Wednesday, June 20, 2007

How many kids are in juvie hall for being mentally ill?

Texas ranks at the bottom among states for providing mental healthcare to children, reports KHOU ("Lack of funding may keep juveniles in jail," June 20), and Harris County is second from the bottom among counties in their level of mental health spending for youth.
By one estimate, more than 40 percent of kids sentenced for serious crimes here have serious mental illness.

But in Texas, the chance they ever got help for those mental problems is worst in the nation.

Yet another study colored Texas dark blue: at the bottom of all states for fewest children getting the mental health treatment they need.

But locally, it’s even worse.

“And Harris County is second from the bottom in per capita funding,” Dr. Steven Schnee said.

11 News: “So were in the lowest ranked states and one of the lowest counties within that state?”

Dr. Schnee: “You got it – absolutely.”

A hopeless situation? No, said Dr. Schnee, the director of the county’s Mental Health Authority.

“The Texas Legislature took several important, important steps,” Dr. Schnee said.

Lawmakers last month approved millions for emergency mental health services and expanded coverage for uninsured kids.

What’s more, the county is using private fund raising to pay for expanding clinics within schools where mentally ill children had sometimes been railroaded into classes for the learning disabled.

“Many of these children have been placed in special ed, special education — act up, go in special ed, no diagnosis, no treatment, nothing,” said Lois Moore with the UT-Harris County Psychiatric Center.

Now at Grimes Elementary on the south side, a mental health clinic will help diagnose kids who might be able to function normally with proper treatment.

“There was nothing available before we started it,” Moore said.
KHOU gave a good analysis of the crisis, and I'm glad to hear HISD will start to perform mental health evaluations. But it's a mistake to think anything the Texas Legislature did in 2007 will fix these problems. At best they took a few baby steps at the start of a marathon.

It's cheaper and produces better public safety outcomes to deal with mental health issues before a kid winds up committing crimes. But since most insurance shortchanges mental health coverage, even families with employer coverage can find themselves in the same predicament as someone with no insurance at all.

There's still an attitude among voters and many in the criminal justice system that mental illness is a personal failing, not a medical condition, even though medical professionals know better.

The result is that we use jails and prisons to house the mentally ill instead of hospitals. At TDCJ, 30% of adult inmates are past clients of Texas' indigent mental health system. I don't know the comparable figure for juveniles, but KHOU reports that "By one estimate, more than 40 percent of kids sentenced for serious crimes here have serious mental illness."

I've long understood that Texas indigent mental health system was inadequate and contributed to worsening public safety. This article adds another item to my "real public safety agenda": Forcing insurance companies to expand mental health coverage. Getting folks, especially kids, the care they need on the outside is a lot cheaper and creates better outcomes than waiting until the mentally ill commit crimes then trying to manage them in jail.

21 comments:

Anonymous said...

I am curious then what you believe should be done with Juveniles or adults that commit crimes witha mental illness. Should we just place them in a hospital and release them once they are stable and how to you make them continue whatever it too k to stabilize them. Should the victims of the srime be left out in the cold since the person has a mental illness.

Gritsforbreakfast said...

The answer would differ for different people and situations.

My point is that we dramatically underinvest on the front end when we could actually prevent crimes. Take the 11-year old in the KHOU story: His Mom can make him take the meds, if she could afford them or if her insurance covered them. So there's a policy measure that could prevent that kid from ever victimizing anyone that's cheaper than incarcerating them afterward.

It's the same argument I've made about dyslexia and crime.

Several years ago during the Bush Governorship I was hired as a contract writer to write a waiver for the state Medicaid program to the federal government requesting to draw down matching funds for "new generation" mental health drugs. (I worked closely on it with Garnet Coleman's office and the Harris County hospital district). Bush submitted the waiver as Governor, campaigned on having done it, then his HHS chief rejected the waiver as President. How many crimes would have been prevented if, as that waiver envisioned, drugs and treatment were available for bipolar and schizophrenic patients with incomes up to 200% of the federal poverty level? Probably a lot.

Personally I think it's wiser to invest in preventing crime, when you can, instead of worrying about placating angry victims after the fact. Punishment does the victim no good except to satisfy vengeance. The real goal of punishment is to increase public safety, and in the case of the mentally ill, incarceration alone doesn't always do that. best,

Anonymous said...

