Children and adolescents afflicted with psychiatric illness are at particularly high risk for becoming part of the juvenile justice system. More than two thirds of justice-involved youth have psychiatric disorders (Abram et al., 2003; Shufelt & Cocozza, 2006; Teplin et al., 2002). Given the involvement of the legal system, youth being separated from families, and a host of other factors, mental health service delivery in a juvenile detention facility poses unique challenges. This article focuses on an overview of the problems commonly encountered in this setting. A clinical vignette will be used to highlight key points. The role and significance of trauma, common psychiatric disorders, and relevant medication rationale will be explored.