We illustrate disparities/inequities and opportunities for equitable suicide prevention across the SIM for youth impacted by the JLS (see Figure 1) using a Structural Racism and Suicide Prevention Systems Framework ( 9), which posits that youth are embedded across multiple ecological systems that illustrate how individual, interpersonal, community, and societal factors intercept and influence each other over time and have an impact on suicide risk. Our iteration of the SIM views the intercepts from a clinical perspective as various touchpoints for culturally responsive, trauma-informed suicide prevention. We expand this to include an intercept zero “Prevention,” separated court processes from confinement, and redefine confinement to include the juvenile-specific types of juvenile detention and long-term placements (either structured residential or psychiatric residential treatment centers). ( 8) applied the SIM to the JLS and outline intercepts as (1) the first contact with either emergency services, (2) initial hearings and detention post-arrest, (3) jails and courts, (4) re-entry, and (5) community corrections. The Sequential Intercept Model (SIM) was developed to describe various points in the criminal justice process at which individuals with mental illnesses could be diverted to alternative rehabilitative services and treatment ( 7). Indeed, suicide rates are up to three times higher for youth impacted by the JLS than youth in the general population ( 3– 5), and risk for suicide increases with greater involvement in the JLS ( 6). When considering the different social systems in where Black and Latinx adolescents are disproportionately embedded in, youth in the juvenile legal system (JLS) are at even greater risk of suicide. Recent data suggests that Black and Latinx adolescent girls have the highest rates of suicide attempts (15.9 and 11.9%, respectively), compared to 9.4% of non-Hispanic White adolescent girls ( 2). However, these rates do not consider the rapid increase in suicide deaths and elevated rates of suicide attempts for Black and Latinx youth. Historically, White youth have higher rates of death by suicide, when compared to Black and Latinx youth. Suicide is the second leading cause of death for adolescents in the U.S. We provide recommendations of priorities to promote health equity in suicide prevention for ethnoracially minoritized youth impacted by the JLS. Our purpose is to provide a comprehensive picture of gaps and equitable opportunities for suicide prevention across each intercept of the SIM. There are various potential touch points of care for suicide prevention and the Sequential Intercept Model (SIM), which outlines community-based responses to the involvement of people with mental and substance use disorders in the criminal justice system, can be used as a strategic planning tool to outline possible equitable interventions across these various touch points. In order to disrupt the current elevated rates of suicide among Black and Latinx youth involved in the JLS, there needs to be more concerted efforts to improve assessment and suicide prevention efforts in the JLS. This public health crisis is also a matter of health equity, knowing that ethnoracially minoritized youth, mainly Black and Latinx youth, have disproportionate contact with the JLS. Despite the already alarmingly high rates of suicide attempts among adolescents, youth involved in the juvenile legal system (JLS) are up to three times more likely to have suicide attempts than their peers not impacted by the JLS. Suicide is the second leading cause of death for adolescents in the United States.
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