In the course of a mental health assessment, in order to learn if a juvenile has certain specific disorders, he/she is asked about engaging in illegal activities such as physically harming others, shoplifting, or substance use. This raises the unwelcome possibility that a youth might self-incriminate by confirming those activitiess truthfully. Facilities responsible for youths prior to adjudication must balance the need to accurately identify mental health problems with the responsibility to protect youths from self-incrimination. Information disclosed to detention staff during a mental health screening or assessment may not be confidential. During mental health screening a youth may admit illegal behavior (e.g., substance use) that was not the focus of detention (e.g., shoplifting). Therefore, justice facilities must have protections in place so that information provided during an intake screen cannot be used in support of current or future charges. Different sites handle these issues in different ways, with some protecting what is disclosed during a mental health assessment from affecting a youth’s legal status, and some following a different predetermined protocol.

Unless there are such existing safeguards at the state or local level, the Center advises sites using the Voice DISC with pre-adjudicated youth to withhold four disorder modules with potentially self-incriminating questions (Conduct Disorder, Alcohol Abuse, Marijuana Abuse, and Other Substance Abuse). These modules can, if necessary, be easily administered at a later date, post-adjudication, and can then be integrated seamlessly into the prior Voice DISC assessment.

There is considerable controversy at present regarding how to balance protections regarding youth self-incrimination and confidentiality with need to address mental health needs. The AACP Standards (2000) recommend a documented policy ensuring confidentiality of all psychological files, records, and test protocols, with access to this material only on a “need-to-know” basis. The NCCHC (1999) report emphasizes the inappropriateness of health services staff collecting forensic information. Although some states have formal and informal procedures for protecting such information, they are rare. Ongoing dialogue among legal advocates, mental health advocates, and justice practitioners is needed.