[NYAPRS Enews] NYT: Youth w Psych Disabilities Strain US Juvenile Justice System

[Kizzi Casale]

NYAPRS Note: The article below highlights the rising numbers of youth
with psychiatric disabilities inside of our nation's juvenile justice
facilities. As budget shortfalls continue, states cut mental health
<http://topics.nytimes.com/top/news/health/diseasesconditionsandhealthto
pics/mentalhealthanddisorders/index.html?inline=nyt-classifier>
programs in communities and schools and our system is increasingly
relying on the juvenile justice system instead of a system based on
community based mental health resources and supports for both the youth
and their families.

Mentally Ill Offenders Strain Juvenile System 

By Solomon Moore
<http://topics.nytimes.com/top/reference/timestopics/people/m/solomon_mo
ore/index.html?inline=nyt-per>  New York Times August 10, 2009

FRANKLIN FURNACE, Ohio - The teenager in the padded smock sat in his
solitary confinement cell here in this state's most secure juvenile
prison and screamed obscenities.

The youth, Donald, a 16-year-old, his eyes glassy from lack of sleep and
a daily regimen of mood stabilizers, was serving a minimum of six months
for breaking and entering. Although he had received diagnoses for
psychiatric illnesses, including bipolar disorder
<http://health.nytimes.com/health/guides/disease/bipolar-disorder/overvi
ew.html?inline=nyt-classifier> , a judge decided that Donald would get
better care in the state correctional system than he could get anywhere
in his county. 

That was two years ago.

Donald's confinement has been repeatedly extended because of his violent
outbursts. This year he assaulted a guard here at the prison, the Ohio
River Valley Juvenile Correctional Facility, and was charged anew, with
assault. His fists and forearms are striped with scars where he gouged
himself with pencils and the bones of a bird he caught and dismembered. 

As cash-starved states slash mental health
<http://topics.nytimes.com/top/news/health/diseasesconditionsandhealthto
pics/mentalhealthanddisorders/index.html?inline=nyt-classifier>
programs in communities and schools, they are increasingly relying on
the juvenile corrections system to handle a generation of young
offenders with psychiatric disorders. About two-thirds of the nation's
juvenile inmates - who numbered 92,854 in 2006, down from 107,000 in
1999 - have at least one mental illness, according to surveys of youth
prisons, and are more in need of therapy than punishment
<http://health.nytimes.com/health/guides/specialtopic/discipline/overvie
w.html?inline=nyt-classifier> . 

"We're seeing more and more mentally ill kids who couldn't find
community programs that were intensive enough to treat them," said
Joseph Penn, a child psychiatrist at the Texas Youth Commission. "Jails
and juvenile justice facilities are the new asylums." 

At least 32 states cut their community mental health programs by an
average of 5 percent this year and plan to double those budget
reductions by 2010, according to a recent survey of state mental health
offices <http://www.nri-inc.org/reports_pubs/2009/BudgetShortfalls.pdf>
. 

Juvenile prisons have been the caretaker of last resort for troubled
children since the 1980s, but mental health experts say the system is in
crisis, facing a soaring number of inmates reliant on multiple - and
powerful - psychotropic drugs and a shortage
<http://www.aacap.org/galleries/LegislativeAction/Continuing%20Shortage%
20of%20Child%20%20Adolescent%20Psychiatrists.pdf>  of therapists. 

In California's state system, one of the most violent and poorly managed
juvenile systems in the country, according to federal investigators,
three dozen youth offenders seriously injured themselves or attempted
suicide
<http://health.nytimes.com/health/guides/disease/suicide-and-suicidal-be
havior/overview.html?inline=nyt-classifier>  in the last year - a sign,
state juvenile justice experts say, of neglect and poor safety
protocols. 

In Ohio, where Gov. Ted Strickland, a former prison psychologist,
approved a 34 percent reduction in community-based mental health
services to reduce a budget deficit, Thomas J. Stickrath, the director
of the Department of Youth Services, said continuing cuts would swell
his youth offender population.

"I'm hearing from a lot of judges saying, 'I'm sorry I'm sending
so-and-so to you, but at least I know that he'll get the treatment he
can't get in his community,' " Mr. Stickrath said.

But youths are often subjected to neglect and violence in juvenile
prisons, and studies show that mental illnesses can become worse there. 

George, 17, an inmate at Ohio River Valley, detailed his daily cocktail
of psychiatric medications, including Abilify and Seroquel. In addition
to having bipolar disorder, he is a sex offender and is H.I.V.
<http://health.nytimes.com/health/guides/disease/aids/overview.html?inli
ne=nyt-classifier>  positive - severe stigmas in prison. 

"I be getting punked," he said, using prison slang to describe how gang
youths routinely humiliate him. He blinked, and his leg shook
uncontrollably. "They take my food, they hit me, they make me do
things."

Demetrius, 16, another inmate there, said he had received a diagnosis of
bipolar disorder. Officials said he has psychotic
<http://health.nytimes.com/health/guides/disease/psychosis/overview.html
?inline=nyt-classifier>  episodes and attacks other inmates. In an
interview in June, he said he was receiving no mental health counseling
or medications. Andrea Kruse, a spokeswoman for Mr. Stickrath, said that
since July 1, he has had more than 20 counseling sessions. 

According to a Government Accountability Office
<http://topics.nytimes.com/top/reference/timestopics/organizations/g/gov
ernment_accountability_office/index.html?inline=nyt-org>  report
<http://www.gao.gov/new.items/d03397.pdf> , in 2001, families
relinquished custody of 9,000 children to juvenile justice systems so
they could receive mental health services. 

Donald has been in and out of mental health programs since he attacked a
schoolteacher at age 5. As he grew older, he became more violent until
he was eventually committed to the Department of Youth Services.

