Health Disparities & Public Policy is a research program in the Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University. Formerly known as the Psycho-Legal Studies program, the research group changed its name to reflect its focus on health disparities. The program’s studies investigate health needs of traditionally underserved populations such as racial/ethnic minorities, impoverished persons, the homeless, and incarcerated populations. Findings from the group’s studies have shaped US public health policy. Results have been cited in Supreme Court amicus briefs, congressional hearings, and Surgeon General’s reports. The program has conducted studies in the following areas:
- The criminalization of the mentally ill
- Prevalence of psychiatric disorders in adult jail detainees
- Correlations between psychiatric disorders and violence
- Development and persistence of psychiatric disorders in youth while they are incarcerated and after they return to their communities
- Patterns of service utilization in high-risk populations
- Trajectories of substance use disorders
- Patterns of incarceration and how they affect health disparities in psychiatric disorders and physical illnesses such as HIV/AIDS
- Mortality rates, focusing on variables associated with early violent death
The Northwestern Project
The Northwestern Project is currently the program’s primary focus. Begun in 1995, the Northwestern Juvenile Project is the first large-scale longitudinal study of mental health needs and outcomes of delinquent youth. We enrolled 1829 randomly selected youth, 1172 males and 657 females, as they entered the Cook County Juvenile Temporary Detention Center from 1995 to 1998. The sample is diverse: 1005 African Americans, 524 Hispanics, 296 non-Hispanic whites, and 4 of other race/ethnicity. Funded by a consortium of federal agencies and private foundations (e.g., NIH, the Department of Justice, CDC), we have been tracking and re-interviewing these youth since November 1998. Unlike many studies that drop participants if they are incarcerated at follow-up, we re-interview our participants wherever they are living when their interview is due. As of August 2013, 1621 are still enrolled in the project: 120 have died and 88 have withdrawn. Thanks to the cooperation of many agencies in Chicago, Cook County, and the State of Illinois, we have had great success in tracking and re-interviewing our participants. For our recently completed 14-year follow-up interviews, we successfully re-interviewed 87.6% of the original sample who were still alive.
Goals of the Study
- To assess the development and persistence of alcohol, drug, and mental disorders as delinquent youth age. We also study patterns of comorbidity, associated functional impairments, and related outcomes.
- To investigate barriers, pathways, and patterns of service use. We are assessing if and when persons who need services receive them (whether they are in the community or incarcerated) and from which sectors: corrections, welfare, education, general health, mental health, and informal services. We also evaluate how services affect outcomes.
- To determine pathways and patterns of drug use, violence, and other behaviors such as HIV/AIDS risk. We examine the development of these risky behaviors among our subjects, focusing on gender differences, racial/ethnic differences, the antecedents of these risky behaviors, how these behaviors are interrelated, and how incarceration affects risky behaviors.
How Is the Northwestern Project Unique?
Many studies have investigated general population youth to see who becomes delinquent. Far fewer studies examine health needs and outcomes among youth already in the juvenile justice system. We study delinquent youth because they are at such a high risk for psychiatric disorders, life-threatening problem behaviors, HIV/AIDS, and premature violent death. Our data will help plan needed intervention strategies for delinquent youth and incarcerated adults.
Guiding Public Policy and Improving Services for Delinquent Youth
The Northwestern Project will help direct the types of prevention programs that best fit the needs of delinquent youth. Moreover, longitudinal data allow us to examine fundamental questions not possible in cross-sectional studies. For example: What are the most common patterns of comorbid disorders? Which variables predict the sequence of disorders as youth age? How do HIV/AIDS risk behaviors (e.g., unprotected sex, trading sex for drugs, needle-risk behaviors) develop over time? How do patterns of incarceration affect drug abuse and HIV/AIDS risk behaviors in adulthood?
The Northwestern Victimization Project
Begun in 1995, the Northwestern Victimization Project was the first large-scale, longitudinal study of crime victimization patterns in severely mentally ill persons living in the community. Prior studies of violence and mental disorder had focused on perpetration, not victimization. We examined the rates, risk factors, and patterns of crime victimization in 936 persons with chronic severe mental disorders. More than one-quarter of the sample had been victims of a violent crime in the past year, a rate more than 11 times higher than general population rates, even after controlling for demographic differences between the two samples. The Northwestern Victimization Project has been replicated in the Netherlands and other countries, where public health officials now realize that victimization in persons with severe mental illnesses is a far more serious threat to public health than the perpetration of violence.
Psychiatric Disorders in Male and Female Adult Jail Detainees
The Health Disparities and Public Policy lab conducted the first large-scale epidemiologic studies of psychiatric disorders among male and female adult jail detainees. Between 1983 And 1995, a series of investigations examined (1) the prevalence of psychiatric disorders in jail detainees, and (2) whether detainees who had severe mental illnesses received treatment while in jail. Our findings highlight the discrepancy between jail detainees’ service needs and the services that they receive. The data showed that of male detainees who needed psychiatric services, only 37 percent received them. Only 20 percent of female detainees who needed psychiatric services received them. Because jails were never intended to be psychiatric hospitals, few have the resources necessary to adequately treat the increasing numbers of detainees entering jails nationwide. The studies provided a model for epidemiologic research at other institutions. They also underscore the need for jails to systematically screen detainees upon admission, provide treatment during their stay, and refer for services after they are released.
