Mentally Ill Youths Warehoused

Mentally Ill Youths Warehoused

Report: Mentally Ill Youths 'Warehoused'

By ERICA WERNER The Associated Press July 8, 2004

WASHINGTON (AP) - Thousands of mentally ill youths are unnecessarily put in juvenile detention centers to await mental health treatment, a House committee reported Wednesday.

Centers usually are not equipped to treat mental illness, and in some cases the youths have not been charged with a crime, said the report by the Democratic staff of the House Government Reform Committee.

``The use of juvenile detention facilities to house youth waiting for community mental health services is widespread and a serious national problem,'' said the report, which found that two-thirds of juvenile detention facilities hold youths who are waiting for mental health treatment.

``This misuse of detention centers as holding areas for mental health treatment is unfair to youth, undermines their health, disrupts the function of detention centers and is costly to society.''

The report, which its authors said was the first national study of its kind, was prepared at the request of California Rep. Henry Waxman, the House Government Reform Committee's top Democrat, and Sen. Susan Collins, R-Maine, chairwoman of the Senate Governmental Affairs Committee.

``Thousands of youth who are in need of community mental health services are stuck in jail until these services become available,'' Waxman said in a statement. ``This is deplorable. Congress must ensure that our children have access to the mental health care that they need.''

Collins scheduled a hearing on the issue Wednesday where Waxman was testifying along with experts on mental health law, youth behavior and juvenile detention.

The report identified 698 juvenile detention facilities in the United States, defined as correctional facilities holding people age 21 and younger awaiting charges or trial or recently tried. Seventy-five percent of the facilities, or 524, responded to the survey, including facilities from every state but New Hampshire. The survey covered six months, Jan. 1, 2003, to June 30, 2003.

The report did not attempt to determine why so many youths who needed mental health treatment were being put in juvenile detention but said administrators blamed the lack of other treatment facilities.

One detention center administrator from Louisiana wrote, ``We appear to be warehousing youths with mental illnesses due to lack of mental health services.''

Among the report's findings:

In 33 states, mentally ill youths were being held in detention centers with no charges against them.

Over the six-month period of the study, nearly 15,000 youths spent time in juvenile detention while they waited for mental health help. Nearly 2,000 youths are in detention waiting for mental health services every night, representing about 7 percent of all juveniles being held.

Youths who are waiting for mental health treatment stay in detention facilities longer than other detainees. They average 23.4 days in detention, compared with an average of 17.2 days for all detainees.

One detention facility reported holding a 7-year-old child who was awaiting mental health treatment, while 117 facilities were holding children 10 years old and younger.

Juvenile detention facilities spend about $100 million each year to house youths who are waiting for community health services.

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Many Youths Reported Held Awaiting Mental Help

By ROBERT PEAR New York Times July 8, 2004

Congressional investigators said Wednesday that 15,000 children with psychiatric disorders were improperly incarcerated last year because no mental health services were available.

The figures were compiled by the Democratic staff of the House Committee on Government Reform in the first such nationwide survey of juvenile detention centers.

"The use of juvenile detention facilities to warehouse children with mental disorders is a serious national problem,'' said Senator Susan Collins, Republican of Maine, who sought the survey with Representative Henry A. Waxman, Democrat of California.

The study, presented at a hearing of the Senate Committee on Governmental Affairs, found that children as young as 7 were incarcerated because of a lack of access to mental health care. More than 340 detention centers, two-thirds of those that responded to the survey, said youths with mental disorders were being locked up because there was no place else for them to go while awaiting treatment. Seventy-one centers in 33 states said they were holding mentally ill youngsters with no charges.

The 15,000 youths awaiting mental health services accounted for 8 percent of all the youngsters in the responding detention centers.

Dr. Ken Martinez of the New Mexico Department of Children, Youth and Families said the data showed "the criminalization of mental illness'' as "juvenile detention centers have become de facto psychiatric hospitals for mentally ill youth.''

Mental health advocates, prison officials and juvenile court judges all testified and recommended three types of solutions: more community mental health services, financed in part by Medicaid; more cooperation between police officials and mental health agencies; and more extensive insurance coverage.