"I've begged D.Y.S. to get him into a mental facility where they're
trained to deal with people like him," said his grandmother, who asked
not to be identified because of the stigma of having a grandson who is
mentally ill. "I don't think a lockup situation is where he should be,
although I don't think he should be on the street either." 

Lawsuits and federal civil rights investigations in Indiana, Maryland,
Ohio and Texas have criticized juvenile corrections systems for failing
to meet their obligation to prohibit cruel and unusual punishment of
prisoners.

Despite downsizing to about 1,650 juvenile inmates from about 10,000
youth offenders in 1996, California's state system remains under a 2004
federal mandate to improve conditions, including mental health services
- the result of a class-action lawsuit that documented the systematic
physical and sexual abuse of wards. 

Under a plan to reduce the state juvenile inmate population, many youths
who once would have been held by the state are now detained by the Los
Angeles County juvenile detention system. Los Angeles County is also
under a federal mandate to improve psychiatric services for juvenile
inmates, especially at the six camps at its Challenger Memorial Youth
Center, which holds most of the county's medium- and high-risk offenders
and most of its mentally ill ones.

"We were told that the Challenger camps are, paradoxically, the only
camps at which staff are authorized to carry O.C. spray," wrote federal
civil rights investigators in a 2008 report to county authorities
<http://www.usdoj.gov/crt/split/documents/lacamps_findings_10-31-08.pdf>
, referring to oleoresin capsicum, known as pepper spray. "One
supervisor told us that he believed that allowing staff to carry and use
O.C. spray made sense given the 'mental health population.' " 

The investigators also recounted how staff members body slammed unruly
juveniles, often breaking their bones.

In May, a reporter toured the Los Angeles County Central Juvenile Hall
with Eric Trupin, a consultant hired by the Department of Justice to
monitor mental health services in California's juvenile justice system.
Dr. Trupin, a psychologist, said some detainees appeared to be held
there for no reason other than that they were mentally ill and the
county had no other institution capable of treating them. 

One inmate at the county's juvenile hall, Eric, 18, was given a
diagnosis of bipolar disorder and prescribed Risperdal, a powerful
antipsychotic, to help him avoid violent flashes of temper. 

A public defender who specializes in juvenile mental health issues, said
Eric had been arrested more than 20 times near his South Los Angeles
home. Dr. Trupin worried that if Eric is released and arrested again, he
will be charged as an adult and enter the Los Angeles County jail
<http://www.aclu.org/pdfs/prison/lacountyjail_kupersreport.pdf> , the
nation's largest residential mental institution, with 1,400 mentally ill
inmates.

In the 1960s and '70s, the increasing availability of antipsychotic
medications coincided with a national movement to close public mental
hospitals
<http://topics.nytimes.com/top/news/health/diseasesconditionsandhealthto
pics/hospitals/index.html?inline=nyt-classifier> . Many private
hospitals barred psychotic patients, including juveniles. By the 1980s,
juvenile justice systems had become the primary providers of residential
psychiatric care for mentally ill youths.

But as cutbacks have worsened, the debate has intensified over what
constitutes adequate mental health care. Often juvenile justice systems
have very little to go on when attempting a diagnosis.

"Often Daddy is nowhere to be found, Mommy might be in jail," said
Daniel Connor, a psychiatrist for the Connecticut juvenile corrections
system. "The home phone is cut off. The parent speaks another language,
so it's often hard to figure out exactly what's going on with each kid."

School records often do not arrive with arrested youths, nor do files
often come from other corrections institutions. The lack of information
is particularly problematic when psychiatrists
<http://topics.nytimes.com/top/news/health/diseasesconditionsandhealthto
pics/psychiatry_and_psychiatrists/index.html?inline=nyt-classifier>  try
to prescribe medications. Joseph Parks, medical director for the
Missouri Department of Mental Health and a national expert on
pharmaceutical drug use in corrections facilities, said many juvenile
offenders are prescribed multiple psychiatric drugs as they move from
mental health clinics to detention halls to juvenile prisons.

A decade ago, it was rare to find juvenile offenders on two psychotropic
drugs at once, Dr. Parks said. Now, many take three or four at a time,
often for nonprescribed uses like helping the youths sleep. 

"If you just give a kid a pill, the prison administration doesn't have
to do anything differently," he said. "The staff doesn't have to do
anything differently. The guards don't have to get more training." 

Census studies of child mental health professionals show chronic
shortages. A 2006 study estimated that for every 100,000 youths, there
were fewer than nine child psychiatrists. Dr. Penn of Texas said the
state youth prison system there recently instituted a system of
telepsychiatry sessions, conducting videoconferences between mental
health professionals and youths being detained hundreds of miles away.

Inadequate mental health services increases recidivism. In a February
report
<http://graphics8.nytimes.com/packages/pdf/us/20090809_juvenile_wills_re
port.pdf>  on psychiatric services at the Ohio River Valley center, Dr.
Cheryl Wills, an independent mental health expert, found that officials
were unnecessarily extending incarceration for youths who acted out
because of their mental illnesses.

Mr. Stickrath, the director of the Ohio Department of Youth Services,
said that one challenge in dealing with large numbers of psychologically
ill youths is determining who is "mad versus bad." He mentioned Donald,
whose file he knew by heart.

"He's been in 130 fights since he's been with us, and there were no
resources in the small county he's from to deal with him," Mr. Stickrath
said. "Our staff worked to get him in a sophisticated psychiatric
residential program, but they said he had to leave because he was
attacking staff." 

Mr. Stickrath shook his head. "He just wears you out."

http://www.nytimes.com/2009/08/10/us/10juvenile.html?pagewanted=print

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