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Published: Tuesday, 9/25/2007

Mental health services limited for delinquents

BY ROBIN ERB
BLADE STAFF WRITER

Last of three parts

On a police report, Dale looks like any other burglar: The defendant did trespass into an occupied dwelling and did steal $522 and a cell phone.

And he might not stand out among the list of kids this day inside the Lucas County Juvenile Detention Center a litany of suspected burglars, thieves, and batterers.

But Dale still colors pictures of Scooby-Doo. His brain functions at a kindergarten level.

He s a 17-year-old kid in a 10-year-old body, with a 4-year-old mind, said one court official.

So on this day, no one seems to know what to do with Dale.

In Lucas County, mental health services especially for adolescents are limited and costly. And throughout Ohio, a mental illness for a juvenile delinquent can be a get-out-of-jail card, said Doug Messer, administrator for Lorain County Juvenile Court near Cleveland.

He and other juvenile justice and mental health officials from around the state have been meeting to establish a mental health statute that would lay out steps to help some of the state s most mentally ill young criminals.

Unlike Ohio s adult courts, the juvenile courts have no protocol for identifying youths who may be unable to defend themselves in court.

In adult court, a defense attorney generally asks for a competency evaluation. If a defendant is too cognitively impaired or mentally ill, a judge may order treatment, triggering a detailed process that might restore them so they can stand trial.

Finally, if they can t be restored to competency, a judge can order them to a secure mental health facility.

Juvenile justice doesn t work like that.

What happens in most jurisdictions is that the charges are dismissed and the child goes on his way, Mr. Messer said.

And there s another issue, he said. Is there a point in which kids are simply too young to defend themselves?

Can you grow or be educated into competency? Is there an age cutoff? Mr. Messer asks.

Kathleen Baird, chief psychologist for the Lucas County Juvenile Detention Center, estimates about 30 percent of juveniles in detention take some kind of psychotropic medication. Kathleen Baird, chief psychologist for the Lucas County Juvenile Detention Center, estimates about 30 percent of juveniles in detention take some kind of psychotropic medication.
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In Lucas County, officials say they use some creative intervention even turning custody of a child over to Children Services to get a young offender the help he needs.

Still, it s not easy.

On a recent morning, Kathleen Baird, chief psychologist for the Lucas County Juvenile Detention Center, had just finished evaluating a 15-year-old felon. Unable to read beyond a second-grade level, it was also unclear if he really understood the gravity of being detained and facing youth prison.

He can t tell a story sequentially. How could he tell his attorney what happened? She didn t finish, frowning instead.

According to the Ohio Department of Youth Services, kids in prison are about four grades behind in math and reading. About half are assigned to some special education classes.

About one in three have some type of mental health issue. As many as 80 to 90 percent have been abused, and nearly all have experienced some tragedy, violence, or some other trauma the sort of event that research suggests interrupts and rewires the brain in critical developmental years.

Not surprisingly, children like Dale pose a real concern for Lucas County where Juvenile Court officials must sort out more than 10,000 delinquency cases each year, ranging from kids sneaking cigarettes to young sociopaths and murderers.

A happy kid who s eager to please, Dale has been urged by older teens to sneak into homes. He s 110 pounds and can wiggle through windows and open doors for them.

There are other kids whose brains misfire and they seem like demons and hear voices. Ms. Baird estimates that about 30 percent of juveniles in detention take some kind of psychotropic medication.

There are those whose brain development is so delayed, they can t appreciate they are in jail.

Juvenile Court Magistrate Laura Restivo knows that her orders for substance abuse or mental health counseling can be a
hardship for some parents, but feels she has no other choice. Juvenile Court Magistrate Laura Restivo knows that her orders for substance abuse or mental health counseling can be a hardship for some parents, but feels she has no other choice.
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Some are violent.

A defense attorney s ethical mandate is to, above all, vigorously defend a client against the criminal charges against him.

But what if evidence in a case is so poor that the attorney knows he can get the charges tossed out yet also realizes that he can get the child into the mental health system only with a finding of guilt?

Sometimes you can go in and win a case, but lose it for a kid, said Ken Phillips, a defense attorney who represents many of Lucas County s substance-abusing youths. It s tough.

Among the suggestions Mr. Messer and others have discussed is enabling a child s guardian ad litem, a person appointed to represent the best interests of the child, to demand a competency evaluation.

That way, the defense attorney can focus on best defending the child against the criminal case while the guardian ad litem can worry about mental health help.

A disturbing example

Just before Thanksgiving last year, the phone rang at Judge James Ray s house in the middle of the night. It was a sheriff s deputy.

A 17-year-old drug addict, suffering from schizophrenia and paranoia, had grown violent. He d threatened people. And he d been arrested.

But juvenile detention staff wouldn t take him. He needed hospitalization, they said.

A local hospital doctor wouldn t accept him either. He needed to be locked up, they said.

The Lucas County jail couldn t take him either. It s for adults.

Exasperated, the judge talked to an emergency room doctor: I said What do you want these deputies to do? This young man doesn t belong in detention. He can t go to jail. Should they put him in the back of their car and drive him around until he expires and then take him to a coroner s office?

Those in juvenile justice say young criminals with serious mental health issues don t just fall through the cracks, they re pushed and shoved through.

Medicaid doesn t cover mental health care inside lockup.

Lockup doesn t provide long-term treatment anyway.

Insurance companies bristle at being court-ordered to provide treatment.

And mental health providers feel criminals sometimes are unfairly dumped into their system.

We re not always in agreement about how we see things, said Karen Olnhausen, director of child and adolescent behavioral health services at the Mental Health and Recovery Services Board of Lucas County.

These days they re working to close the gaps in Lucas County, say the leaders of the county s public mental health agencies and juvenile court.

There is more open-mindedness that we really do have to work better together on these kinds of kids. We have to stop trying to turf them other places, said Ms. Baird.

It will take awhile, said Connie Darling, a longtime county juvenile probation officer: It s a stressed system, and it s discouraging.

Still, everyone agrees on this: Finding the right court sanction from time behind bars, to counseling, to community service, to a host of other options is critical to changing criminal behavior and ultimately to making the streets safer.

Inappropriate sanctions aren t just ineffective, they can backfire, said David Arredondo, a child psychiatrist and leading national expert on juvenile mental health issues.

According to both mental health and juvenile justice experts, the first step is understanding that even in the best circumstances the adolescent brain is undergoing an explosion of neurobiological, psychological, social, and moral development.

Archambeau Archambeau
AMY E. VOIGT Enlarge

Finding what works is even more complicated when it s a kid who may be simply surviving in chaos, neglect, and fear, and panics rather than being nurtured by routine, expectation, and love.

Some of these kids, horrible backgrounds, horrible environments. [If a] kid s mom was doing meth when he was in utero, God knows what s going on with his brain, said Dr. Arredondo.

How do you know?

So how do you sort out mental health from sociopathy, from normal teenage angst and obnoxiousness?

It s very hard, even for a professional sometimes, said Dr. Lurley Archambeau, medical director of the Lucas County Mental Health and Recovery Services Board.

You have a kid that the parents bring in, and they re misbehaving, or not being truthful, or disobeying. Is this part of a normal teenager emancipatory process and who they re hanging around with and trying to fit in with the group? Or is this an underlying sign of some kind of nascent mental illness that s developing?

To be honest, sometimes only time will give you the answer to this.

That s not to say youths shouldn t be held accountable, but lockup simply isn t always the best answer, he and others said.

But even in times when community safety is not the overriding issue, it s often the only option.

Said Thomas Stickrath, director of Ohio Department of Youth Services, which provides some mental health care: From time to time, courts tell me, judges tell me, I m sorry I m sending Johnny to you. He really needs mental health treatment, but we re not sure the options are there locally.

They re especially limited in Lucas County for those kids whose substance abuse problems are so deep that they need residential treatment.

Two decades ago, several Toledo-area hospitals featured long-term substance abuse and psychiatric wards, and in West Toledo there was St. Anthony Villa, a long-term residential treatment center where staff were specially trained to deal with the complexities of mental health and sometimes violent, criminal behavior.

But as insurance policies changed over the years, many cut back on mental health and substance abuse services. That, in turn, meant some of those services, including St. Anthony Villa, closed down, mental health providers say.

This month a change in state law will mandate that most policies expand certain coverage for the care of biologically based mental illness, like schizophrenia, the same way they do for physical illnesses, said Kelly McGivern, president and CEO of the Ohio Association of Health Plans, which includes about 20 health care companies serving 6 million Ohioans.

Insurance shifts

She said the old one-size-fits-all policies diversified over the years. The advantage was that customers were able to get coverage more tailored to their needs.

In that evolution, she said, other health issues took priority over mental health and substance abuse services. In some policies, such coverage became supplemental.

The insurance coverage responds to the demands of consumers, she said.

Plus, she said, agencies that offered those services to youths seemed to have dwindled.

These days, only Connecting Point has long-term residential treatment for substance abusing teens. It s limited to boys and there s always a waiting list.

Additionally, it must give priority to clients with Medicaid because of changes in the way the state reimburses mental health agencies and a growing gap of working poor who are underinsured or uninsured.

Sometimes that means turning away a client with a questionable ability to pay for one backed by Medicaid.

Frank Ayers was interim head of Zepf Center when it tried to merge with Connecting Point earlier this year. The merger fell apart at the last minute when financial backing pulled out, concerned about financial instability.

The problem, Mr. Ayers said, is the group of clients who desperately need the help but can t cover the costs of it.

Their heart is bigger than their pocketbook and that works for a while, but at some point, it doesn t work and you have to start limiting things, said Mr. Ayers.

As the longtime head of Rescue Crisis, Mr. Ayers, executive director of Toledo Rescue Mental Health Services before his role at the Zepf Center, knows well the struggles of helping the mentally ill and those with addictions.

Ultimately, financial stability means cutting both services and who you serve.

What you end up with is longer waiting lists for certain clients, and care that is more aggressively managed.

Aggressively managed, he said, is a euphemism for limited.

Trevor s life

Trevor slumps in a hard plastic chair waiting for his turn in the courtroom.

He s been here before. It s always the same. They talk about him. About what he needs. The lady judge and his mom. What do they know? he sulks.

What Magistrate Laura Restivo and his mother have been talking about for months now is how to get Trevor a mental health and substance abuse assessment.

At 3 years old, his mother says, he never played with toys; he destroyed them. By 4, he screamed at her friends and terrorized other kids.

We went to a counselor one time, and the counselor said, What do you like to do? He said break glass, his mother said.

Now 14, he drinks and smokes weed. He steals and bolts from the house at night to run the streets with friends, she said. Beat cops know his face.

So is he a criminal? A brat? Or a kid who needs substance abuse or mental health counseling?

It s tough to say without an assessment, but his mother a single mother with her own business tells Magistrate Restivo it will run $125 a session and treatment could be $1,200 a month or more.

There s just no way, his mother says of paying the bills herself. That s just more than half of my income.

Yeah, that s crazy, the magistrate responds.

But Magistrate Restivo is stuck, too.

She reasons: She can t not order treatment.

I understand there s a hardship, and some parents don t have the money, she says later. But you can t lower the standard, you know, like If you can t afford it, you can t get the treatment. I can t fix the financial status of it all.

If your kid s sick, you still have to take them to the doctor whether you have the resources or not, she said.

So she orders Trevor s mom to negotiate a better price for assessment and treatment. Magistrate Restivo, for her part, will court order Trevor s biological father to help pay half.

And Trevor?

She orders house arrest. He grumbles, but she holds his gaze.

This is a hole you ve dug and we re going to try to help you dig out of it. But let s be clear: You re here because of your choices and your decisions, she said. And now you have to live with my decision.

Trevor strolls out of the courtroom and shrugs. Whatever.

Contact Robin Erb at:robinerb@theblade.com or 419-724-6133.


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