On March 11, 2013, the Inter-American Commission on Human Rights held a hearing on the "Human Rights Situation of Children Deprived of Liberty with Adults in the United States." Below is the text of a letter Human Rights Watch sent to the executive secretary of the commission in advance of this hearing.
Emilio Álvarez Icaza
Inter-American Commission on Human Rights
Organization of American States
1889 F Street, NW
Washington, DC 20006
Re: Thematic Hearing on the Incarceration of Youth in US Adult Prisons
Dear Secretary Icaza:
Human Rights Watch is pleased to have this opportunity to submit an expert letter on the topic of the incarceration of persons who were below the age of 18 at the time of offense (youth offenders) in adult prisons in the United States. We commend the commission for holding this hearing and for engaging in a productive dialogue with the United States on this topic of grave importance to the human rights of children.
Youth offenders in the United States enter adult jails and prisons while still children or, depending on how long their trials and court proceedings last, as the youngest of adults. We estimate that in each of the last five years, more than 93,000 young people under age 18 were held in adult jails and that more than 2,200 young people under age 18 were held in adult prisons. Thousands more spend their early adulthood in prison. The effect on young lives is devastating.
Jails and prisons in the United States are often tense and overcrowded facilities in which all prisoners struggle to maintain their self-respect and emotional equilibrium in the face of violence, exploitation, extortion, and lack of privacy. There are stark limitations on family and community contacts and few opportunities for meaningful education, work, or other productive activities. Spending time in jail or prison is particularly difficult and damaging for young people.
Human Rights Watch has conducted in-person interviews and correspondence with more than 600 youth offenders sentenced to time in adult prisons and jails in the US. Based on this information and supporting research, we can describe the conditions that define the lives of such youth offenders.
Our research has found human rights abuses primarily in four categories:
First, youth offenders are among the inmates most susceptible to physical and sexual assault during their incarceration. Second, many young inmates are placed in isolated segregation, often constituting solitary confinement, some spending years without any but the most fleeting human contact. Third, many are denied access to adequate educational and vocational programs. Finally, facing violence, stultifying conditions, and separation from family and friends, many youth offenders sentenced to adult prison terms experience psychological harm, including deep depression and intense loneliness. Failed by prison mental health services, many contemplate and attempt suicide; some succeed.
Teens and young adults have developmental needs that must be met in order in order for them to fully mature into adulthood. For a youth offender in the middle of this essential developmental phase, denial of these opportunities for growth has life-long effects. Young people also need special protection from harm. Systematic failure to provide such opportunities and failure to protect young offenders from widespread violence and abuse in prison can turn a prison sentence into a punishment of excessive cruelty.
In addition to our reporting, a growing body of evidence suggests that a significant proportion of young offenders who enter the US adult criminal justice system are young people with disabilities. Young people with disabilities are entitled to special protections under international and regional human rights law to safeguard their right to full enjoyment “of all human rights and fundamental freedoms, on an equal basis with other [youth],” including when in conflict with the law. Failure to provide for young people with disabilities at such a crucial phase of their development can thus be doubly devastating to their rights as children and as persons with disabilities.
This letter will summarize some of our findings, detailed in Human Rights Watch reports over the last eight years.
I. Physical Harm and Sexual Assault of Youth in Adult Prisons
Violence is endemic in US prisons. Youth offenders who enter adult prison while they are still below the age of 18 experience more violence than those in juvenile training schools. According to a 1989 study surveying youth in adult prison and in juvenile training facilities, youth in adult prisons were “twice as likely” to report being “beaten up” by staff and “fifty percent more likely to report being attacked with a weapon” than youth in juvenile training facilities.
For many youth offenders sentenced to adult terms in US prisons, violence becomes a daily reality. Almost all of approximately 500 youth offenders serving life without parole that were interviewed or surveyed by Human Rights Watch suffered physical violence at the hands of other inmates. “Someone tried to cut my throat with a razor knife,” Gary J. told us. Nearly every respondent to a 2007 Human Rights Watch survey of youth life-without-parole inmates in California reported witnessing violent acts, including stabbings, murders, rapes, strangulations, and severe beatings. “I've seen more death in here than I did when I was living in the inner city,” Rudy L. said.
