Northwestern University Feinberg School of Medicine

Department of Psychiatry and Behavioral Sciences

Health Disparities & Public Policy

The Health Disparities & Public Policy program (formerly the Psycho-Legal Studies program) investigates health needs of traditionally underserved populations such as racial/ethnic minorities, impoverished persons, the homeless, and incarcerated populations.  

Findings from the group’s studies have shaped US public health policy, and been cited in Supreme Court amicus briefs, congressional hearings, and Surgeon General’s reports.  

We have studied the following topics:

Current Studies

The Northwestern Juvenile Project (NJP)

The NJP is the first large-scale, longitudinal study of the mental health needs, substance abuse, antisocial and criminal behaviors, and adult outcomes of delinquent youth.  From 1995 to 1998, we enrolled 1829 randomly-selected youth, 1164 males and 665 females, as they entered the Cook County Juvenile Temporary Detention Center.  The sample is stratified by gender, race / ethnicity (African American, non-Hispanic white, Hispanic), age, and severity of charge.  Importantly, it includes sufficient African Americans and Hispanics (including diversity among Hispanics) to examine health inequities. Funded by a consortium of federal agencies and private foundations (see Grants and Funding below), we have been tracking and re-interviewing our participants since April 1996.  Unlike many studies that lose participants if they are incarcerated at follow-up, we re-interview our participants regardless of whether they are living in the community or are incarcerated.  Thanks to the generosity of our participants, state-of-the-art search tools, a sophisticated data management system, and the cooperation of many agencies in Chicago, Cook County, and the State of Illinois, we re-interviewed 81.6% of participants still enrolled in the study at the 16-year follow-up. 

How Is the Northwestern Juvenile Project Unique?  Most prior investigations examined community populations to see who becomes delinquent; the Northwestern Juvenile Project studies youth already in the juvenile justice system.  We study these youth because they are at great risk for psychiatric disorders, life-threatening problem behaviors, HIV/AIDS, and premature violent death. Most studies of correctional populations focus only on criminogenic variables; the Northwestern Juvenile Project also examines health and social outcomes, and follows these outcomes over time.  To date, participants have been interviewed up to 13 times.  Our longitudinal design thus includes data on adolescence (10-17 years), emerging adulthood (18-24 years), and young adulthood (25+ years).  Our findings help guide the development of intervention strategies for delinquent youth and incarcerated young adults.

We disseminate our findings to maximize the benefit of the study for the public. We publish articles in scientific journals that are widely read and broadly disseminated.  In addition, we archive a copy of the data at National Archive of Criminal Justice Data, allowing other investigators to pursue additional analyses.  Finally, we collaborate with organizations such as the National Juvenile Detention Association, American Bar Association, and the National Institute of Corrections to ensure that our findings are available to guide innovative justice policy.  Our findings have been cited in Supreme Court amicus briefs, in congressional hearings, and by many federal agencies, private agencies, and advocacy groups.

The Northwestern Juvenile Project: Next Generation

Our next step is to study the children of the original participants in the Northwestern Juvenile Project, focusing on characteristics that promote resilience in at-risk families.  We recently received grants from the U.S. Department of Justice and the National Institutes of Health focusing on resilience to drug abuse and firearm involvement.  In addition, we plan to examine how a parent’s incarceration (especially during the child’s lifetime) affects their children, and what factors promote mental health, being substance free, avoiding problem behaviors, and positive educational outcomes.

Previous Studies

The Northwestern Victimization Project

Started in 1995, the Northwestern Victimization Project was the first large-scale, longitudinal study of crime victimization patterns in persons with severe mental illnesses living in the community.  Prior studies of violence and mental disorders had focused on perpetration by persons with severe mental illnesses, not victimization.  We examined the rates, risk factors, and patterns of crime victimization in 936 persons with chronic, severe mental disorders.  More than one-quarter of the sample had been victims of a violent crime in the past year, a rate more than 11 times higher than general population rates, even after controlling for demographic differences between the two samples.  The Northwestern Victimization Project has been replicated in the Netherlands and other countries, where public health officials now realize that victimization of persons with severe mental illnesses is a far more serious threat to public health than perpetration.