As a matter of fact incarceration makes matters worse for most mentally ill inmates. TDC has its hands tied behind its back on helping MI inmates. Very few receive "enough" treatment. Most are given the bare minimum. I speak from experience as my son has a severe mental illness and is presently housed in isolation. How do you think he is going to act when he gets out?

Anonymous said...

So the impression I am getting from you is that its the governments responsibility to treat your sons mental illness. Its sad that people in american believe its someone elses responsibility to fix our problems. We never take responsibility for our own actions. That is what prison is about the action (crime) is punished by the response (incarceration) no the prison system isnt a good place for treatment and I dont believe anyone is saying it is. However crimes need to be punished to a varying degree of course based on all factors but they should never be just washed away due to any illness. If that is the same than how do you think about the individual who is on drugs and commits a murder. they didnt understand what they did but yet they did it. Should we just say oh well its ok you were high. Yes menatl illness isnt a decision the person made like taking drugs is however getting treatment is a option so the question is why didnt they make the effort to get treatment or why didnt the parents make that effort for the child. If they did make the effort why didnt they stay stable did they stop taking the medication and isnt that their decision just like taking the drugs was in the earlier example.
All I ever here is how we need to allow individuals with mental illness go free since they didnt know what they were doing based on the psych condition they have. Personally I disagree with this. I find it offemnsive to believe that a rapist who committed his rape should ever be excused just because he/she had a mental illness. It is unfortunate that we are so willing to ignore the behavior and decisions we make and create more victims of crime that also have trama that will take many years of counseling to move beyond.
I have worked in the Cj field for 17 years now and I have seen alsmot ever excuse there is for what offense the criminal committed. What we must remember is they still committed a criminal offense. maybe they didnt get enough love as a child so what what is everyones else;'s excuse for why they didnt commit crimes. Maybe they were abused as a child only 1 out of 3 individuals abused grow up to abuse so what is the other 7 individuals excuse. and why should some innocent person have to pay for those 3 peoples failure to get help. treatment is awesome but it isnt a cure all. Prison isnt a cure all but its the best we have in dealing with criminal behavior.
The last legislature made alot of changes in TYC system but really hasnt solved any of the issues present. Now like bfore its a system of treatment without any control. The reason these youth are here in the first place is lack of control by parents. Its sad that a youth in TYC has a home life that created his/her behavior but that isnt something the goventment can fix. Maybe its time we looked at ourselves and said what have I dont to make this situation.

Gritsforbreakfast said...

@2:13 - What is the purpose of punishment if it's not a deterrent in the first place, and doesn't intervene in a person's behavior to prevent it happening again? Especially for nonviolent mentally ill offenders, why wouldn't inpatient stabilization treatment be a better option if it were available? You say "crimes needs to be punished," but I think crime needs to be lessened, and among the mentally ill sometimes inappropriate punishment increases crime, as the inmate's father pointed out.

As for your social darwinist view of mental health, America is the only major industrialized country where 1/4 of people are uninsured and we don't have a national healthcare system. So in any any other civilized part of the world, yes it would be government's responsibility to help care and medicate folks who can't afford it. Here we just wait for them to commit a crime and throw them in prison - much smarter, don't you think?

Finally, most mentally ill aren't committing rapes, so using that as your example is a red herring. Instead they're committing petty theft, peeing in public, getting high and stealing to support a habit, assaults - those are the sorts of things filling up the jails and prisons. I'm not arguing against incarcerating rapists or other violent people, but for a different approach to managing the thousands of low-level mentally ill offenders cycling in and out of the system with no end in sight.

There are some good points in your comment, 2:13, but they're a little hard to draw out amidst the mean-spiritedness and hyperbole. You write, "We never take responsibility for our own actions." That's very true. However, given that such huge numbers of mentally ill are in the prisons and jails, I think THEY'RE already being held plenty responsible, by your logic. By contrast, politicians who fail to fund mental health treatment, vote continuously to boost criminal sentences, then don't blink an eye when our prisons are full of mental health clients should ALSO be held responsible. But I hear a lot less crowing from the tough on crime crowd on that score. best,

Anonymous said...

In your opinion, is burglary a non-violent offense? I know that you think possession of small amounts of illegal drugs is not but I'm curious about burglary. Thanks.

Gritsforbreakfast said...

It's not a function of a my opinion - burglary isn't a violent offense because the law does not consider it so, not because of anything I do or don't believe. Typically the appellation "violent" in legal settings means violence toward people, not your stuff.

Anonymous said...

Hey 2:13...if you believe it's up to parents to diagnose their children's problems and fix them, I wonder why yours did nothing to help you with your writing skills.