Consequences of deinstitutionalization: The police as streetcorner psychiatrist
Incarceration of the mentally ill disproportionately affects minorities, who are least likely to be able to afford mental health care. In an observational study of police officers, Health Disparities and Public Policy found that mentally ill persons had an arrest rate nearly double that of non–mentally ill persons. Police reluctantly arrested mentally ill persons when a mental health evaluation and treatment would have been preferable but was not available. The findings suggested that reduced community services had resulted in mentally ill persons being “criminalized”; for many, arrest had supplanted hospitalization. The findings supported the thesis, set forth by public health experts, that for poor persons—especially racial/ethnic minorities—arrest and incarceration had become the entrée for receiving mental health services. The findings of this study were cited in amicus briefs to the Supreme Court, were used in many hearings by Congress, and highlighted the need for special diversion programs for mentally ill persons in the criminal justice system.
- Cognitive and academic functioning of juvenile detainees: Implications for correctional populations and public health. Lansing, A. E., Washburn, J. J., Abram, K. M., Thomas, U. C., Welty, L. J., & Teplin, L. A. (in press). Journal of Correctional Health Care.
- Prevalence and persistence of psychiatric disorders in youth after detention: a prospective longitudinal study. Teplin, L. A., Welty, L. J., Abram, K. M., Dulcan, M. K., & Washburn, J. J. (2012). Archives of General Psychiatry, 69(10), 1031-1043. PMC3737771
- Childhood maltreatment and psychiatric disorders among detained youths. King, D. C., Abram, K. M., Romero, E. G., Washburn, J. J., Welty, L. J., & Teplin, L. A. (2011). Psychiatric Services, 62(12), 1430-1438. PMC3742320
- Functional impairment in youth three years after detention. Abram, K. M., Choe, J. Y., Washburn, J. J., Romero, E. G., & Teplin, L. A. (2009). Journal of Adolescent Health, 44(6), 528-535. PMC2759315
- hPsychiatric disorders among detained youths: a comparison of youths processed in juvenile court and adult criminal court. Washburn, J. J., Teplin, L. A., Voss, L. S., Simon, C. D., Abram, K. M., & McClelland, G. M. (2008). Psychiatric Services, 59(9), 965-973. PMC2718561
- HIV/sexually transmitted infection risk behaviors in delinquent youth with psychiatric disorders: a longitudinal study. Elkington, K. S., Teplin, L. A., Mericle, A. A., Welty, L. J., Romero, E. G., & Abram, K. M. (2008). Journal of the American Academy of Child and Adolescent Psychiatry, 47(8), 901-911. PMC2754224
- Perpetration of violence, violent victimization, and severe mental illness: balancing public health concerns. Choe, J. Y., Teplin, L. A., & Abram, K. M. (2008). Psychiatric Services, 59(2), 153-164. PMID18245157
- Perceived barriers to mental health services among youths in detention. Abram, K. M., Paskar, L. D., Washburn, J. J., & Teplin, L. A. (2008). Journal of the American Academy of Child and Adolescent Psychiatry, 47(3), 301-308. PMC2945389
- Suicidal ideation and behaviors among youths in juvenile detention. Abram, K. M., Choe, J. Y., Washburn, J. J., Teplin, L. A., King, D. C., & Dulcan, M. K. (2008). Journal of the American Academy of Child and Adolescent Psychiatry, 47(3), 291-300. PMC2945393
Grants and Funding
The Health Disparities & Public Policy program has been funded by a consortium of federal agencies and private foundations, including:
- The National Institute on Drug Abuse (NIDA)
- Office of Juvenile Justice and Delinquency Prevention (OJJDP)
- National Institute of Mental Health (NIMH)
- National Institute on Alcohol Abuse and Alcoholism (NIAAA)
- Centers for Disease Control and Prevention (CDC)
- Center for Substance Abuse Prevention (CSAP)
- Center for Mental Health Services (CMHS)
- Center for Substance Abuse Treatment (CSAT)
- NIH Office of Behavioral and Social Sciences
- NIH Center on Minority Health and Health Disparities (NCMHD)
- NIH Office of Research on Women’s Health (ORWH)
- NIH Office of Rare Diseases
- Department of Labor
- Department of Housing and Urban Development
- Robert Wood Johnson Foundation
- William T. Grant Foundation
- Chicago Community Trust
- MacArthur Foundation
- Open Society Institute
- National Institute of Justice
- The Illinois Department of Mental Health and Developmental Disabilities
Contact Linda A. Teplin, PhD, Owen L. Coon Professor of Psychiatry, for more information about Health Disparities & Public Policy or email us.