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This paper draws together insights into young people with complex needs in the juvenile justice system. Looking comparatively at Australia and England and Wales, juvenile justice institutions are filled with some of the most vulnerable young people in our societies. These young people generally have low educational attainment, backgrounds of economic and social disadvantage, housing instability, drug and alcohol addiction, mental and cognitive disability, experiences of trauma and abuse, and/or placements in out-of-home-care. Using critical disability and critical criminology theoretical orientations, our work suggests these complex needs are created by social and institutional arrangements that normalise the criminalisation of disability related behaviours and present challenges to young people themselves, as well as to policymakers and those who work in services intended to support them. This research looks at interventions and support for vulnerable young people comparatively; at the provision of healthcare within the community and in custodial settings; the detrimental impacts of detention; and finally raises questions around the appropriateness of custody as a sanction of punishment for this group of young people. How these issues are approached and managed in practice is not only dependent on international and intra-national contexts, but varies significantly within local contexts themselves.