If you are going to grandstand against criminals with preventable illnesses...for heaven's sake, check up on your own disabilities first and find a spellchecker.

Truthman30 said...

How many kids are misdiagnosed as being "mentally ill" ? How many kids are damaged by SSRI antidepressanst such as Paxil (Seroxat in the UK)

for more on Paxil, check out my blog

Anonymous said...

To Grits I am sorry you feel I am being mean spirited but I do not agree as for my spelling I am also sorry my spelling isnt up to par for some of your readership but since I am typing on the fly its not a major concern of mine. I will probabbly disagree with your position to some extent for the remainder of my life but then I am also jadded by what i have seen and done. I use sex offenders as a example since that is what i usually work with so have most time in dealing with.
As far as incarceration of non violent crimes such as peeing in public you have got ot be kidding right how many people are in TDCJ for that offense? As far as inpatient stabilization would be great but once the individual is out they tend to stop taking the meds that made them stable in the facility so what do we do with then then? It is also my understanding that anyone can go to the MHMR free emergency clinic and get help is this not true. OR do we consider that they may have to wait for a few hours to be to mush of a inconvience. I also find it interesting that you consider assault a non violent crime last i checked it was a violent one. My last comment on this I guess will be I have always found it interesting how people defend the criminal until they become victims and then they tend to change their view. I wont argue the point that treatment prior to incarceration needs more money but I dont control that issue. To stop the criminal issue you need alot more than money though and you need to start way before the criminal ever ends up in TYC or TDCJ.Maybe start looking at the family. And no i dont expect the family to diagnose mental illness but lets face it they should have some idea there is a problem and get it looked into. If they cannot be counted on to do this since they should know the person better than anyone else who do we expect to do it? I also wanted to say thats for the replies since I really didnt expect one but it has been a interesting discussion.

Anonymous said...

Oh yea sorry I forgot a PS I wanted to inclue I tend to ramble so just ingnore that part of my comments.

Gritsforbreakfast said...

"how many people are in TDCJ for that offense?"

I said JAILS and prisons, and named other offenses for which there are many people in TDCJ. Both local and state lockups are full of nonviolent mentally ill offenders.

I don't consider assaults nonviolent, I said "low level." There are different levels of assaults down to Class C misdemeanors, differing levels of culpability, and for the mentally ill, a real debate over whether incarceration will teach a lesson or keep it from happening again.

Finally, you say start earlier, but you appear to only want to start the blame earlier (at the family, etc.). No doubt there are crappy families - it's ever been thus and that won't change. My argument is we should start public policy SOLUTIONS earlier. Incarceration for most mentally ill offenders IMO does little for public safety if you don't treat the ailment. best,

Anonymous said...

Okay, so burglary is not a violent offense. By law. Correct.

Well, if that is true and I suppose you would know that, then I must start objecting to your proposals that non-violent offenders be released and serve no jail or prison time.

Gritsforbreakfast said...

You oversimplify immensely.

Burglary is a dramatically UNDERENFORCED crime. One professional burglar may be responsible for hundreds of break-ins and most PDs don't investigate at all - burglary clearance rates often are in the low single digits. Putting more effort into enforcement instead of punishing to the Nth degree the handful who are caught would do more to actually reduce crime.

In addition, a big burglary problem is addicts stealing to pay for their habit. Put them in prison, fail to treat the addiction, and when they get out the same cycle will occur. Same with the mentally ill - incarceration does nothing to break the cycle and you can't lock them up forever. So we get more crime instead of less. If you think that's a preferable outcome, by all means oppose any changes to the system. I think most reasonable people recognize that strategy hasn't been working too well for us. best,

Anonymous said...

If they would have kept this fellow in jail for his entire sentence instead of 5 months out of a 7 year sentence, Tracy Gee would be alive and raising kids today.

After all, he was only in jail for burglary and possession.

Gritsforbreakfast said...

What if he'd gotten drug treatment while in the can and strong supervision upon release including home visits, employment requirements, etc.? What if there were funding for re-entry programming once he was out? What if his probation officer didn't have a 140 person caseload and could pay closer attention to his charges?

You point to the current broken system as reason why we shouldn't change it. The criminal justice system got ahold of this guy, did what it does, and look what happened! How can you look at this outcome and argue the current approach worked? We need to put the penitent back in penitentiary - if what we're doing isn't changing people's hearts or addressing underlying causes like mental illness and addiction, we're frequently wasting our time, not to mention a massive pot of taxpayers' money. best,

Anonymous said...

