Statistics from the Court Statistics Report and the White Paper on Crime show that over the past ten years, the number of juvenile offenses by those with mental health disorder is on the rise. A rise in juvenile offenses by them is not a new problem as we have witnessed a steady increase. In this regard, since the early 2000s, increase in delinquency by youth with mental health problems and lowering age of juvenile offenders have become key words of the juvenile justice.

The increase in juvenile crimes caused by mental disorders, such as substance abuse, learning disabilities, anxiety disorders, behavioral disorders like attention deficit hyperactivity disorder (ADHD), and developmental disabilities, is not a problem of Korea alone. In order to prevent recidivism of youth offenders with mental health problems and help them become healthy members of society, juvenile protection facilities prioritize providing appropriate medical treatment to juvenile offenders for mental illness while they are placed in a juvenile detention and residential treatment facility. However, in reality, those juvenile facilities fall short of properly managing mentally ill youth and providing needed therapies and medial treatment to them.

For the purpose of figuring out the most needed medical treatment for delinquent juveniles with mental illness, this study examines the current system and operation status of the treatment for mentally ill juvenile delinquents, in particular focusing on those who are subject to the protective detention Number 7 of placing juveniles a hospital, a sanatorium or a juvenile medical care and protection institution (Article 32 Decision of Protective Detention of Juvenile, the Juvenile Act). This study presents results of In-depth interviews and surveys on staff of medical rehabilitation and juvenile centers, juvenile classification judges, and juvenile detention staff to identify problems in treatment of juvenile offenders with mental health issues and ways to address them. 

Currently, the Juvenile Detention and Residential Treatment Facility (Daejeon Juvenile Center), specializing in performing the functions of medical rehabilitation, provides medical and therapeutical treatment, social adaptation training, and special education to prevent recidivism and promote sound growth of mentally ill juvenile offenders. However, because of the recent increase in the number of juvenile delinquents with mental health issues, detention and residential treatment facility alone is not enough to provide required medical treatment and services to all detained youth who are in custody in a detention and residential treatment facility following the protective detention order. In fact, even medical rehabilitation juvenile centers are not able to exclusively serve to providing medical rehabilitation treatment to them due to various reasons, such as chronic shortage of dedicated medical personnel, overcrowding of detained juveniles, and other works that the staff should handle besides medical rehabilitation. 

Looking at the re-admission rate of mentally ill juveniles who were admitted to a detention and residential treatment facility following the No. 7 disposition of protective detention over the past 4 years (2017-2020), the re-admission rate within one year stood at 7.1% in 2017 while the rate within 2 years was 22.2%. The re-admission rates have not changed much. The re-admission rate within one year was 8.3% in 2018, 9.8% in 2019, 11.5% in 2020 and in 2018 while two year was 9.8% in and 23.55% in 2019 respectively. 

The re-admission rate of juvenile with mental illness is relatively higher than those without mental health disorder (6.2~8.3% within 1 year, 15.3~17.0% within 2 years). Specifically, comparing the readmission rate of the two groups, that of those with mental health issues was about twice as high as or three times as high as at most. This increase in re-admission of mentally ill youth reflects insufficient post-care of them after they are released. 

Problems involving protected juveniles under rehabilitation and medical treatment should not be seen only within the frame of juvenile crime or delinquency, but be viewed broadly as 'problems of child and youth welfare' such as mental health issues of children and youth. In order to promote the welfare of those protected juveniles under medical treatment and rehabilitation, it is necessary to strengthen connections among related laws such as Juvenile Act, the Mental Health Act and laws related to child and youth welfare, solve structural problems, and figure out the blind spot so that protected juveniles could receive needed services and cares. 

Leveraging the analysis of these problems, this study suggests followings to improve operational efficiency of the detention and residential treatment facilities. 

First of all, the system of detention and residential treatment facilities should be improved. Unlike other dispositions, the purpose of disposition No. 7 of protective detention is to provide medical treatment and help rehabilitation of protected juveniles by considering put first their mental health condition than the fact of delinquency. Therefore, since the key of disposition of No. 7 protective detention is to provide professional medical treatment as the premise of protection. In addition, the classification review criteria should be prepared accordingly, but in reality this is not the case. Thus, it is needed to build standardized classification tools and criteria that can be applied in the process of classification review for the disposition No. 7. Considering the fact that medical conditions of all protected juveniles under the disposition No. 7 are not the same, it is impossible for them to get customized medical treatment. Mentally ill juveniles experience growth spurt so they require treatment in a specialized medical facility. Therefore, the Deajeon Juvenile Center shall develop a specific screening procedure to classify juvenile delinquents suitable for education and medical treatment or not. 

Second, as mentioned above, medical conditions of all juveniles requiring medical and rehabilitation treatment are not the same, so the number of medical rehabilitation practitioners specialized in juvenile treatment shall be expanded. Detention and residential treatment facilities are not a hospitals, it is necessary to increase the number of staff to appropriately respond to impulsive and violent acts of those juveniles. As previous studies suggested regarding the expansion of dedicated practitioners, detention and residential treatment facilities shall be included in medical facilities where public health practitioners are assigned so that they could strengthen professional competence and expertise. In addition, Daejeon Juvenile Center might be designated and operated as an intern training center for graduate students majoring in psychotherapy, art and play therapy, counseling, and social welfare in the Daejeon and areas of the surroundings. Third, to treat juveniles who are subject to the disposition No. 7 and taken into ordinary mental institutions, more number of experts and practitioners are needed than adult patients due to the characteristics of adolescence, for example impulsive and aggressive behavior. In addition, problems frequent in treatment facilities for juveniles, like disturbance, self-harm, sexual issues, make it difficult to take care of them in private mental institutions. For this reason, it is hard to select a privately run small hospital as an entrusted institution for juveniles with mental health issues, despite their excellence in expertise in treating mental illness and greater access to medical services. Therefore, efforts to expand entrusted medical institutions through cooperation between the court and the Ministry of Health and Welfare are needed. It also would be good to add items related to disposition No. 7 to the public health and medical service uation system and to provide incentives for public institutions to play an active role in medical treatment of juveniles requiring medical treatment and rehabilitation. 

Fourth, in the case of the disposition No. 7, there are no provisions setting out annexing it with other protective dispositions. The juvenile act should be amended to allow order the disposition No. 7 with the disposition No. 4 (placing a juvenile concerned under the short-term probation) and No. 5 (placing a juvenile concerned under the long-term probation). Under the current legislation, the cost of medical treatment, such as medicine treatment, is supported for 10 years for protected juveniles after released from medical rehabilitation juvenile reformatories, but after-care services for them is not properly provided. If probation is combined with the disposition No. 7, the probation officer can supervise and manage those released juveniles. Therefore, in terms of after-care of released protected juveniles, private medical institutions and community welfare organizations will be able to provide stable support to released youth. 

This study examines the disposition No. 7 as a way to improve operational efficiency of juvenile residential detention facilities and suggests to improve the relevant legislation and system. This study may contribute to enhancing operational efficiency of detention and residential treatment facility facilities, as it presents a future direction of the medical treatment system for juveniles requiring medical treatment and rehabilitation. Lastly, it is expected that findings and suggestions of this study may be useful in improving the current system for those juveniles at a time when treatment of the youth with mental health problems becomes a social issue.