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Monday, July 16, 2001
By Steve Twedt, Post-Gazette Staff Writer
The sun has not yet brightened Lincoln-Lemington on April 25 when staff members at Shuman Juvenile Detention Center wake one of their young residents to prepare him for a ride across Pennsylvania.
He is 16 and has hallucinations -- hearing voices no one else hears, seeing objects no one else sees -- and he has a history of clawing at himself until he bleeds. He first came to Shuman more than a year before, after he assaulted someone, inflicting serious injury. Before that, a fire he set also caused serious injuries. Shuman staff would discuss his case only on the condition that he not be identified.
In the 15 months before this dawn, the teen has left Shuman seven times, only to return each time, either because he finished an emergency psychiatric hospitalization, or because he "failed to adjust" at a residential placement.
At one point, he underwent surgery for a brain tumor. Once he had recovered, he was back at Shuman for a short time -- until he had to be rehospitalized after he pulled out his surgical staples and violently banged his head against a wall.
This day, he'll be shackled and handcuffed for the ride to the Allentown Secure Treatment Unit in Lehigh County, a 16-bed, one-story brick structure surrounded by a fence topped with razor wire, considered the last stop for aggressive, mentally disturbed boys. The state has no such special facility for girls.
This young man, while not a typical Shuman resident, is not so unusual either.
On the day he leaves for Allentown, 117 teens and pre-teens are at Shuman, awaiting a hearing or placement. Twenty of them -- about 1 in 6 -- will stop by the clinic during the day for medications to stabilize their moods. Eight of the 117 have yellow cards attached to their files because they're considered suicide risks.
This time a year ago, Shuman staff members were responding to two or three suicide attempts each week, never knowing each day when the first crisis would come. Out of necessity, they set up a first-of-its-kind, on-site crisis center inside Shuman, with the help of Western Psychiatric Institute and Clinic. Within weeks, the average number of emergency psychiatric hospitalizations at Shuman dropped from five to seven per month, to fewer than one.
It's not that the teens were having fewer problems, but by finding a way to isolate them and deal with them face-to-face, Shuman kept many of them from having to be taken to an outside hospital.
Watching for warning signs
That has addressed one problem, but larger ones persist. What does a detention facility do when, on any given day, up to 20 percent of the children may be on the verge of a mental breakdown?
"We go back and forth about whether we should have them on one unit," says Terri DeFazio, who manages health services for Shuman. "Right now, we think it works better to have them spread throughout the building." Her fear is that having all the mentally unstable youths on one unit could turn one child's crisis into a domino-style catastrophe.
This morning, DeFazio is fretting about a new admission, a young man recently transferred from the Allegheny County Jail after a psychotic episode. Police say he was a passenger in a car used during a burglary; DeFazio wonders if he could have even known what was going on.
At a group therapy session the previous day, she says, the young man had become something of a target. "The kids were laughing at him and teasing him because he was a little bit out of it. That's my worry, that this kid's going to get scapegoated a lot."
DeFazio oversees the suite of offices down the hall from Shuman's main entryway. It's here that the teens, dressed in matching blue coveralls, come for their medications two to four times a day, starting at 8 a.m. There also is a room for crisis intervention, a place where youths go when they can no longer cope.
"What happens inside these four walls stays within these four walls," says Christine Drgon, who has been the full-time Western Psychiatric crisis specialist at Shuman since October. "They come in here, and yell and scream, and it doesn't go to court with them."
Just the afternoon before, Drgon had earned a hard-fought victory when a 16-year-old girl with bipolar disorder had agreed to start taking her medications again.
The short, strawberry-blond teen had been a difficult case. She was 12 the first time she came to Shuman, on burglary charges. Between then and now, she'd been in four different foster homes, and had "failed to adjust" at two residential treatment facilities. Her record showed that her mother, who also had bipolar disorder, had committed suicide when her daughter was 11.
"Her mood goes all over the place, and she goes with it," Drgon notes.
The girl had been in Shuman this time since March, and she had consistently refused medication, which is the right of any child over 14. But when she still didn't know after a month where she'd be sent, the stress overtook her. She got into a fight in the cafeteria on Friday. Then another fight on Monday, and a third one Tuesday.
That's when Drgon finally convinced her to get back on medication while she waits for her next placement.
"I wish there were other options out there," Drgon says. "Some females stay here three to four months waiting for placement. That's hard on the staff and it's hard on the kids. They get frustrated."
With the toughest cases, even when they eventually do leave, everyone knows it's only a matter of time before they strike out at someone again, and end up back in detention, tagged with the "failure to adjust" label.
"Once they've FTA'd, they've failed," Drgon said. "These kids have already failed because they came here, then we send them to a place where they fail again. That kid's going to think, 'I fail all the time.' How does that play on their self esteem and self image?"
Terri DeFazio, health services manager at Shuman, says the staff has considered putting the growing number of mentally ill teens in one unit, but fears that if one youngster has a meltdown, it will set off a domino-style catastrophe. (Robin Rombach, Post-Gazette)