National Survey Finds Thousands of Children With Mental Illnesses "Warehoused" in Juvenile Detention Centers
Thousands of children with serious emotional disturbances are being incarcerated in juvenile detention centers as they await community mental health services, according to a new report by the Special Investigations Division of the U.S. House of Representatives. Many of the youths have no criminal charges pending against them. Others who have been charged with crimes must remain inappropriately incarcerated for extended periods because no inpatient bed, residential placement, outpatient treatment, or specialized foster care is available.
Detention centers have become the "placement of last resort" for children with complex treatment needs, which most such facilities are ill equipped to address. As a detention center administrator in Florida noted, "It appears that detention is used as a dumping ground for youth with mental health problems that no one else can control." A Virginia administrator wrote, "It isn't unusual for a mental crisis counselor to decide to leave a suicidal child in detention… . The waiting list for outpatient appointments is six to eight weeks."
The 19-page report summarizes findings from a national survey covering the period from January 1 to July 1, 2003. Of the 698 U.S. facilities that provide secure juvenile detention, 524 (75 percent) responded to the survey. (Facilities in the juvenile prison system, where youths who are convicted of crimes serve their sentences, were not surveyed.) Responses were received from every state except New Hampshire and were evenly distributed among rural, urban, and suburban settings.
Two-thirds of the responding facilities—347 detention centers in 47 states—reported holding youths who did not need to be in detention as they awaited mental health services from providers outside of the juvenile justice system. Seventy-one facilities in 33 states held youths with mental disorders who had no charges against them. As a Georgia administrator wrote, "No other place would accept these children." Fifteen facilities reported that they incarcerated children awaiting services who were as young as seven or eight years old. Responses from 117 facilities indicated that the youngest such detainees were nine or ten years old, and in 138 facilities the youngest were 11 or 12 years old.
Facility administrators reported a range of serious mental disorders among the incarcerated youths awaiting services, including depression (noted in 315 facilities), substance abuse (315 facilities), attention-deficit hyperactivity disorder (302 facilities), retardation and learning disorders (234 facilities), and schizophrenia (137 facilities). Of the 347 facilities that held youths waiting for services, 95 (27 percent) reported poor, very poor, or no mental health treatment for youths in detention, and 187 (54 percent) reported that staff received poor, very poor, or no mental health training.
Suicide attempts among youths awaiting services were reported at 168 of the 347 facilities (48 percent), and 195 facilities (56 percent) reported that these youths assaulted other detainees or staff. A Missouri administrator wrote, "Youth who are banging their head or fist or feet into walls or who are otherwise harming themselves must be restrained, creating a crisis situation… . Consequently detention staff have to divert all resources to that one youth for an extended period of time."
Many juvenile detention administrators reported frustration with the quality of services provided by outside agencies. A Texas administrator described a case of an incarcerated boy with auditory and visual hallucinations who was homicidal and suicidal. "We immediately contacted [the mental health department]. They came and did a brief assessment and identified a need for hospitalization. However, we were told it would be at least a month before he could even see a psychiatrist. He was not of top priority because he was in a secure environment." As a Michigan administrator wrote, "Children are entering the juvenile justice system who should be cared for by mental health or social services solely because juvenile justice provides long-term care—the wrong kind but still long-term."
Administrators from 280 facilities were able to provide quantitative data on the number of youths with mental illnesses who were awaiting community services. The authors of the report used these data to calculate national estimates: each night, nearly 2,000 youths wait in detention for community mental health services. They account for about 7 percent of all youths held in juvenile detention centers. The survey also found that youths awaiting treatment stayed longer than the general population of detainees—an average of 23.4 days in detention, compared with 17.2 days for all detainees.
The annual cost to U.S. taxpayers for days of unnecessary incarceration of these youths—based on a mean per-capita cost of $140 per day for holding a young person—is about $100 million, according to the report. This calculation does not take into account any additional expenses, such as the provision of extra services and staff time. The report also lists several reasons why its estimates are likely to be conservative: One-quarter of juvenile detention facilities did not respond to the survey. Some facility administrators did not provide usable quantitative data. And, according to several expert consultants to the Special Investigations Division, 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.
