Opinion: What a doctor learned from one young man’s second chance

DR. David L. Bell. Photo via

By David L. Bell

When I meet a 19-year-old in the clinic, the law tells me he is an adult. My medical training and more than two decades caring for adolescents and young adults tell me something more complicated.

I see the gap between knowing right from wrong and consistently making sound decisions in moments of anger, fear, trauma, or peer pressure. I see young people who say they want to finish school, support their families, and stay out of trouble, but whose ability to pause, regulate emotions, and consider long-term consequences is still developing.

This is not an excuse for harm. It is a clinical reality.

Medicine and neuroscience recognize ages 19 through 25 as “emerging adulthood,” a distinct developmental stage. By the late teens, most young people can reason and understand consequences. But the parts of the brain involved in impulse control, emotional regulation, long-range planning, and susceptibility to peer influence are still maturing into the mid-20s. Researchers call this period “transient immaturity.”

In my practice, I have seen how a decision made in a moment can change the course of a young person’s life.

I think of one former patient whom I first met when he was a teenager. He came to see me for two years and then disappeared. About five years later, he returned to my office, struggling with depression; during his absence, he had made a serious mistake and was incarcerated. When he came back to my office, he was trying to rebuild his life but his incarceration history became a hurdle.

He did not receive a life sentence, but the consequences extended beyond prison. He carried significant stress and struggled to imagine a future beyond the worst decision he made as a teenager.

Thankfully, we were able to support and help him persist. In a short period, he completed college. We then connected him to a lawyer, who helped get his case sealed. Today, he is a firefighter, serving the kind of community that may once have viewed him only through the lens of his past.

His story is not simply about individual determination. It shows what is possible when a young person has treatment, education, and most of all support and help navigating the barriers justice-involvement creates.

Many young people who enter the criminal legal system have already experienced various adverse childhood experiences. Incarceration compounds that trauma. Research links youth incarceration with depression, anxiety, post-traumatic stress disorder, and suicidal ideation. It can also disrupt mental health care and make it difficult for young people to trust providers and seek help after release.

The Youth Justice & Opportunities Act offers a chance to prevent more young people from having to travel the difficult path my former patient faced. For eligible New Yorkers ages 19 to 25, the legislation recognizes emerging adulthood in law and gives judges more options for community-based Alternatives to Incarceration, including trauma-informed counseling, education, workforce development, and other supports.

It does not erase accountability. It makes it more constructive: helping young people confront harm, build developing skills, and stay connected to treatment, education, and supportive relationships, so a serious mistake does not become the defining story of their life.

As a physician, I am trained to intervene before an injury becomes irreversible. New York should apply the same principle to emerging adults: hold them accountable, provide the support they need to heal, and give them a real opportunity to become more than their mistakes.

David L. Bell, MD, MPH, is the medical director at The Lawrenceville School. He formerly served as professor of pediatrics and population and family health at Columbia University Irving Medical Center and was medical director of the Young Men’s Clinic at New York-Presbyterian Hospital.