timing and setting of first community mental health contact after youth justice supervision (aim 1), identified characteristics associated with time to first contact (aim 2), and estimated the association between early contact after release and reincarceration (aim 3). This retrospective cohort study included 1,589 justice-involved adolescents aged 10 to 17 years in custody or on community orders in New South Wales, Australia. They were drawn from four total-population youth justice health surveys, linked to health, justice, and mortality records. Mental health disorder at or before baseline (release from custody, or survey date on community orders) was ascertained from health records and self-reported prior diagnosis. Aim 1 was descriptive. Time to first community mental health contact over 24 months of custody-free follow-up was modelled using flexible parametric survival models (aim 2). Landmark analyses at 7, 14, 21, and 28 days after release estimated adjusted reincarceration risks by contact status using modified Poisson regression (aim 3). A mental health disorder at baseline was ascertained in 676 of 1,589 justice-involved adolescents (42.5%). Among them, 17.8% made contact within 30 days and 48.4% none within 24 months. Of 349 first contacts, 29.2% occurred through an emergency presentation, same-day hospital episode, or psychiatric admission. Contact was slower among Aboriginal and/or Torres Strait Islander adolescents (adjusted hazard ratio 0.74, 95% confidence interval [CI] 0.58 to 0.94) and after release from custody (0.44, 0.27 to 0.66, at 24 months). Contact was faster among adolescents with mood disorder and among those with psychosis. Early contact was associated with lower reincarceration at every landmark (adjusted risk ratios 0.82 to 0.84). Community mental health contact after youth justice supervision was delayed or absent for many justice-involved adolescents with a mental health disorder. Nearly a third of first mental health contacts occurred through emergency or inpatient care. Early contact after release was associated with lower reincarceration. Early linkage to community mental health care after release should be a shared priority for youth justice and mental health services.