 
|
|
|
 |
 |
 |
 |
 |
 |
 |
 |
Sunday, July 22, 2001
All too accurate
My compliments to Post-Gazette staff writer Steve Twedt and photographer Robin Rombach for an outstanding but very sad description of the plight of too many youth in Western Pennsylvania and America ("It's a Crime: How Mentally Ill Teens Are Trapped in Lockups," July 15-19). For many in the field, what they describe comes as no surprise. I hope it serves as a call to action.
For the past 10 years, America has consciously and radically altered how health care is made accessible through how we pay for and manage that care. Ten years ago, these same children might have found more access in a treatment system supported by grant-funded services. Today, receiving those same services would require eligibility for benefits, authorization to access those benefits and a fee/claim for each service rendered.
Additionally, before treatment might be authorized or allowed, it is often necessary for youth to meet adult criteria for "medical necessity" when their displayed behavior, while not "medical" by definition, is as predictable as any physical indicator, only not as accepted. The net result is the rapidly growing criminal justice system of young people with mental illness -- and a clinical treatment system for youth that is in deterioration -- if present at all outside of criminal justice.
In 1999 the state of California, seeing this same phenomenon, passed a mental health parity law specifically for children. Based on both scientific and economic analyses, this state saw it was in its best interest to ensure for all children that certain mental diagnoses were treated -- thereby forestalling the mass entry of their youth into the criminal justice system. Four other states have since done similarly. This might be one idea.
Defining age-appropriate clinical (medical necessity) criteria for benefits and making benefits more accessible would be another. The Wraparound Milwaukee model described is a third, where the sources of payment are made indistinct to the needs of the adolescent with the subsequent reduction in criminal justice involvement documented.
One thing is for sure: Unless we understand the loss so tragically described in these articles, how we help create the problem and how the still-present bias against mental illness as a full medical illness impacts the solution, we will likely continue to read such tragic histories -- and the criminal justice system will continue to grow.
MIKE FLAHERTY
Rehabilitation of youth
As a child forensic psychiatrist, I work with mentally ill youth in juvenile and adult correctional facilities. Several clients to whom I have provided treatment in juvenile justice settings have later become my patients in adult jails and prisons.
I have learned that in correctional placements (as well as in society) seriously mentally ill youth may adjust poorly. They may be disciplined more often, because they do not conform as rapidly as their peers, who quickly identify these vulnerable youth as different. When they are sent home, their families and communities may lack sufficient resources to provide necessary support and services for them.
Quality mental health treatment may enhance one's clarity of thinking. Treatment may improve one's capacity to prioritize, to cope, to respect authority and to interact appropriately with one's peers. Consequently, mental health services may improve the accessibility of residential placements to seriously mentally ill youth.
The primary function of the juvenile justice system is rehabilitation of youth. The dearth of available resources to mentally ill youth is tragic and profound. Increased funding for mental health services to juvenile justice systems is long overdue.
CHERYL D. WILLS, M.D.
I want to help
I am 16 years old. On Sunday, I started reading Steve Twedt's series on how mentally ill teens are not being helped in the ways needed most. Reading the articles made me realize that we -- other teen-agers -- have a responsibility to help.
I was truly surprised and angered to find out the facts concerning the lives of other teens, serious criminals or not. I was especially angered to read that so many of them were turned away from treatment. How could someone do that to another person? That is not the way most of us were raised. The majority of us were taught to reach out a hand to those in need.
I thank Steve Twedt for opening my eyes to the growing need of our fellow people. I would like to help to re-establish the institutions that will save so many adolescents from going through such awful situations in the future. There are young people who care enough and want to help.
MARIA LIRA
Director
Behavioral Health Initiatives
Jewish Healthcare Foundation
Downtown
Columbus, Ohio
Editor's note: The writer completed a residency in adult psychiatry and a fellowship in child psychiatry at the UPMC Western Psychiatric Institute and Clinic. In August, she will become director of psychiatric services at a juvenile corrections program in New Orleans.
Bulger