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Sunday, July 22, 2001
Gwen White, director of an Allegheny County intervention program for troubled pre-teens, said it most succinctly: "We're building the plane while we're flying." That's no way to fly a plane with mentally ill youngsters aboard, but unfortunately it's an accurate description of how treatment for such children is often provided.
A troubling theme in last week's four-part series by Post-Gazette staff writer Steve Twedt and photographer Robin Rombach ("It's a Crime: How Mentally Ill Teens Are Trapped in Lockups") was the seat-of-the-pants approach to treating children who have committed crimes linked to psychiatric disorders. Because many states, including Pennsylvania, have been shutting down their adolescent psychiatric units, mentally ill children end up dropping into and out of juvenile detention homes and a patchwork of other programs that are rarely adequate and sometimes counterproductive.
A mentally ill teen-ager placed in Shuman Detention Center, for instance, won't get help for his bipolar disorder. But he could pick up tips on delinquent behavior.
The first-ever mental health screening of juveniles in Pennsylvania detention centers last year showed that as many as 45 percent exhibited serious mental health problems. That this screening was even conducted is a first step in addressing the problem of treatment for mentally ill juvenile delinquents. Now what?
First of all, fragmentation of funding must end. Competition for government and private funds promotes turf protection and territoriality among programs and personalities. It does nothing for sick children. In Milwaukee, all money for children's services goes into one pot and is used, as needed, for each child. Removing the boundaries between services and departments has meant that more children in that city are being properly treated for mental illness rather than being locked up. And no institution can refuse to take a child.
Also, care providers must work against any one-size treatment plan for all youths. A look at the diagnoses of children in the Post-Gazette series -- bipolar disorder, schizo-affective disorder, Asperger's Syndrome, severe depression or various combinations of these -- will tell you that each treatment needs to be highly personalized to be effective. A close look at individual needs also should lead to better treatment for mentally ill girls and minorities, groups that have been poorly served.
Some teen-agers may need to be in a secure facility where they can't hurt themselves or others and where, as one nurse said, they are "captive therapy patients." Others may thrive in a group home, while still others are reliable enough to faithfully show up for outpatient appointments.
Forty percent of the detention centers that responded to a nationwide Post-Gazette survey said they keep children with mental health problems longer than others, because there's nowhere else to put them. That's called warehousing, a throwback to an unenlightened time when the misunderstood mentally ill were locked up and forgotten. But we understand the problem now, and it's time to address the answer.