THURSDAY NIGHT IS HEALTH CARE CHANGE NIGHT, a weekly Daily Kos Health Care Series
The prevalence of mental health disorders among adolescents in the justice system is alarming: federal studies estimate that 50-75% of incarcerated kids have diagnosable mental health disorders and nearly half have substance abuse problems. Many of these kids might have avoided the justice system altogether if they had been able to access mental health services. Instead, children are incarcerated, where poor conditions and mistreatment exacerbate mental health conditions and behavioral problems. One study revealed that only 4% of adjudicated adolescents receive a mental health placement. National reform is imperative in order to provide mental health screening, comprehensive evaluation and appropriate treatment for these children.When my son was in his early teens and I needed a place for him to go when he was out of control, mental health professionals kept asking me if he had a probation officer and recommended calling the sheriff's department when he lost control until he got one.
I offer that by way of introduction because my experience is not all that uncommon. Tucson, AZ, had no mental health emergency shelter beds, and only two inpatient units which only admitted children who were actively suicidal or violent (now only one). When I called the sheriff's department enough times, a deputy told me he would have to call DCF if I continued. As an adoptive parent, I had a dread of all social service agencies. Another deputy had told me on the phone that these things were a matter of environment, and I was responsible for my son's environment. Yet it was only when we finally went before a juvenile judge that I felt understood and truly supported as his parent. My son and his judge developed a strong positive relationship that was instrumental in his being able to complete his probation, and wanting to do better.
We also were one of the first families in Tucson accepted into the program that was part of a grant from the Substance Abuse and Mental Health Services Administration (SAMHSA) of HHS. Thus I became acquainted with the Systems of Care approach to mental health services for children and families. This grant was for the treatment of children who interacted with at least two agencies dealing with children (mental health, developmental disabilities, foster care, juvenile justice, corrections, special education), known as complex needs.
The Arizona program had been developed because of a lawsuit, as many progressive programs around the country are. This led to the Arizona principles of care, that treatment should be child centered, family driven, community based, strength based, culturally appropriate, inclusive of all providers of services, supporting the child and family with community support systems both professional and non-professional. Planning centers around the child and family team, made up of people important to the family as well as all relevant professionals. It is the idea of bringing services to the child and family, rather than bringing the child and family to the services.
We were involved during the first two years of the program, and had a mixed experience. I will not go into details. Our involvement ended when my son turned eighteen, which was six years ago.
For writing this diary, I interviewed Joannie Rosenberg, a social worker at Tucson's only inpatient unit for children and adolescents. She pointed out several contradictions in the system. First, it is better, if you live in Arizona, not to have private health insurance. (This is not true for adults.) The public system, made up of the regional authority (for both children and adults) and four contracting agencies for children - three in Tucson, and one for the communities to our south, provides an array of services. One agency has a satellite in Sells, on the Tohono O'odham reservation. Two agencies have contracted to provide non-traditional services based in the home and community. After discharge from the hospital, a child is seen by a psychiatrist within five to ten days. If you have private insurance, it can take as long as two months to schedule an appointment, and the whole array of services is not available. Insurance companies generally do not pay for non-traditional services.
A second contradiction is that, as the emphasis is on community based treatment, fewer higher-level services are available locally. As I said, there is only one inpatient unit in Tucson. All local residential treatment centers have closed. Most children needing residential treatment have to go to other states, most often Texas or Colorado, which restricts family involvement. It also means that all relationship of the child with the community (e.g. field trips and use of public recreational facilities, or church attendance) are cut off.
There are also improvements. A major addition is a transitional/respite facility, where a child can go for up to ten days while transitioning out of the hospital or needs to be in a secure setting but does not meet the requirements for hospitalization. This has to be in place from the start. This was one of the most serious deficits when we were involved in the system, and is a greatly needed service. And there seems to be greater flexibility on the child and family teams and on the part of the providers.
If you want to learn more about child and adolescent mental health and systems of care, including symptom lists and access to resources in your area, these links are a beginning: