Findings should be interpreted within the context of the study limitations. First, this study used a cross-sectional design, so that we were unable to make causal inferences. Second, the psychoactive substance use was based on self-reports that might be under-reported due to social-desirability bias. Third, the study participants were recruited from only the MMT clinics with more than 80 current clients in five provinces of China, so the results might not be generalizable to clinics with fewer clients or clinics outside of the study areas. Despite the limitations, the study has implications for the MMT programs in China. The study findings highlight the importance for policy-makers and health administrators to recognize and respond to the issue of psychoactive substance use within MMT clinics.It is recommended that more attention should be paid to a subset of MMT clients who are young, those who concurrently use heroin, and those who demonstrate depressive symptoms. Overall rates of psychiatric diagnosis found in this juvenile population are fairly consistent with those reported in prior studies of mental health disorders in youths in the juvenile justice system.4,28 Rates are slightly higher than in some other general population detention samples, but the difference may be explained by the fact that juveniles in this study were specifically identified by the judge’s questions about psychiatric difficulties. Rates of detention increased over time and, consistent with our hypotheses,grow tables and trays receiving a dual diagnosis of substance use and other psychiatric disorders substantially heightened the risk of future juvenile detention for these young offenders.

This strong prospective association remained, even after we accounted for known demographic predictors, such as older age, male gender, repeat offender status, and primary externalizing diagnosis, all of which are commonly linked to reoffending and detention. Thus, severe substance use that co-occurs with an Axis I psychiatric disorder may be associated with an increased risk of committing another offense that results in detention. Those in juvenile justice settings should consider expanding their concern about status or criminal offending juveniles with co-occurring substance use and mental health problems, to reduce the risk of future detention. Within 48 hours of detention, many U.S. and international juvenile detention settings implement a brief mental health and substance use screening measure . This type of measure assists unit staff and correctional clinicians in identifying whether the juvenile requires substance use or psychiatric intervention or both. The MAYSI-2, for example, has been widely disseminated in detention and probation settings. To our knowledge, however, neither the MAYSI-2 nor any similar measure has been tested or implemented in court involved, non-incarcerated juveniles supervised in the community who may never be detained or on probation. Implementation and testing of a brief measure that screens for substance use and other psychiatric concerns could be useful in triaging juveniles to the appropriate treatment referral opportunities and thereby perhaps in reducing the risk of future detention. Our data suggest that repeat offenders referred for forensic evaluation have higher rates of psychiatric impairment and co-occurring substance use than those referred at the time of the first offense. Therefore, screening and possibly intervention at the time of the first offense could be critical in preventing entrenched behavioral problems, psychiatric difficulties, and repeat legal involvement. Paraprofessional court staff can be trained to conduct mental health and substance use diagnostic screenings on juveniles before the youths accumulate a history of status or criminal offenses.

Licensed court clinicians could then provide consultation on results and referrals, as needed. From a prevention standpoint, assisting these juveniles in receiving the appropriate treatment at the earliest point of court contact, particularly for substance use, could divert them from their course toward detention and result in positive outcomes for the juveniles and families as well as cost savings for mental health, legal, school, and health systems. From a legal and justice system standpoint, however, it should be considered that improved surveillance of dual-diagnosis offenders can actually lead to more detention than treatment. This possibility could be realized if our findings reflect the negative attitudes of the juvenile justice system toward substance-using young offenders versus the individual factors that we hypothesized are associated with detention. Likewise, judges may impose detention on these young substance abusers to mandate them to treatment within the detention setting, independent of the severity of the offense . The current chart review study was limited to the available clinical data, but future study designs may consider inclusion of data on the attitudes of the juvenile justice system toward substance-abusing young offenders, to understand more about these complex associations. It is also noteworthy that in a sample of juveniles with high rates of mental health disorders, most did not get detained. Thus, psychiatric disorders may not be indicative of the worst future legal outcomes for these youths. Specific psychiatric diagnoses, profiles, or comorbidities also may not be so useful in determining risk of detention among a group of adolescent offenders with severe mental health needs. Consistent with the small body of literature in this area, understanding more about specific mental health profiles or attempting to identify particular diagnoses with risk for detention may not be as helpful in understanding the prospective course of risk for these juveniles. Instead, identifying specific symptoms, symptom constellations, and differences in degree versus kind of symptomatology may be more relevant. Taking a more dimensional versus categorical approach to understanding psychiatric presentation and tailoring recommendations for screenings and interventions based on this dimensional approach may be more predictive of criterion outcomes , as has been demonstrated for the construct of juvenile psychopathy.