Statistics on sexual violence in US prisons also reveal a serious problem for youth offenders, especially since sexual violence is so severely underreported. US Department of Justice data suggest that between one-third and one-half of the victims of inmate-to-inmate sexual abuse in prisons in the United States are under age 25. Almost every male inmate we interviewed described having been approached by otherprisoners for sexual favors, or having to fight to protect themselves from rape. Warren P. wrote that when he first came to prison, at the age of 15, “I was the target of covert sexual predators. Adults would pretend to be your best friend to get close to you, then they would try you…. Officers would be hard on me more so than the adults for they believe that the younger inmates need rougher treatment.”
Small physique heightens the risk of sexual abuse. At 17, when Billy G. was convicted, he was tiny: “At trial, I was 5’5” and 119, 120 pounds.” Upon first entering adult prison, he said, “I was scared, confused, and intimidated,” and he explained that he had been physically assaulted, although he did not elaborate as to whether the assault was sexual in nature. In a 12-month period between 2008 and 2009, an estimated 88,500 inmates age 18 and older—64,500 in prison and 24,000 in jails—reported experiencing one or more incidents of sexual victimization by another inmate or facility staff. The youngest adults (those in the age group 18 to 19) and those in the lowest weight quartile (60 to 168 pounds for men and 65 to 144 pounds for women) reported the highest rates of sexual victimization, particularly that perpetrated by facility staff.
II. Solitary Confinement
Youth offenders often spend significant amounts of their time in US adult prisons and jails isolated from the general prison population. Life in long-term isolation usually involves segregating inmates for 22 or more hours a day in their cells. Prolonged periods of isolation can be devastating for anyone, but are especially devastating for young people. Such treatment is inconsistent with the obligation to treat young people humanely and with respect for the inherent dignity of the human person. The American Civil Liberties Union and Human Rights Watch published a report in 2012 detailing the use of solitary confinement of youth in US adult jails. In over 125 interviews and correspondence with people who were detained in adult jails and prisons while under the age of 18, these young offenders frequently described their experience in segregation as a profoundly difficult ordeal. Adolescents in solitary confinement described cutting themselves with staples or razors; hallucinating; losing control of themselves; or losing touch with reality while isolated. These mental health problems were often even more traumatic for young people with disabilities. They talked about only being allowed to exercise in small metal cages, alone, a few times a week, and about being prevented from going to school or participating in any activity that promotes growth or change. Some said the hardest part was not being able to hug their mother or father.
A growing consensus views protective isolation as acceptable only as a last resort and interim measure. Yet isolation is commonly used by prison officials as a quick—and long-term—solution, whether for punishment measures or protection challenges. The reason for the segregation is mostly lost on young inmates. “[I felt] doomed,” Molly J. told us. “[L]ike I was being banished … like you have the plague or that you are the worst thing on earth. Like you are set apart [from] everything else. I guess [I wanted to] feel like I was part of the human race—not like some animal.”
Severe psychological effects from isolation are not uncommon. Paul K., who spent 60 days in protective solitary confinement when he was 14, described how he came to want to end his life:
The hardest thing about isolation is that you are trapped in such a small room by yourself. There is nothing to do so you start talking to yourself and getting lost in your own little world. It is crushing. You get depressed and wonder if it is even worth living. Your thoughts turn over to the more death oriented side of life.… I want[ed] to kill myself.
Luz M. said suicidal thoughts came immediately after she went into solitary confinement: “I hung up [tried to hang myself] the first day. I took a sheet and tied it to my light and … [t]he officer, when she was doing rounds, found me. She was banging on the window: ‘Are you alive? Are you alive?’”
III. Lack of Education and Rehabilitative Programs
The paradigm of prison as a place for rehabilitation has steadily lost public support and political currency over the last two decades in the United States. Most prisons pay nominal attention to improving inmates’ skills and lives, regardless of their sentences. Concern about promoting successful reentry is gaining recognition as an effective means of preventing recidivism but has yet to make a meaningful impact on the nature of most prison programs. Yet basic literacy programs and primary education are required under international human rights law for persons under age 18, and other forms of rehabilitative programs are important in fulfilling governments’ responsibilities to promote the human development of youth offenders.
It is not just a lack of programming that harms young inmates. Testimony and survey responses gathered by Human Rights Watch show that youth offenders are often deemed ineligible for existing programs or are placed at security levels that reduce their access to programming. Prison systems categorize inmates as they enter the prison system, and the categorization determines where an inmate is placed within the system. Rigid classification processes put youth offenders at a disadvantage: their lack of experience in the world counts as a risk factor in correctional analysis, resulting in their being placed at a higher level of security. Placement has far-reaching ramifications. Generally, the higher the level of security, the less access there is to programs and services.