Psychiatric Disorders in Male and Female Adult Jail Detainees

The Health Disparities and Public Policy program conducted the first large-scale epidemiologic studies of psychiatric disorders among male and female adult jail detainees.  Between 1983 And 1995, a series of investigations examined (1) the prevalence of psychiatric disorders in jail detainees, and (2) whether detainees who had severe mental illnesses received treatment while in jail.  Our findings highlight the discrepancy between jail detainees’ need for mental health services and the services that they receive.  The data showed that of male detainees who needed psychiatric services, only 37 percent received them.  Only 20 percent of female detainees who needed psychiatric services received them.  Because jails were never intended to be psychiatric hospitals, few have the resources necessary to adequately treat the increasing numbers of detainees entering jails nationwide.  Our findings demonstrated that jails must systematically screen detainees upon admission, provide treatment during their stay, and refer them for services after they are released.

Psychiatric Disorders in Male and Female Adult Jail Detainees

The Health Disparities and Public Policy program conducted the first large-scale epidemiologic studies of psychiatric disorders among male and female adult jail detainees.  Between 1983 and 1995, a series of investigations examined (1) the prevalence of psychiatric disorders in jail detainees, and (2) whether detainees who had severe mental illnesses received treatment while in jail.  Our findings highlight the discrepancy between jail detainees’ need for mental health services and the services that they receive.  The data showed that of male detainees who needed psychiatric services, only 37 percent received them.  Only 20 percent of female detainees who needed psychiatric services received them.  Because jails were never intended to be psychiatric hospitals, few have the resources necessary to adequately treat the increasing numbers of detainees with psychiatric disorders entering jails nationwide.  Our findings demonstrated that jails must systematically screen detainees upon admission, provide treatment during their stay, and refer them for services after they are released.

Consequences of Deinstitutionalization: The Police as Street-corner Psychiatrists

Incarceration of persons with psychiatric illnesses disproportionately affects minorities, who are least likely to be able to afford mental health care.  In an observational study of police officers, our findings showed that mentally ill persons had an arrest rate nearly double that of non-mentally ill persons.  Police reluctantly arrested mentally ill persons when a mental health evaluation and treatment would have been preferable but was not available.  The findings suggested that reduced community services had resulted in mentally ill persons being “criminalized”; for many, arrest had supplanted hospitalization.  The findings supported the thesis, set forth by public health experts, that for poor persons—especially racial/ethnic minorities—arrest and incarceration had become the entrée for receiving mental health services.  The findings of this study were cited in amicus briefs to the Supreme Court, were used in many hearings by Congress, and highlighted the need for special diversion programs for mentally ill persons in the criminal justice system.


Our Publications

Northwestern Juvenile Project Peer-Reviewed Publications

High-Impact Publications (Selected)

 Government Publications

Grants and Funding

The Health Disparities & Public Policy program has been funded by a consortium of federal agencies and private foundations, including:

Faculty

Linda A. Teplin, PhD, Owen L. Coon Professor of Psychiatry
Karen M. Abram, PhD, Associate Professor
Leah J. Welty, PhD, Assistant Professor
Amelie Petitclerc, PhD, Assistant Professor

Current Graduate Students

María José Luna
Nanzi Zheng

Staff

David Aaby, MS, Senior Statistical Analyst
Ron Cleveland,BA, Field Interviewer
Nicholas Meyerson, MA, Data Assistant
Rosa Narvaez, Tracking Coordinator
Erika Ostrander, MA, Project Manager
Kristin Porzak, BA, Research Assistant
Michele Reitsma, Program Assistant
Hillary Rowe, MA, Project Coordinator

Contact Us

For more information about Health Disparities & Public Policy, contact us at: 312-503-3500

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