The witnesses included experts on psychiatry and juvenile justice. Judge Ernestine S. Gray of New Orleans Juvenile Court testified that 70 percent to 85 percent of the youngsters who appeared before the court had mental health or drug problems.

"All too often,'' Judge Gray said, "children charged with delinquent behavior are identified early on as needing mental health services. But because the services are not available, the children are sent back home until there is another violation. After several brushes with the law, the children are incarcerated, so they might have a chance at getting mental health services.''

Leonard B. Dixon, director of the Wayne County Juvenile Detention Facility in Detroit, said mentally ill children were "more difficult to manage, more explosive and more easily agitated.'' "Most juvenile detention centers,'' Mr. Dixon said, "do not have the luxury of separating youth with mental health problems from the general population.''

Carol Carothers, executive director of the Maine chapter of the National Alliance for the Mentally Ill, told of a 13-year-old who was sent to a detention center even though he was suffering depression and had suicidal thoughts. He was held in isolation for 152 of his first 240 days there, Ms. Carothers said. He was sent to the youth center four more times, becoming more depressed and aggressive, and was punished for misbehavior, worsening the symptoms of his mental illness, she added.

Mr. Dixon, who is also president of the National Juvenile Detention Association, a professional organization, described a 16-year-old who was detained after having been accused of stabbing a classmate in the neck with a pencil. The youth was psychotic and severely depressed and had hallucinations, but was held in a detention center for months before going to a psychiatric hospital for treatment, Mr. Dixon said.

Dr. Steven S. Sharfstein, president-elect of the American Psychiatric Association, said: "We are in a much better position to diagnose and treat mental illness in children than we were just 15 years ago. Many kids who get in trouble should be in treatment. But because of the lack of money and the lack of services, they end up in the criminal justice system.''

In an interview, Dr. Sharfstein, who is president of the Sheppard Pratt Health System in Baltimore, said: "It used to be thought that these were bad kids. But many of them are sick and could benefit from treatment such as medications, psychotherapy or therapeutic education - small classes and individualized attention that focuses on learning disabilities.''

In California, 27 centers reported unnecessary incarcerations of youths awaiting mental health services; 19 reported that some of the children had attempted suicide.

Texas had 17 detention centers with children who could have been released if mental health services were available, according to the survey. New Jersey had 13, Florida and Illinois 7 each and New York 4.

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Thousands of Children with Mental Illness Warehoused in Juvenile Detention Centers Awaiting Mental Health Services

Bazelon Center for Mental Health Law News Release

WASHINGTON (July 7, 2004)_Thousands of children with mental illnesses await needed community mental health services in juvenile detention centers across the country, according to a new report released at a hearing in the U.S. Senate_s Governmental Affairs Committee this morning.

_Children who need a safety net instead wind up waiting in juvenile detention,_ said Tammy Seltzer, senior staff attorney at the Washington-based Bazelon Center for Mental Health Law. _Thousands of children are locked up because the system isn_t offering them the help that they need when they need it._

_ Juvenile detention centers are designed to care for children who have been charged with crimes and those who are awaiting court hearings or placement,_ said Charles J. Kehoe, president of the American Correctional Association (ACA). _Juvenile detention facilities lack the resources and staff to confront this problem; yet, corrections is being forced to shoulder the burden of the nation_s failure to properly diagnose and care for children with mental or emotional disorders._

The survey_commissioned by Representative Henry Waxman (D-CA) and Senator Susan Collins (R-ME) and conducted by the Special Investigations Division of the minority staff of the Government Reform Committee of the U.S. House of Representatives_is the first Congressional investigation to look specifically at children with mental health needs unnecessarily incarcerated in juvenile detention centers because they are awaiting services in the community. Key findings in the report include:

Thousands of children are incarcerated in juvenile detention centers awaiting mental health services in the community. Over a six-month period, nearly 15,000 incarcerated youth waited for community mental health services. Each night, nearly 2,000 youth wait in detention for community mental health services, representing 7% of all youth held in juvenile detention. Yet a quarter of the facilities surveyed reported that they provide no or poor mental health services.