Typically the security level is based on several factors, including the inmate’s sentence and behavior. Inmates placed at a higher level can work their way down to housing placements at lower levels of security with evidence of good behavior. In some situations, however, behavior is not counted. For example, for youth sentenced to life without parole in California, state regulations mandate placement at the maximum level of security for every person serving a life without parole sentence. While other inmates can, in essence, work their way down to lower levels, these youth offenders cannot.
In addition, segregation can exacerbate the lack of opportunities for existing programs described in more detail later in this letter:
Right now I’m not receiving no schooling or counseling due to being in ASU (Administrative Segretion Unit.) They have no schooling for me or etc. They are way out of conduct here. I been asking to receive some GED work but I haven’t receive no responce. I wish to recieve schooling. I learn how to read and write in prison and I want to be successful. I might get out one day.
Many youth offender inmates serving life without parole sentences told us that the sentence itself puts them on the lowest rung of waiting lists for GED classes and substance abuse rehabilitation groups like Alcoholics Anonymous (AA), with priority being given to inmates with a set number of years on their sentence. “Those programs are mainly for people that are going home,” one youth said, echoing the conclusion of many.
VI. Psychological Harm
There is a considerable incongruity between the physical or mental immaturity of young prisoners and the kinds of experiences and people prison forces them to confront. Many of those interviewed by Human Rights Watch reported suffering from, and being medicated for, depression. Studies have found alarmingly high rates of suicide among children in prison. The US Department of Justice has reported that the average annual suicide mortality rate for youth under 18 in prison between 2000 and 2002 (52 per 100,000 inmates) was nearly four times that for all other age groups (14 or below per 100,000 inmates); and it was 6.5 times that of persons in a similar age group who are not incarcerated (approximately 8 per population of 100,000 10- to 24-year-olds).
David C., now 29, was sent at age 18 to one of California’s highest security prisons:
[I was] scared to death. I was all of 5’6”, 130 pounds and they sent me to PBSP [Pelican Bay State Prison]. I tried to kill myself because I couldn’t stand what the voices in my head was saying…. “You’re gonna get raped.” “You won't ever see your family again.”
David C. was not the only one who said he had tried to kill himself. A number of others interviewed by Human Rights Watch told us they had considered or attempted suicide when they entered prison. Yekonya H. wrote, “I felt scared not knowing what would become of me, nor what to expect. I was alone, in desperate need of guidance. I thought about killing myself to escape the pain and frustration I felt, for not being a better child.” Several of those interviewed described watching other inmates commit suicide.
Nearly every youth offender described isolation from friends and family as one of the most profound factors affecting mental health during incarceration. These negative psychological effects are more likely to be acute in those who enter prison at a younger age. Research also suggests that mental illness is prevalent among youth in the criminal justice system.
Thank you for this opportunity to present information to the commission on the serious human rights problems faced by youth offenders in adult prisons. We specifically urge the commission, or its special rapporteur on the rights of the child, to undertake a mission to observe and report on this practice in the United States. Within the scope of any fact-finding, we urge the commission to request additional information from the United States government (and its states) on these practices, such as:
- the precise number of youth offenders charged or sentenced as adults or held in jails and prisons;
- information about the risk and incidence of physical and sexual assault for youth offenders held in adult facilities;
- the rates at which young people are subjected to solitary confinement or other forms of physical and social isolation in adult jails and prisons;
- the numbers of youth offenders subject to adult criminal supervision (such as parole, probation, and sex offender registration); and
- a further request that any such statistics be disaggregated by age, race, sex, gender or gender identity, disability status, and sexual orientation.
We hope that the commission’s review of the US practice will encourage US compliance with its international and regional human rights obligations to provide age-appropriate treatment for youth and to respect their dignity and rights.
Director, US Program
Human Rights Watch
 In this letter, “youth offender” means persons convicted of crimes committed while they were below age 18.
 Human Rights Watch, Growing Up Locked Down: Youth in Solitary Confinement in Jails and Prisons Across the United States, October 10, 2012,https://www.hrw.org/reports/2012/10/10/growing-locked-down, p. 5.
