Tough love? Boot camps? Or psychotherapy?

This story about Monique, a teen with history of mental illness housed in a youth offender facility, is from Detroit, but it could just as easily been in any other state or province in the US, Canada, the UK, Australia, or any other nation. The simple fact is that our children are falling through the cracks in increasing numbers, caught between a failing mental health system and a failing correctional system.

Detroit Free Press, September 7, 2004 — At 16, Monique struggles with the same anguish caused by schizophrenia that her birth mother has lived with for years, said Cynthia Hunter of Detroit, who is her legal guardian and who has raised Monique since infancy. The nightly terror of shadows and the daily torment of voices are the same things that drove Monique to hoard knives and shudder at things others can’t see or hear.

But Hunter has a better life planned for the teen she considers her own little girl, and she has spent years guiding Monique through the outdated public mental health system in hopes of helping Monique achieve her dreams. “I would like to see my daughter at peace, to put all these demons behind her,” Hunter said.

That’s meant more than a decade of counseling and therapy, multiple stays in psychiatric hospitals, time in the Wayne County Juvenile Detention Facility’s mental health ward and, finally, placement in the Adrian Training School, a youthful offender facility where she will stay until at least December.

It’s a familiar story for children with severe mental illness, such as schizophrenia, bipolar disorder or depression. Increasingly, experts say, those children are ending up in the juvenile justice system, where they finally get some kind of the treatment they need.

This is in spite of the fact that it costs more to keep young offenders in secure correctional facilities than it does to provide them with mental health services. Part of the problem is the swing of the pendulum begun back in the late 1970s and early 1980s toward patient advocacy, which although well-meaning has hampered the efforts of psychiatry and psychology to assist involuntary patients, both teens and adults.

Susan McParland, executive director of the Michigan Association for Children with Emotional Disorders, says, “Too many children are being detained and incarcerated because they exhibit behaviors linked to their illness that are mistaken for delinquent acts.” In fact, 36 percent of families surveyed by the National Alliance for the Mentally Ill reported their children were in the juvenile justice system because mental health services weren’t available. “A lot of kids are needlessly going into crisis because the system just isn’t geared to anything else,” said Christopher Burley, deputy director of communications for the Bazelon Center for Mental Health Law, a Washington, D.C., advocacy organization for people with mental disabilities. “Every day that policymakers fail to act on this is another night that 2,000 kids across this country are going to bed in juvenile detention facilities because they can’t find mental health services in the community.”

I understand the concerns that individuals and their families have about protecting themselves from what is perceived to be rising criminal violence (although in fact all of the statistics regarding violent youth crime in the past 10 years show the opposite: violent crime among youth is declining, at least in North America). One thing is clear: We need to find better ways to distinguish between children and teens who need mental health assistance and those who need to be incarcerated to protect other citizens. We also need to ensure that mental health services are available for those who need it. And one way to do that is to stop spending money needlessly to house adolescent mental health clients in expensive secure correctional institutions.

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