Warehousing youths with mental illnesses

July 21, 2004|By Charles J. Kehoe and Robert Bernstein

ON ANY NIGHT, nearly 2,000 youths languish in juvenile detention facilities across the country because they cannot access mental health services. As a result, children are endangered and traumatized and corrections staff struggle to serve a population they are ill-equipped to handle, all at taxpayer expense.

Until recently, policy-makers have ignored the issue. Democratic Rep. Henry A. Waxman of California and Republican Sen. Susan M. Collins of Maine commissioned the first national survey of children held in juvenile detention centers awaiting mental health services. Their findings, unveiled at a congressional hearing this month, highlight an expensive public policy failure.

"The misuse of detention centers as holding areas for mental health treatment is unfair to youths, undermines their health, disrupts the function of detention centers and is costly to society," the report said.

During six months in 2003, nearly 15,000 incarcerated youths were unnecessarily detained awaiting community mental health services, the report said. Many have no criminal charges pending, while others were arrested for minor offenses such as truancy or trespassing that generally were traced to their mental health problems.

Investigators found that juveniles with mental or emotional disorders also stay in detention 36 percent longer than all detainees. Living in these traumatic settings, with poor or no mental health services, their conditions worsen.

The rate of self-inflicted injury and suicide among juveniles while incarcerated is four times that of youths overall. Children with mental disorders also may be victims of violence by other detainees because they appear more vulnerable.

Correctional officers are often overwhelmed trying to serve a population for which they have few resources and little training to help. Resources are diverted from monitoring other juveniles, and correctional officers are placed at risk.

Incarcerating youths who are waiting for mental health services is also wasteful. Investigators found that this failed policy cost taxpayers nearly $100 million in 2003.

Unfortunately, the number of these children is just one symptom of a crisis in children's mental health. As reported in The American Journal of Psychiatry in 2002, nearly 80 percent of 6- to 17-year-olds with mental disorders do not receive mental health care. The tattered "safety net" for children with mental illnesses drives too many into the juvenile justice system, leaving them to wait for scarce mental health services in the community.

While model programs are rare, effective alternatives to incarceration exist. Blending funding from the city's child welfare and juvenile justice agencies and pooling it with private and public insurance, the Wraparound Milwaukee program has been able to work closely with parents to provide individually tailored services so children can stay out of the juvenile justice system.

In its first five years, the program reduced monthly per-child costs from $5,000 to $3,000, according to the Juvenile Justice Journal. Because the savings were reinvested in the program, Wraparound Milwaukee has been able to nearly double the number of children served. Most important, a child's ability to function at home, in school and in the community has improved significantly and the number returning to the juvenile justice system has been cut in half.

With blended funding and cross-agency collaboration, other jurisdictions could improve access to children's mental health services. The federal government can also play a role. The Keeping Families Together Act would help reduce the number of children with mental or emotional disorders in juvenile detention centers by supporting states' efforts to develop coordinated systems of care.

Policy-makers should adopt these reforms. Too many children with unmet mental health needs are ending up in our juvenile justice system, out of luck and behind bars.

Charles J. Kehoe is president of the American Correctional Association. Robert Bernstein is executive director at the Bazelon Center for Mental Health Law.

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