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Chicago Tribune
HEADLINE: Mentally Ill Tax Juvenile Jail System

DATE: May 29, 2003
By Ronald Kotulak

Juvenile detention centers were never intended to serve as mental hospitals. Yet that is what seems to be happening as an influx of psychiatrically ill youths threatens to overwhelm facilities not designed to treat them.

The problem is evident at the Cook County Juvenile Detention Center, the nation's largest such facility, where the typical inmate is likely to be delusional, psychotic, depressed, manic or suffering anxiety disorders.

A recent federally funded study found that two out of three 10- to 18-year-old boys and nearly three out of four girls in the center, formerly known as the Audy Home, have diagnosable psychiatric illnesses.

These are youngsters who have fallen through the cracks of the mental health system. The late '80s and early '90s saw budget cutters slash away at state and county facilities for mentally ill children.

Many who once might have received treatment wind up in juvenile detention when they commit crimes. Their conditions often worsen after that. Bereft of emotional support and lacking psychiatric help, many grow up to a life marred by violence, crime and lost potential.

"Most people in the field feel that the problem of kids with mental health issues is probably the No. 1 problem in the juvenile justice system," said Mark Solar of the Youth Law Center in Washington, D.C.

Preliminary results of the juvenile center study prompted Dr. Venkata Vallury, medical director, to initiate a crash program a year ago to improve mental health services.

The center has so far increased its mental health staff by about 75 percent. It now includes three psychiatrists, two psychologists and two social workers for about 500 youths. Despite these improvements, officials acknowledge there is still a long way to go.

The final results of the study, the largest and most thorough examination ever of juveniles in detention, appeared in the December issue of General Psychiatry. It was conducted by Northwestern University psychologist Linda A. Teplin and was funded by other organizations in addition to the federal government.

Experts say the results would have been different in the Audy Home days.

"Twenty years ago you would not have seen so many psychiatrically disturbed kids in the detention center because they were in mental health facilities," said Dr. Carl Bell, president of the Community Mental Health Council, which operates in disadvantaged Cook County neighborhoods.

"But now they're showing up in the child welfare and juvenile justice systems."

Researchers also have documented a sharp increase in mental, emotional and physical disabilities among all children, especially black children. Such disabilities have increased 77 percent since the 1970s among blacks younger than 18--affecting 67 children out of every 1,000, according to the National Institute of Mental Health.

In the mid-'90s the detention center's population swelled, nearly doubling to 800 inmates. It is now down to about 500, still slightly higher than the number of juveniles it was designed to hold. More than 100,000 juveniles are in detention facilities nationwide, Solar said.

Criminal justice experts have long known that many of those kids are emotionally disturbed, even if government officials do not acknowledge it.

"No one has wanted to notice that before, because if you admit that you have mentally ill kids in the detention center you put yourself in the legal and constitutional obligation to provide care for them, and that's costly," said Mark Heyrman, clinical professor of law at the University of Chicago.

Few get help

There also is growing evidence that many youngsters at risk of becoming chronic lawbreakers could be diverted from such destructive paths, but few get the help they need to straighten out their lives.

"We've pushed our mentally ill children and adults into the correctional system over the last several years," said Benjamin Wolf of the American Civil Liberties Union. The ACLU filed suit last year to force the center to improve mental and physical services for inmates, to which the county has agreed.

Incarcerating mentally disturbed youngsters often makes them worse. They rebel at the discipline, and many become victims of abuse from other juveniles and staff members.

"These kids will typically act out in ways that are usually not dangerous but are usually a pain in the neck to handle," Solar said. "They are often put in isolation rooms or in restraints, often with the staff assuming that it's for the kids' own good."

Charles Ingoglia, the National Mental Health Association's vice president for research, said most juvenile offenders with a mental illness are detained for non-violent crimes, usually related to impulse control. "As long as people with mental illness are in treatment and free of substance abuse, they are no more prone to violence than the general population," he said.

That makes treating such illnesses crucial, experts say.

"Once you recognize that a large number of these kids have psychiatric problems and you recognize that treating those psychiatric problems is more likely to make them do well and not commit further crime, then you've got to be able to get the effective services to them," said Patrick Tolan, director of the Institute for Juvenile Research at the University of Illinois at Chicago.

Psychologists stress the word "effective." They have seen the failure of many programs intended to help disturbed youths, with some efforts doing more damage to the children.

One program that shows early signs of success--and one that the National Institutes of Health has already poured more than $25 million into--was developed by Scott Henggler of the Medical University of South Carolina. In his program, called Multisystemic Therapy or MST, a therapist works closely with a child and his family for four to six months. The program is operating on a small scale in 30 states, including Illinois, and seven countries.

The task of the therapist, who is available around the clock, is to figure out the particular factors in each juvenile's life--family, peers, school, neighborhood influence--that are contributing to the delinquency. The therapist then focuses on changing those factors as a way to decrease anti-social behavior.

"We find that a lot of the time the reason the kid's behavior is so outlandish and out-of-control is because the parents are not closely supervising him, not monitoring his behavior on an ongoing basis," said Mary Ann Williams, MST supervisor for the Community Mental Health Council.

Helping parents, teachers

Parents are taught how to supervise their child's behavior, how to monitor his or her association with peers and how to deal with rewards and consequences, she said. In school, therapists work with teachers and counselors to make sure juveniles are in the right class and whether they skip class, dotheir homework and relate well with other students.

Children who have been in the relatively new program are 50 percent less likely to spend time in incarceration than non-participants, according to Bell, of the Community Mental Health Council. Their rearrest rate is 40 percent lower than non-participants.

But the result that has attracted the most notice is that the program's $5,000 cost per youngster is estimated to save at least $31,000 in incarceration and felony conviction expenses, Bell said.

"If the goal is to increase the chances that a kid is going to become a productive citizen and decrease the chances that he's going to be involved in crime and drugs, our perspective is that you take mental health resources and devote them to building a positive family environment around him, whether it's school or family," Henggler said.

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