Children are at increased risk of self-harm and violence. Youth waiting in detention for community mental health services attempted suicide in over 160 facilities. According to previously released research, the rate of suicide among juveniles while incarcerated is four times that of youth overall. Children with mental disorders may also be at particular risk of victimization by others due to their illness.

Detention centers are overwhelmed. A Pennsylvania administrator interviewed for the report noted that _mentally ill youth placed in juvenile detention facilities stress our centers more than any other problem._

Warehousing children awaiting mental health services is expensive. The report estimates that juvenile detention facilities spend an estimated $100 million each year to house youth who are waiting for mental health services.

_Major improvements in community mental health services are urgently needed to prevent the unnecessary and inappropriate incarceration of thousands more children and youth in the United States,_ says the report.

About 5-9% of children ages 9 to 17 are affected by a serious emotional disturbance (SED), according to the Surgeon General. Yet nearly four in five children who could benefit from mental health services do not receive them.

Today, the Bazelon Center, ACA and more than 130 other organizations representing children and families, correctional officers and others called on Congress to address gaps in services for children with mental disorders. In a letter to Members of Congress, the groups urged lawmakers to adopt specific legislation to reduce the number of children with mental or emotional disorders inappropriately warehoused in juvenile detention centers.

Among the proposals was a bill introduced by Senator Collins last fall_the Keeping Families Together Act (S. 1704, H.R. 3243). The legislation would support states_ efforts to develop coordinated systems of care and improve access to community-based services for children with mental disorders.

_Today_s hearing underscores the critical need to do something concrete to address the crisis in children_s mental health,_ said Seltzer. _Senator Collins_ bill is an essential step toward creating a children_s mental health system where kids get services, not jail time, when they need help._

_Warehousing children in juvenile detention centers when they should be getting mental health treatment is a no-win situation,_ said Kehoe. _We_ve got to get kids the help they need, so we can keep them out of jail._

The survey will be available online at: http://www.house.gov/reform/min/

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Children First Lack of mental help keeps kids locked up

Stays in detention cost millions, survey finds

BY JACK KRESNAK FREE PRESS STAFF WRITER July 7, 2004

Thousands of children sit needlessly in the nation's juvenile-detention facilities because they need mental health services, costing those facilities more than $100 million a year, according to a survey commissioned by two lawmakers to be released today in Washington.

Juvenile-detention facilities have become, by default, a last-resort placement for many mentally ill or emotionally disturbed children, said Leonard Dixon, director of the Wayne County Juvenile Detention Facility in Detroit.

"Kids are coming into detention who really should not be in detention; they should be served in the community," said Dixon, who is among six experts scheduled to testify before the Senate Governmental Affairs Committeetoday in Washington.

Such youths "are more difficult to manage, more explosive, more easily agitated, require more intensive supervision and create more strain on direct-care staff than other youths within a juvenile-detention facility," said Dixon, who is president of the National Juvenile Detention Association.

The survey, commissioned by Rep. Henry Waxman, D-Calif., and Sen. Susan Collins, R-Maine, found that during a 6-month period of 2003, nearly 15,000 youths -- about 8 percent of all children in more than 500 centers surveyed from 49 states -- were in detention because there were no suitable mental health services available for them. The survey was conducted after years of complaints by advocates for mentally ill people and incarcerated youths. The average length of stay for most juveniles at the Wayne County facility is about 18 days, Dixon said, but kids with serious mental health needs stay more than twice as long because there are not enough suitable mental health programs for them.

Between May 1, 2003, and May 31, 2004, 4,152 youths ages 10-17 were admitted to the Wayne County facility , and 2,331 of them -- 56 percent -- were identified as needing mental health services, Dixon said. Those children were treated in the mental health clinic at the detention facility.

But juvenile detention is expensive -- $350 a day per child at the Wayne County center. Dixon said many community-based mental health programs are less expensive.

So why isn't the less expensive option used more often? Under federal spending restrictions, children from poor families who are eligible for Medicaid are cut off from federal funding if they are placed in a public juvenile detention facility. But families often face difficulty in accessing care or they lack insurance, according to the survey. Also, there are often waiting lists for community mental health programs.

