The circumstances of crime (and punishment) are much more complicated than what even a Sunday afternoon marathon of Law & Order could possibly portray. Behind the stereotypes of hardened criminals and unruly juvenile delinquents are flesh-and-blood people whose actions aren’t made in a vacuum, free of unseen influence.

It’s a reality that can be best seen in the findings of a recent study published in the Journal of Adolescent Health. The study found that the rate of youth hospitalizations for mental health issues was dramatically skewed toward those kids who were incarcerated at the time. “Detained juvenile offenders are hospitalized for very different reasons than the general adolescent population,” the study authors concluded. “Mental illness, often with comorbid substance abuse, requiring long inpatient stays, represents the major cause for hospitalization.”

Analyzing the more than two million hospitalizations of California children aged 11 to 18 over a 15-year period (1997-2011), the authors found that when juvenile inmates were admitted to the hospital, it was because of a mental health diagnosis 63 percent of the time — three times higher the rate for the non-detained, at 19 percent. As has been commonly seen elsewhere, the problem was disportionately worse for girls. Overall, there were 11, 367 such hospital stays.

"We know young people in the juvenile justice system have a disproportionate burden of mental illness, but I was really surprised by the magnitude of the problem, because hospitalizations typically occur for very severe illness," said lead author Dr. Arash Anoshiravani, clinical assistant professor of adolescent medicine at the Stanford University School of Medicine, in a statement . "If you just looked at girls, 74 percent of their hospitalizations were for mental illnesses. That's pretty sobering."

These illnesses included depression, substance abuse and other behavioral disorders, with there being little difference between the two groups of children. That lack of difference indicates that these problems likely began long before they ever got into trouble with the legal system. "They're regular kids who have had really, really horrible childhoods," Anoshiravani said.

These kids were more likely to be African American, male and older. And their hospitalizations were usually longer, especially for those who got transferred to substance abuse facilities -- the median stay there for an inmate was 71 days, compared to 28 days for the nonincarcerated.

Sadly, the trend is only following in the footsteps of their elders. A 2006 report from the Bureau of Justice Statistics concluded that 73 percent of women and 55 percent of men who were in a state prison had mental health problems; similar rates were seen for those in federal prisons or local jails.

Anoshiravani and his colleagues hope that their study can shock people into realizing that the current approach to children who get in trouble with the law isn’t working. "We are arresting kids who have mental health problems probably related to their experiences as children," he said. "Is that the way we should be dealing with this, or should we be getting them into treatment earlier, before they start getting caught up in the justice system?"

Source: Anoshiravani A, Saynina O, Chamberlain L, et al. Mental Illness Drives Hospitalizations for Detained California Youth. Journal of Adolescent Health. 2015.