First community mental health contact after youth justice supervision among adolescents in New South Wales, Australia: timing, setting, and association with reincarceration in a population-based data-linkage study

<title>Abstract</title> <p>Background. Mental disorders are highly prevalent among justice-involved adolescents, and continuity of mental health care is least well maintained when adolescents move between custody, community supervision, and release. We described the timing and setting of first community mental health contact after youth justice supervision, identified characteristics associated with time to first contact, and estimated the association between early contact after release and reincarceration. Methods. This population-based retrospective cohort study included 1,589 adolescents aged 10 to 17 years in custody or on community orders in New South Wales, Australia, drawn from four total-population youth justice health surveys linked to administrative health, justice, and mortality records. Mental health disorder was ascertained from health records and self-report. Time to first community mental health contact over 24 months of custody-free follow-up was modelled using flexible parametric survival models. Landmark analyses at 7, 14, 21, and 28 days after release estimated adjusted reincarceration risks using modified Poisson regression. Results. Mental health disorder was ascertained in 676 adolescents (42.5%). Among them, 17.8% made community mental health contact within 30 days and 48.4% had no contact within 24 months. Of 349 first contacts, 29.2% occurred through an emergency presentation, a same-day hospital episode, or a psychiatric admission. Contact was slower among Aboriginal and/or Torres Strait Islander adolescents (adjusted hazard ratio 0.74, 95% CI 0.58 to 0.94) and after release from custody (0.44, 0.27 to 0.66, at 24 months), and faster among adolescents with mood disorder and psychosis. Early contact was associated with lower reincarceration at every landmark (adjusted risk ratios 0.82 to 0.84). Conclusions. Community mental health contact after youth justice supervision was delayed or absent for many adolescents with a mental health disorder, and first contact frequently occurred through emergency or inpatient care. Early linkage to community mental health care after release should be a shared priority for youth justice and child and adolescent mental health services.</p>