A substantial majority of children and adolescents behind bars are not getting the mental health care they desperately need, according to new findings from the Coalition on Juvenile Justice. The dilemma is that while as many as 75 percent of juvenile offenders have one or more diagnosable psychiatric disorders, most juvenile detention facilities are not equipped to treat them.

The Coalition for Juvenile Justice, which is a federally funded group consisting of representatives appointed by governors from states and territories participating in the 1974 Juvenile Justice and Delinquency Prevention Act, gathered statistics and anecdotal evidence from the Office of Juvenile Justice and Delinquency Prevention, a division of the U.S. Department of Justice.

The findings were released as part of the group’s 2000 annual report, titled "Handle With Care: Serving the Mental Health Needs of Young Offenders."

"Neglect and indifference come at a high cost," said Robert Pence, national chair of the Coalition for Juvenile Justice, at a recent press conference in conjunction with the release of the report. "Without counseling and support, youth with mental health problems become more vulnerable, more volatile, and more dangerous to themselves and others."

The seriousness of this problem is evidenced by the fact that there is an average of 17,000 incidents of suicidal behavior in juvenile facilities each year, and that youth suicide in juvenile detention facilities is more than four times greater than in the general population. While psychiatric inpatient units are safeguarded against suicide attempts, findings show that 75 percent of juvenile offenders are incarcerated in facilities that fail to meet even the most basic suicide prevention guidelines.

Tragic incidents ensue—take "Thomas," for example. The report follows the 15-year-old boy from the streets of San Jose, Calif., to juvenile hall to an inpatient mental health facility. Thomas had appeared before judges on numerous delinquency charges before being diagnosed with bipolar disorder. After the diagnosis, a judge placed him in a locked mental health facility with "generic programming" and rigid schedules to which Thomas did not adjust. Without specialized care, Thomas became more agitated and eventually escaped. He wandered the streets, was picked up by police, brought back to juvenile hall, and went back into the mental health facility.

This behavior became a pattern, and eventually the mental health facility refused to take Thomas back. He returned to juvenile hall, where staff did not have the intensive mental health training that would have enabled them to understand the complexity of youngsters’ emotional responses, such as Thomas’s despondence after long periods of staff-imposed isolation, or the sudden and unexplained happiness he showed to staff one day—the same day that Thomas hung himself with a bed sheet while no one was looking.

Stories of unnecessary tragedies such as this are not uncommon. For instance, in 1998, the Department of Justice found that youth in a juvenile detention center in Georgia had been attacked with pepper spray, beaten, and shackled to toilets. Remarked Pence, "Children in corrections have been forcibly and brutally restrained, overmedicated, or beaten because corrections staff misinterpret symptoms of illness."

In contrast, there are successful model programs that provide highly individualized, quality care across the range of juvenile justice and mental health care settings. According to Nancy Gannon, who is the deputy executive director of the Coalition for Juvenile Justice, "Treatment methods for young offenders with mental health problems using intensive mental health services have been shown to reduce recidivism by as much as 75 percent."

One such program is Wraparound Milwaukee, which is held up as a model of care in the coalition’s report. The program offers specialized care across mental health, juvenile justice, child welfare, and education systems, and serves more than 600 youth with serious emotional disturbances who are under court order in the child welfare or juvenile justice system. According to the report, Wraparound Milwaukee has decreased inpatient psychiatric hospitalization in the area by 80 percent.

The program’s care coordinators have small caseloads and rally to assemble all supports in the young person’s life—family, church members, probation officers—to pitch in and develop a plan of care for the youth.

Wraparound Milwaukee staff members are also dedicated to promoting mental health education in juvenile justice settings, and in November 2000 participated in a four-day, training focus group sponsored by the Coalition for Juvenile Justice. "We had speakers on racial, cultural, and gender issues, and professionals from every aspect of mental health care at the focus group," said Gannon.

Gannon added that the coalition has already launched a major media campaign, which will engage the coalition’s staff and members throughout the country to promote discussion of mental health—related topics and bridge gaps in mental health care for incarcerated juveniles.

The coalition is composed of State Advisory Group (SAG) members and chairs who will together launch their own three-year plans for delinquency prevention, scheduled for late 2001. The three-year plans are a framework for using federal funds at the local level to prevent delinquency.

"We are asking SAG members to incorporate a mental health component, a strong system-of-care model, and/or early screening and assessment into their three year plans," commented Gannon, who mentioned that the coalition is urging governors to appoint more psychiatrists and mental health professionals to the state advisory groups, said that there is a shortage of psychiatrists and, in particular, child psychiatrists participating in these groups.

Information on how to become a member of a local Coalition for Juvenile Justice State Advisory Group is available from Nancy Gannon, deputy executive director, at (202) 467-0864, ext. 6. The Coalition for Juvenile Justice’s 2000 Annual Report can be found on the Web at www.juvjustice.org/. ▪