 The New York City Department of Corrections reported to Human Rights Watch that 48 percent of adolescents (youth 16-18 years old) detained there last year had a diagnosed mental disability (that is, a diagnosis of a mental health condition defined by the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association). Human Rights Watch, Growing Up Locked Down: Youth in Solitary Confinement in Jails and Prisons Across the United States. Other researchers have found rates of psychosocial disabilities as high as 68 percent. Jason Washburn et al., “Psychiatric Disorders Among Detained Youths: A Comparison of Youths Processed in Juvenile Court and Adult Criminal Court,” Psychiatric Services, vol. 59, no. 9 (2008), http://ps.psychiatryonline.org/data/Journals/PSS/3857/08ps965.pdf, p. 965 (accessed August 27, 2012).
 Convention on the Rights of Persons with Disabilities (CRPD), adopted December 13, 2006, G.A. Res. 61/106, Annex I, U.N.GAOR, 61st Sess., Supp. (No. 49) at 65, U.N. Doc. A/61/49 (2006), entered into force May 3, 2008, arts. 7(1), 14. The United States signed the CRPD in 2009 but has not ratified.
 Martin Forst et al., “Youth in Prisons and Training Schools: Perceptions and Consequences of the Treatment-Custody Dichotomy,” Juvenile & Family Court, vol. 4 (1989), p. 9. See also Jason Ziedenberg and Vincent Schiraldi, “The Risks Juveniles Face When They Are Incarcerated with Adults” Justice Policy Institute, July 1997, http://www.justicepolicy.org/images/upload/97-02_REP_RiskJuvenilesFace_J... (accessed December 12, 2011).
 Survey response from Gary J. (pseudonym), serving life without parole in California, to Human Rights Watch, July 26, 2007 (on file with Human Rights Watch).
 Ninety-one percent of respondents to the Human Rights Watch survey reported that they had witnessed violence while in prison. Respondents often provided longer, narrative answers to explain with more specificity the types of violence witnessed and the perpetrator. Several did not answer the question and wrote that they feared retaliation if they answered the question. Without being asked directly about the type of violence witnessed, 46 percent of respondents who wrote a narrative answer describing violence they had witnessed noted that they had seen stabbings.
 Survey response from Rudy L. (pseudonym), serving life without parole in California, to Human Rights Watch, July 29, 2007 (on file with Human Rights Watch).
 National Prison Rape Elimination Commission, “National Prison Rape Elimination Commission Report,” June 2009, https://www.ncjrs.gov/pdffiles1/226680.pdf (accessed December 25, 2011), Chapter 1: A Problem That Must Be Solved, p. 39. As noted in the report Against All Odds, Human Rights Watch came across many cases of sexual violence against youth offenders that were never reported. Human Rights Watch, Against All Odds: Prison Conditions for Youth Offenders Serving Life without Parole Sentences in the United States, January 4, 2012, https://www.hrw.org/reports/2012/01/03/against-all-odds-0.
 Paul Guerino and Allen J. Beck, Bureau of Justice Statistics, “Sexual Victimization Reported by Adult Correctional Authorities, 2007-2008,” January 2011, http://www.bjs.gov/content/pub/pdf/svraca0708.pdf (accessed December 9, 2011); and Allen J. Beck, Paige M. Harrison, and Devon B. Adams, Bureau of Justice Statistics, “Sexual Victimization Reported by Adult Correctional Authorities, 2006,” August 2007, http://www.bjs.gov/content/pub/pdf/svrca06.pdf (accessed December 9, 2011). Other reports have also found that victims consistently tend to be younger than perpetrators. See Austin et. al, The JFA Institute, “Sexual Violence in the Texas Prison System,” March 2006, https://www.ncjrs.gov/pdffiles1/nij/grants/215774.pdf (accessed December 9, 2011); and Pat Kaufman, National Institute of Justice, “Prison Rape: Research Explores Prevalence, Prevention,” March 2008, https://www.ncjrs.gov/pdffiles1/nij/221505.pdf (accessed December 9, 2011).
 Letter to Human Rights Watch from Warren P. (pseudonym), serving life without parole in Florida, March 2, 2004 (on file with Human Rights Watch).
 Human Rights Watch interview with Billy G. (pseudonym), serving life without parole in California, June 29, 2007.
 Allen J. Beck and Paige M. Harrison, Bureau of Justice Statistics, “Sexual Victimization in Prisons and Jails Reported by Inmates, 2008-09,” August 2010, http://bjs.ojp.usdoj.gov/content/pub/pdf/svpjri0809.pdf (accessed December 19, 2011). There are few studies focusing specifically on sexual abuse of youth under age 18; however the recent report produced by the Prison Rape Elimination Commission cited a 2005 study: “Youth confined with adults also are at high risk of sexual abuse. In 2005, for example, individuals under the age of 18 made up less than 1 percent of all inmates in US jails. Yet 21 percent of all victims of substantiated incidents of sexual abuse involving jail inmates that year were under the age of 18.” “National Prison Rape Elimination Commission Report,” p. 42 (citing A. J. Beck and P. M. Harrison, Bureau of Justice Statistics, “Sexual violence reported by correctional authorities, 2005,” 2006) (internal citations omitted).
 Because of the potential impact, US courts have looked closely at placement of adults into isolation, the length of isolation time imposed, and conditions in the isolation cell. See Bureau of Justice Assistance, US Department of Justice, “Juveniles in Adult Prisons and Jails: A National Assessment,” October 2000, https://www.ncjrs.gov/pdffiles1/bja/182503.pdf (accessed December 28, 2011), p. 25, citing Harris v. Maloughney, United States District Court for the District of Montana, 1993 (827 F. Supp. 1488 (D. Mont. 1993)); McCray v. Burrell, United States Court of Appeals for the Fourth Circuit, 1975 (516 F.2d 357 (4th Cir. 1975)); and Lareau v. MacDougal, United States Court of Appeals for the Second Circuit, 1972 (473 F.2d 974 (2nd Cir. 1972)).
 Convention on the Rights of the Child (CRC), adopted November 20, 1989, G.A. Res. 44/25, annex, 44 U.N. GAOR Supp. (No. 49) at 167, U.N. Doc. A/44/49 (1989), entered into force September 2, 1990. The United States signed the CRC in 1995 but has not ratified. See also Organization of American States, American Declaration of the Rights and Duties of Man, art. VII, XXV, O.A.S. Res. XXX, adopted bythe Ninth International Conference of American States (1948), reprinted inBasic Documents Pertaining to Human Rights in the Inter-American System, OAS doc. OEA/Ser.L.V/11.82 doc.6 rev.l at 17 (1992). The United Nations Committee on the Rights of the Child has suggested that punitive solitary confinement of young people under age 18 is cruel, inhuman, or degrading treatment. UN Committee on the Rights of the Child, General Comment 10, Children’s rights in juvenile justice, U.N. Doc. CRC/C/GC/10 (2007). The Office of the United Nations Special Rapporteur on Torture has twice called for a ban on the solitary confinement of children. Special Rapporteur on Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment Juan Mendez, “Interim Rep. of the Special Rapporteur on Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment,” para. 77, U.N. Doc. A/66/268, August 5, 2011; Special Rapporteur on Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment Manfred Nowak, “Interim Rep. of the Special Rapporteur on Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment,”paras. 78-85, Annex (Istanbul Statement on the Use and Effects of Solitary Confinement), U.N. Doc A/63/175, July 28, 2008.
 Human Rights Watch, Growing Up Locked Down: Youth in Solitary Confinement in Jails and Prisons Across the United States.
 “National Prison Rape Elimination Commission Report,” p. 8.
 Human Rights Watch interview with Molly J. (pseudonym), Michigan, March 2012.
 The American Academy of Child and Adolescent Psychiatry has said that, “due to their developmental vulnerability, juvenile offenders are at particular risk of … adverse reactions” to solitary confinement and opposes the use of the practice on juveniles. Juvenile Justice Reform Committee, American Academy of Child and Adolescent Psychiatry, “Policy Statements: Solitary Confinement of Juvenile Offenders,” April 2012, http://www.aacap.org/cs/root/policy_statements/solitary_confinement_of_j... (accessed February 20, 2013).
 Human Rights Watch interview with Paul K. (pseudonym), Michigan, March 2012.
 Human Rights Watch interview with Luz M. (pseudonym), New York, April 2012.
 See, for example, Michele D. Buisch, “Budget Cuts Present Challenge to Many State Correctional Agencies,” Corrections Today, December 2003; Erin M. Samolis, “Divergent Clockwork Oranges: The Juvenile Justice Systems of the United States and Great Britain,” University of Chicago Law School Roundtable, vol. 8 (2001), p. 189; Barry C. Feld, “Juvenile and Criminal Justice Systems’ Responses to Youth Violence,” Crime and Justice, vol. 24 (1998), p. 189; Craig Haney, “Psychology and the Limits to Prison Pain,” Psychology, Public Policy, and Law, vol. 3, no. 4 (1997), p. 499.