The survey found that staff members at the nation's juvenile-detention facilities are overwhelmed by youths who often cannot be easily segregated from other delinquents. The youths have mental health problems that include depression, substance abuse, retardation, learning disabilities such as attention-deficit/hyperactivity disorder and schizophrenia, the survey found.

In his testimony today, Dixon will give three examples of youths with mental problems in his facility. One, a 16-year-old boy, stabbed a classmate in the neck with a pencil without warning. When placed at the Wayne County facility, the youth was psychotic and depressed. He was declared incompetent to stand trial and placed in a mental health facility in another state because his parent could not get him into a Michigan facility, Dixon said.

Another youth, an 11-year-old girl, was placed in the center after assaulting her mother. Her family had a history of bipolar disorder, and she had previously been treated in a psychiatric hospital.

Dixon said the girl's mother, who suffered from depression, decided to let her daughter stay in detention for three months to "teach her a lesson."

"The family should have been engaged in outpatient therapy, and the detention system should not have been used to separate the child from her mother," Dixon said.

The third youth was a 15-year-old boy who had been in foster care for several years because of abuse and neglect. Dixon said the youth preferred the juvenile-detention facility and called it "home." The boy, diagnosed with depression, is still at the facility because there is a lack of a suitable alternatives, Dixon said.

Ninety youth-advocacy organizations have signed a letter to the Senate Government Affairs Committee on which Waxman and Collins serve, asking that the various systems involved with children -- such as the juvenile justice and mental health departments -- be allowed to collaborate more effectively with flexible federal funding. Then the dollars will follow the children who need mental health care.

Along with Dixon, others set to testify are Waxman; Carol Carothers, executive director of the National Alliance for the Mentally Ill of Maine; Tammy Seltzer, senior staff attorney of the Bazelon Center for Mental Health Law; Chief Judge Ernestine Gray of Orleans Parish Juvenile Court in New Orleans, and Kenneth Martinez, director of children's behavioral health of New Mexico's Department of Children, Youth and Families.

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Stop Putting Sick Children in Jail: Congressional Investigative Report Released; NAMI Testimony Calls for End to National Scandal

ARLINGTON, Va., July 7 /PRNewswire/ -- NAMI (National Alliance for the Mentally Ill) today condemned state and local governments that warehouse children and adolescents with mental illnesses in the juvenile justice system, simply because adequate treatment and services in their communities are unavailable.

"We are spending money in all the wrong places," declared NAMI Maine executive director Carol Carothers, testifying on behalf of the national organization before a hearing of the U.S. Senate Governmental Affairs Committee on a special Congressional investigative report on the scandal.

NAMI's full testimony is available on-line at http://www.nami.org/kidsjails.

"Youth with mental illnesses are being held in juvenile detention for the sole purpose of awaiting mental health treatment. It is hard to imagine a worse place to house a child. Surely we would not dream of placing a child with another serious illness, like cancer, in a juvenile detention center to await a hospital bed or community-based system."

In Maine, Carothers noted, 10-year-old children may be housed with 20- year-olds, where they are vulnerable to physical or sexual assaults. Keeping children in the community, however, leads to better outcomes and saves taxpayer dollars: $30,000 to provide intensive in-home services for a family for one year, compared to $80,000 to lock a child in a detention center.

In criminal justice settings, symptoms of mental illnesses are misinterpreted as disobedience, defiance, or threats. Well-meaning, but poorly-trained corrections officers respond with anger, discipline or force. Minor incidents escalate. Risks of harm increase. Many techniques used in correctional settings -- like prolonged isolation and restraints -- actually worsen symptoms, leading to greater acting out and self-harm, through self- mutilation or suicide.

The Congressional investigative report documents "a national crisis," Carothers said resulting in part from reduction or elimination of mental health services as states struggle to balance budgets. However, money cut from such services is not saved. "Instead it will be shifted to corrections budgets, a waste of the taxpayer's money."

Carothers was one of 10 persons nationwide recently honored with a $120,000 award from the Robert Wood Johnson Community Health Leadership Program for her efforts to reform the mental health and criminal justice systems in Maine.

Source: NAMI

Source: New York Times

Source: Bazelon Center for Mental Health Law

Source: Detroit Free Press

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