What if we just gave him his own personal trainer? Why not limit probation officers to a single case? The logical extension of your argument is that it is society's responsibility to babysit every person, one on one.

Nope, not gonna fly. If they would have kept him in prison, Tracy Gee would be alive today. No bleeding heart policy can get beyond that.

Gritsforbreakfast said...

Nothing bleeding heart about it - that's just you resorting to a smear when your arguments fall flat. I'm advocating evidence-based reforms aimed at reducing crime, and you're advocating more of the same failed policies that directly resulted in the tragedy you lament. It's almost nonsensical, but I can tell you're sincere. At best, though, all your suggestion would do is postpone the tragedy and make someone else the victim.

The system as it exists failed Ms. Gee. That's not a bleeding heart sentiment, it's an objective observation. The state spent a lot of money to arrest prosecutre and incarcerate her killer, and that was the state's chance - indeed the moment of its obligation - to intervene in the man's life to reduce future criminality. Instead, prison was like college for crooks and he got out to commit more serious crimes. Sorry, but your short-sighted suggestions are what falls flat - you're defending outcomes that obviously, repeatedly are failing us, and especially crime victims. You point directly to a case where that's true, but think the system bears no responsibility for doing a better job - I want more in return for my tax dollars than this level of failure and incompetence, thank you very much.

Finally you're the one suggesting crooks get a full-time babysitter. That's what prison is, the ultimate nanny state. best,

Anonymous said...

213,First of all I believe it is very rude for someone to point out your grammer usage and therefore very petty. You are only stating your opinion and that should be the topic at hand.If they disagree with you that is fine but they should not attack you. We all make mistakes when writing.
On the topic of the mentally challenged I believe that we have to look at those whom were put on this earth with mental problems on a one by one case. I work for TYC and I work with mentally challenged students.Some of these guys should not be in jail because they simply do not understand right and wrong. They do not have the ability to process the difference. On the other side of the fence there are those who know exactly what they did and that it was wrong. There are those that have committed violent offenses. There are some that simply never should have been sent to jail because their crime did not cause bodily harm to anyone.
Mentally challenged still does not give them an open door to steal, rob, or abuse others properties. Jail or treatment, neither will actually fix them or stop most of them from repeating the crime or moving on to a more violent crime. So it is a catch 22 system. But we need a place for them to go to try to treat them in the best way we can and jail certanily is failing those whom are born this way or other medical reason they have become mentally challenged.
I am all for locking those up who have molested children, raped and murdered. As society we certanily need to protect our children and family members and others from the mentally ill. Turning them out on the streets is a death sentence for the victim and the mentally ill. If they don't kill someone, someone usually ends up killing them. They are prime targets for gangs and others who want someone else to commit the crime and take the heat. There is very little hope for most of them in this society today.
Family is a major role in the treatment and care for the mentally ill. Most of them do not have family that have the education or the desire to care for them. If they had family support and family members that are willing to oversee the where abouts of their family member with mental illness lots of things would change for them. Our system might not be over burden with taking care of those whom no one wants. The sad part of this is that alot not all of the families see's these people as a government check each month and which none is going to the care of the mentally ill. Now before someone bashes me for that statement it is a sad fact of life.
You can not force a person to take their medication and believe it or not they are smart enough to make you think they are taking it only to get rid of it when the parent turns his/her head. If you think about it a mentally ill person will never believe they need it to begin with! We know if we take something for a headache it might go away, try explaining to a mentally ill person to take your meds and you will be well. Well! They don't believe they are sick to begin with. This is where family members will fail in the care of the mentally challenged if they are not dedicated to the care of them.
There is just not an answer to this delima if there was we would not be having this blog.
In closing the courts need to really take a long look at those whom are violent offenders and figure out programs or places for them to reside and a way to fund it. We are paying for them to live on the streets so lets start putting our tax dollars into something to keep our communties safe from violence.

Dr. Papschmear said...

Grits,

On a completely "out of left field", totally unrelated tangent...In one of your early blogs regading the dismissals occurring at TYC you gave the name of an attorney in San Antonio. Any chance of posting it here for me?

Gritsforbreakfast said...

I don't normally recommend attorneys, but it was actually a probation officer from San Antonio who suggested y'all call David Van Os, an Austin lawyer and former Democratic AG candidate who's representing them in their union's lawsuit against their probation director.