Substance Use & Mental Health

Mental health and substance use challenges affect a large share of youth entering the justice system. Yet too often, these are treated as disciplinary problems instead of medical ones. This article explores how states are shifting toward treatment-first approaches—and what data reveal about where gaps remain.

Introduction: The Overlap Between Systems

In nearly every Mid-South state, behavioral health needs are among the strongest predictors of system involvement. Youth struggling with depression, trauma, or substance use often cycle through detention and reentry without consistent care. Historically, mental health and justice systems have operated in silos—one focused on treatment, the other on control.

The emerging shift is toward integrated care—bridging behavioral health and supervision data so services can follow youth wherever they go.

Key Findings

• Prevalence remains high: Roughly half of justice-involved youth report symptoms of depression or anxiety; one in three meet criteria for a substance use disorder.
• Continuity is fragile: Youth often lose Medicaid or private coverage at the point of detention, interrupting treatment.
• Telehealth is expanding: Rural counties report major gains in access through school-based telehealth and crisis hotlines.
• Co-occurring disorders are underdiagnosed: Many programs still treat substance use and mental health separately, despite evidence they are tightly linked.

State Comparisons

Arkansas partners with community behavioral health providers to offer Care Coordination Units for youth under supervision. Louisiana and Mississippi have expanded mobile crisis teams that divert youth from emergency rooms. Texas maintains one of the largest adolescent SUD treatment networks in the region, integrating programs through Medicaid Managed Care. Tennessee has piloted trauma-focused cognitive behavioral therapy (TF-CBT) in group homes, while Oklahoma is testing telepsychiatry in juvenile facilities.

What Works

• Screen early, treat continuously: Routine behavioral health screens at intake catch emerging crises before escalation.
• Integrate systems: Data-sharing between juvenile justice and health departments reduces redundancy and improves follow-up.
• Invest in family-based therapy: Models like Multisystemic Therapy (MST) and Functional Family Therapy (FFT) reduce reoffending and relapse.
• Normalize care: Framing treatment as strength-building rather than punishment increases youth engagement.

Future Outlook

The next challenge is scaling proven models while protecting privacy. States are exploring shared electronic health records for youth in custody and “warm handoff” protocols to ensure no one leaves detention without a treatment plan. Broader access to school-based counseling, peer support networks, and culturally competent clinicians will be critical to sustaining progress.

Behavioral health reform isn’t just about access—it’s about belonging. When systems treat care as connection rather than compliance, outcomes change.

Sources

• SAMHSA / NSDUH State-Level Adolescent Data (2015–2024)
• Arkansas Department of Human Services: Behavioral Health Initiatives
• Texas HHSC: Youth Substance Use & Treatment Network Report (2023)
• Mississippi Behavioral Health Planning Council: Youth Services Report
• OJJDP: Behavioral Health Integration in Juvenile Justice Systems Toolkit

Related reading: Health & Family — how family stability and healthcare access support recovery.