After the report's release, the American Psychiatric Association was among 130 national and state advocacy organizations that signed an open letter calling on members of Congress to enact proposed legislation to improve access to essential community and school-based mental health services and supports. The letter specifically mentioned "two bipartisan proposals meriting consideration and swift approval": The Keeping Families Together Act and The Mentally Ill Offender Treatment and Crime Reduction Act.
The report concludes that "the misuse of detention centers as holding areas for mental health treatment is unfair to youth, undermines their health, disrupts the function of the detention centers, and is costly to society." Incarceration of Youth Who Are Waiting for Community Mental Health Services in the United States, which was prepared at the request of Rep. Henry A. Waxman (D.-California) and Sen. Susan Collins (R.-Maine), is available on the Web site of the House Committee on Government Reform at www.house.gov/reform/min.
News Briefs
CDC highlights innovative foster care programs to reduce youth violence: An independent, nonfederal task force appointed by the director of the Centers for Disease Control and Prevention has released a summary of research findings indicating that therapeutic foster care programs can significantly reduce violent crimes among adolescents with a history of chronic delinquency. Such programs reduced violent crimes an average of 70 percent compared with programs for youths in standard group residential treatment facilities. One study showed that for every dollar spent on therapeutic foster care for these youths, an estimated $14 was saved in court and corrections system costs. Therapeutic foster care programs place troubled youths with trained foster families. Adolescents live for six to seven months in a structured environment where they are rewarded for positive social behavior and penalized for disruptive and aggressive behavior. The task force recommends that communities use these findings to support, expand, and improve care programs for the more than 100,000 juveniles currently in foster care in the United States. The Task Force on Community Preventive Services, established in 1996, recommends public health interventions based on evidence gathered during rigorous, systematic scientific reviews of published studies. To date, 92 reports have been published, providing new guidance for public health leaders making decisions about the application of limited public health resources. More information on the task force's review of therapeutic foster care programs is available at www.thecommunityguide.org/violence.
SAMHSA Releases Materials for Recovery Month: The Substance Abuse and Mental Health Services Administration (SAMHSA) has released materials for use as part of the 15th annual Recovery Month this September, as well as a new report, State Estimates of Persons Needing but Not Receiving Substance Abuse Treatment. Recovery Month is designed to highlight the need for substance abuse treatment and to honor persons who are in recovery. This year's theme is "Join the Voices of Recovery … Now!" Materials include a Recovery Month planning kit, television and radio public service announcements (PSAs), and other Web-based and print materials. The PSAs, produced in both English and Spanish, aim to dispel stereotypes about people who have achieved sobriety and to provide information for people who may be thinking about getting treatment. The report on treatment need, which is based on data from SAMHSA's National Survey on Drug Use and Health, indicates that in 2002 a total of 6.3 million persons nationwide needed but did not receive treatment for a drug use problem and that 17 million needed but did not receive treatment for an alcohol problem. The report is available online at www.oas.samhsa.gov. Recovery Month materials can be found at www.recoverymonth.gov.
Program for Minority Research Training in Psychiatry: The American Psychiatric Institute for Research and Education, through its Program for Minority Research Training in Psychiatry (PMRTP), is seeking to increase the number of psychiatrists from minority groups who undertake psychiatric research. The program provides medical students and psychiatric residents with funding for stipends, travel expenses, and tuition for an elective or summer experience in a research environment. Stipends are also available for one- or two-year postresidency fellowships. Deadlines for applications are December 1 for residents seeking a year or more of training and for postresidency fellows, or three months before training is to begin for medical students. Training takes place at research-oriented departments of psychiatry in major U.S. medical schools and other appropriate sites nationwide. Research mentors at each site oversee training. For more information, call the toll-free number for the PMRTP, 800-852-1390, or call 703-907-8622. Queries can also be directed to Ernesto Guerra, PMRTP project manager ([email protected]).
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Published online: 1 August 2004
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