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By Elinor Nelson
It sounds impossible in twenty-first century America. In fact,
it sounds like the sort of thing nineteenth century reformers would
advocate against. And yet, a Congressional report released in July
describes the use of juvenile detention centers to hold children
with serious mental health disorders when appropriate placements
are unavailable. The report estimates a national expenditure of
$100 million each year to hold youth in these jails.
The report, issued by Senate Governmental Affairs Committee Chairperson
Sen. Susan Collins (R-ME) and House Government Reform Committee
Ranking Member Henry Waxman (D-CA), is based on responses by 49
states (only New Hampshire failed to respond).
Over the six-month period covered by the report, all 49 states
admitted to incarcerating a total of nearly 15,000 youth in juvenile
detentions centers, simply because they were waiting for mental
health services.
The youngest child was seven years-old and many children were held
with no charges pending against them. Their mental disorders included
depression, retardation and learning disorders, schizophrenia, anorexia
nervosa, posttraumatic stress disorder and autism.
"The use of juvenile detention facilities to 'warehouse' children
with mental disorders is a serious national problem," says Collins.
"On any given night, as many as 2,000 children and teenagers are
languishing in juvenile detention facilities across the country
simply because they cannot access the mental health services they
need."
"These inappropriate detentions are a regrettable symptom of a
much larger problem, which is the lack of available, affordable,
and appropriate mental health services and support systems for children
with mental illness and their families," Collins adds.
The report had been sent to every juvenile detention center in
the United States and 500 administrators responded, a rate of more
than 75%. The number of incarcerated youth amounted to roughly seven
percent of all children in the centers surveyed.
The report concluded that two-thirds of juvenile detention facilities
lock up mentally ill youths because there is nowhere else for them
to go and in 33 states, this population includes youths with no
charges against them of any kind. In other cases, youth who have
been charged with crimes but are able to be released remain incarcerated
because no clinically appropriate placement is available. Also,
168 of these centers report that youth held unnecessarily have attempted
suicide and 195 report that they have attacked others.
One quarter of these facilities reported providing no or poor quality
mental health services and more than half cited inadequate levels
of training. But even when care was available the setting was poor.
A Maine administrator notes, "Due to the high turnover, it is difficult
to do long-term treatment."
The survey was not designed to assess why this situation is occurring,
but juvenile detention administrators expressed frustration with
difficulties accessing community residential treatment, inpatient
and outpatient psychiatric care and foster care services.
As Waxman stated in his testimony before the Senate committee,
"We get the picture - and it is deplorable."
The report suggests that its own results are likely underestimating
unnecessary incarcerations. It refers to the one-quarter of the
facilities failing to respond and notes that some facilities did
not provide usable quantitative data that could be calculated into
report results. It speculates that administrators may have been
reluctant to "report the inappropriate use of their facility out
of fear that it would reflect poorly on the detention center itself."
Of the New England states responding, Massachusetts and Connecticut
reported holding mentally ill youth with no charges pending against
them.
In an effort to address the situation, Collins (with 11 Senate
co-sponsors and 46 House co-sponsors) co-authored and introduced
legislation entitled, "The Keeping Families Together Act." The bipartisan
legislation would provide grants to states to support statewide
care systems serving these children while keeping them with their
families. The legislation follows hearings held by Collins to explore
the issue of parents giving up custody of seriously mentally ill
children in order to obtain treatment for them.
Additionally, it would establish an interagency task force to study
and make recommendations about mental health issues in the child
welfare and juvenile justice systems. And, it would facilitate the
use of Medicaid home and community services for mentally ill children.
The legislation has been in committee since last October.
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