Finally, juvenile court clinics should perhaps consider ways to implement brief substance abuse treatment interventions to divert juveniles from future detention. Evidence-based, brief interventions for substance abuse, particularly those that involve motivational interviewing approaches, have achieved great success in reducing alcohol and drug use and associated negative consequences among those in the adolescent community and in clinical samples. However, such brief interventions have rarely been implemented and tested in juvenile detention or juvenile intake settings . To our knowledge, no such brief interventions have been developed or tested for juveniles referred to court clinics. However, our pattern of results suggests that enrolling juveniles and their families in a brief, evidence-based intervention at the point where the family is already referred for court clinic assessment services could be efficient, timely, and perhaps effective in reducing the likelihood of juvenile detention and other negative outcomes. Close to one billion people are affected by mental illness and substance misuse worldwide. In many developed countries, mental illness ranks top for burden of disease , is more common, impactful and costly than other health conditions, and is a core component of overall health. The total cost of mental illness in the USA is estimated to be $2.5 trillion ,marijuana grow tables the global antidepressant market is worth over $13.5billion and the wellness sector is estimated to be worth over $4.5 trillion . Despite record increases in psychiatric medication prescription rates, the prevalence of mental illness is not reducing and may well be increasing in certain populations, such as the young . There are indications that rates of mental illness have increased during the coronavirus disease 2019 pandemic . Evidence indicates that the efficacy of leading drug and psychological interventions is modest, and there is scope for improved tolerability and access . Most mental health interventions are reactive. Effective prophylactic intervention would be hugely valuable . Relatedly, early life trauma and mental illness are reliable predictors of future morbidity. There is a legacy of division between the biological and psychological arms of mental health care and research. A notable initiative towards innovation in biomedical psychiatry is the Research Domain Criteria . The main principle of RDoC is that, since diagnostic criteria are a product of clinical expediency, transdiagnostically relevant pathological mechanisms and treatment targets may have been overlooked. Relatedly, there is now good evidence for genetic overlap between psychiatric disorders . RDoC is primarily a biological initiative that aims to translate mental illness into ‘brain illness’, for the purpose of discovering candidate brain biomarkers and treatment targets .

Notable initiatives towards innovation in psychological health care include efforts to improve the cost-effectiveness of , access to and reach of psychotherapy – e.g. through utilising technological advances and social and familial networks . So-called ‘third wave’ psychotherapeutic approaches have gained traction, e.g. with a spike in the popularity of mindfulness and growing interest in – and evidence for – acceptance and commitment therapy . Bearing in mind relevance to RDoC, one important characteristic of these approaches is their alleged transdiagnostic relevance, i.e. that they seek to identify and target a common pathological mechanism, but more work is needed to link the relevant psychological constructs, such as ‘psychological flexibility’, with biological processes. There are promising signs of confluence between psychiatry’s biological and psychological divisions however, including a growing appreciation of the value of both psychological and neurobiological accounts of mental illness and its aetiology, as well as how environment, mind, brain and body interface and interact – consistent with the ‘biopsychosocial’ model . Specific examples of biopsychosocial research in psychiatry include studying: gene × environment and drug × environment interactions – of which drug assisted psychotherapy can be considered an example , neurophenomenology and the biological mechanisms of psychological interventions . Into this arena comes psychedelic therapy, a quintessentially biopsychosocial intervention. Evidence indicates that psychedelic therapy is a particularly promising and progressive mental health care solution . Classic serotonergic psychedelics can be most precisely defined by their pharmacology, i.e. agonist action at the serotonin 2A receptor, which, if blocked, effectively abolishes their signature psychological effects . Psychedelic therapy is defined here as psychologically supported classic psychedelic drug experiences – although we recognise that psychotherapy alongside experiences induced by certain other psychoactive substances, e.g. MDMA and ketamine, bears relation to classic psychedelic therapy. Psychedelic therapy has shown promise for a range of different mental health conditions, including: depression , end-of-life anxiety , addiction and obsessive compulsive disorder . Indirect evidence also supports its potential for treating eating disorders and chronic pain . See Andersen et al. for a review. The Food and Drug Administration has granted ‘breakthrough therapy’ status to two independent multi-site double-blind randomised controlled trials , aiming to bring psilocybin therapy to marketing authorisation for depression, while related work is currently underway across Europe. Population and controlled studies , as well as large retrospective and prospective surveys , are generating evidence for improved mental well-being across a large demographic, potentially opening psychedelic therapy up to a sizeable wellness market. The successful initiative to legalise psilocybin therapy in Oregon, USA, intentionally included access for healthy individuals. In addition to its putative transdiagnostic utility, other reasons to feel optimistic about psychedelic therapy include: its novel action , and rapid and enduring therapeutic impact . Unlike traditional psychiatric drugs, positive effects have been observed for several months after just one or two doses. In terms of safety, psychedelics such as psilocybin have a favourable toxicity profile and therapeutic index, and negligible addiction potential . Not wishing to neglect rare cases of putative iatrogenesis, including those of so-called ‘hallucinogen persisting perceptual disorder’ , the main hazards of psilocybin therapy relate to the intensity of the psychological state produced by higher doses, and associated need for a carefully engineered contextual container, e.g. with effective psychological preparation, supervision and aftercare. The utilisation of a drug-induced period of heightened cortical plasticity is likely to be a core component of psychedelic therapy’s mechanism of action and candidate functional and anatomical biomarkers of this are already being examined. In the context of a predictive processing framework, the ability of psychedelic therapy to relax and recalibrate cognitive and behavioural biases may be a central part of its action – as may an accelerated learning rate . How can we best advance the science of psychedelic medicine? Here we advocate pragmatic considerations , the utilisation of ‘basket’ protocols , as well as digitally aided data registries. Distinguishing pragmatic from confirmatory trials, the former refers to the actual, realistic conditions under which a therapeutic intervention will be received , whereas confirmatory trials typically engineer experimental conditions to support strong scientific inferences, but these often poorly reflect real-world conditions.