 Convention on the Rights of the Child, art. 28.1(a) requires states to “make primary education compulsory and available free to all.” In addition, the UN Rules for the Protection of Juveniles Deprived of their Liberty state that “children should be guaranteed the benefit of meaningful activities and programs which would serve to promote and sustain their health and self-respect, to foster their sense of responsibility and encourage those attitudes and skills that will assist them in developing their potential as members of society.” UN Rules for the Protection of Juveniles Deprived of their Liberty, G.A. Res. 45/113, annex, 45 U.N. GAPR Supp. (no. 49A) at 205, U.N. Doc. A/45/49, (1990), http://www.un.org/documents/ga/res/45/a45r113.htm (accessed December 12, 2011), para. 12.
 Human Rights Watch telephone interview with Ross Meier, Sacramento, California, November 14, 2007. California State prisons are divided into four levels of security, with level I being the lowest level of security and IV the highest. See California Code of Regulations, Title 15§3375.(2)(a), which states, “An inmate serving a sentence of life without possibility of parole shall not be housed in a facility with a security level lower than Level IV, except when authorized by the Departmental Review Board.” Meier told Human Rights Watch that individuals serving life without parole are allowed to petition to have their level lowered. However, for those serving life without parole, a change in security classification to a level III requires a decision by the deputy director after review by a classification committee. Meier refused to speculate as to how often an inmate serving life without parole has his or her classification reduced. None of the 135 individuals in California with whom Human Rights Watch communicated said they had had their classification reduced from a level IV to a level III.
 Survey response from Randy T. (pseudonym), serving life without parole in California, to Human Rights Watch, August 7, 2007 (on file with Human Rights Watch).
 Survey response from “Anonymous,” serving life without parole in California, to Human Rights Watch, 2007 (on file with Human Rights Watch).
 Christopher J. Mumola, Bureau of Justice Statistics, “Suicide and Homicide in State Prisons and Local Jails,” August 2005, http://www.bjs.gov/content/pub/pdf/shsplj.pdf (accessed December 9, 2011) (reporting suicide rates of 14 per 100,000 prisoners age 18 to 24, 25 to 34, and 35 to 44, as well as a suicide rate of 13 per 100,000 for those prisoners age 45 to 54 and 55 or older).
 Center for Disease Control, “National Suicide Statistics at a Glance, Trends in Suicide Rates Among Both Sexes, by Age Group, United States, 1991–2009,” http://www.cdc.gov/violenceprevention/suicide/statistics/trends02.html (citing data from 2002 for comparison purposes).
 Survey response from David C. (pseudonym), serving life without parole in California, to Human Rights Watch, July 28, 2007 (on file with Human Rights Watch).
 Survey response from Yekonya H. (pseudonym), serving life without parole in California, to Human Rights Watch, July 26, 2007 (on file with Human Rights Watch).
 Craig Haney, “The Psychological Impact of Incarceration: Implications for Postprison Adjustment,” in Jeremy Travis and Michelle Waul, eds., Prisoners Once Removed: The Impact of Incarceration and Reentry on Children, Families, and Communities (Urban Institute Press, 2003). Researchers have also observed that “individuals experiencing longer incarcerations have a harder time preserving their self-identity and their self-esteem,” which may be exacerbated when an individual’s character is not formed to begin with. Kristy Matsuda, “The Impact of Incarceration on Young Offenders,” Ph.D. dissertation, June 2009, https://www.ncjrs.gov/pdffiles1/nij/grants/227403.pdf (accessed December 9, 2011) (citing T.J. Flanagan, “Dealing with long-term confinement: Adaptive strategies and perspectives among long-term prisoners,” Criminal Justice and Behavior, vol. 8, no.2 (1988), pp. 201, 222).
 Daniel C. Murrie et al., “Psychiatric Symptoms Among Juveniles Incarcerated in Adult Prison,” Psychiatric Services, vol. 60, no. 8 (2009) (stating that prevalence rates may exceed 60 percent). See, for example, Jason J. Washburn et al., “Psychiatric Disorders Among Detained Youths: A Comparison of Youths Processed in Juvenile Court and Adult Criminal Court,” Psychiatric Services, vol. 59, no. 9 (2008), Table 2.