Out of Mind, Out of Sight

For a growing number of Texas kids with mental illnesses, the only place to get help is behind bars.

On February 28, the House Appropriations Committee adopted the $35 million pilot program Turner authored geared toward improving mental health care for offenders. The plan is to identify kids with mental illness while they're incarcerated and continue care after they leave.

The project is a joint effort of TYC, the Texas Department of Criminal Justice, the Texas Juvenile Probation Commission and local mental health authorities coordinated and funded by the Texas Council on Offenders with Mental Impairments. "The intent is to keep them from progressing in the system," says Dee Kifowit, director of the council. "To keep them from going to prison."

Harris County is getting the lion's share of the funding, receiving $2.5 million. One million is for juvenile programs; the other $1.5 million is for adults. The state's seven largest counties received funding to hire therapists and train four juvenile probation officers to work with 60 mentally ill kids to make sure they see their counselors and take their medication. "There are many that quite honestly deserve the services that we won't ever get to," Bailey says. "But the thought's there." Harris County already has trained two probation officers, but they can't start working because the Mental Health and Mental Retardation Authority hasn't hired the 13 counselors for which it got grant funding. The jobs were posted weeks ago, Schnee says, and the money is in the bank, but qualified candidates haven't surfaced.

Dr. Don Brantley, superintendent of the Corsicana facility, says mentally ill kids need more flexibility when incarcerated.
Wendy Grossman
Dr. Don Brantley, superintendent of the Corsicana facility, says mentally ill kids need more flexibility when incarcerated.
Linda Green is nurse manager over child and adolescent services at the juvenile unit at Harris County Psychiatric Center. The center tries to give kids a better sense of their own individuality than typical juvenile lockups.
Deron Neblett
Linda Green is nurse manager over child and adolescent services at the juvenile unit at Harris County Psychiatric Center. The center tries to give kids a better sense of their own individuality than typical juvenile lockups.

Dallas County Metro Care hired therapists before completing its proposal and contracts with the coalition. Dallas' first juvenile probation officer trained to work with "special needs" kids began in mid-October, and a second followed two weeks later. "We've started officially without any money," director Griffiths says. "We understand the legislative intent, and we are moving forward."

Three years ago the Dallas County Juvenile Probation Center created an eight-bed in-house psychiatric unit with seven Ph.D.'s and six master's-level clinicians doing assessments and outpatient counseling. The department spends about 15 percent of its budget on children with mental illness, Griffiths says. It has contracts with 26 residential treatment centers throughout the state and around the country and 30 contracts with nonresidential treatment programs. Severely psychotic children who are deemed "unmanageable" are sent to the Terrell State Hospital 30 miles east of Dallas, Griffiths says. "Regardless of the charges, if the child needs care, then [the juvenile judges are] going to order them into that facility and hold them in contempt of court if they refuse to admit them," Griffiths says.

It's rare that a Harris County juvenile judge orders an offender into Harris County Psychiatric Center's acute care unit, Bailey says. A kid who commits a violent crime can't be admitted to the 16-bed subacute psychiatric unit. "If he tricked us or if he got well over there and he wanted to leave, he possibly could because it's not a secure environment," Bailey says. "If they escaped, nobody could feel safe. They stay in detention, they get medicine, they get helmeted, they get constantly watched. We put a big guy in the doorway. They just don't get to have the opportunity to abscond." Two kids escaped from the subacute unit this year. They boosted each other over the wall and went home. They didn't commit any crimes; probation officers found them and took them back to the hospital.

Security measures make it so people who need the most help can't easily get it. A 15-year-old African-American boy was arrested in September. A week later, he sits slumped in a white plastic chair on the fifth floor of the Harris County Juvenile Detention Center, heavily drugged, his empty eyes staring at the white wall. He's schizophrenic, and staffers say he needs more care than he's getting, but because he's charged with murdering his brother, he's deemed too dangerous for the 16-bed unit.

"How are you doing, sir?" asks Diana Quintana, a licensed psychologist who is the department's administrator of mental health services. He looks at her blankly, his eyes half closed. She tells him it's really important to let the doctors know how he's doing on his medication. He doesn't answer.

Three weeks later he stops eating and refuses to take his medicine, and the psychiatric staff say he's steadily deteriorating; a judge orders him into the acute unit at the Harris County Psychiatric Center. "He couldn't stay in detention any longer," Bailey says.

The detention center is a depressing place; locked doors lead to metal detectors surrounded by security cameras. The mostly bare walls are covered in scratches and patches (staff members say they haven't decorated because they're moving to a new building in a few years). In the stairwell, a trash can catches yellow water that drips through the soggy ceiling.

In a dimly lit, noisy area, boys' shouts echo off the empty walls. Here, offenders are given the Massachusetts Youth Screening Instrument, a 52-question true-or-false test that helps identify teens who might have mental or behavioral problems. "It tells us whether we need to ask more, harder questions," Bailey says. "We can decide between those who just want to create victims and those who need help in order to change."

Court-ordered psychological and sanity screenings are mostly performed by the Mental Health and Mental Retardation Authority's Child and Adolescent Services Forensic Unit (staffed by a licensed psychologist, a psychiatrist and two master's-level clinicians). Formerly the clinical supervisor for the forensic unit, Quintana is the only licensed psychologist the detention center employs, and she does more administrative work than therapy. The probation department's psychiatric staff is composed of a nonlicensed psychologist, three master's-level therapists and two social workers with master's degrees. The mental health authority employs a psychiatrist who prescribes and monitors psychotropic medication twice a week.

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