Friday, May 04, 2007

Released TYC youth include mental health discharges

Apparently some mentally ill kids at TYC are already headed home. In most cases, where there are facilities, funding and a plan in place to maintain continuity of care, that's a good thing. Lisa Sandberg has an item at the Houston Chronicle's Texas Politics blog on a mentally ill TYC youth who came home last week on a mental health discharge. She writes:

A mobile crisis unit makes weekly house calls. The specialists feel he's been confined long enough and want to work with him where he'll be most comfortable. He's back on medication. Yesterday, he spent his first full day as a ninth-grader in a special ed class at a local high school. His peers were taking final exams. Marquieth showed up so he could get to know the students who will be his classmates next year. "He'll be ready," Tarsha says proudly.

Tarsha says her son appears happy to be home. Just don't ask him about his years in TYC. "Every time you mention TYC, he has this shutdown. He doesn't want to talk about it."
I'm glad to hear there's a followup plan for mentally ill youth who are released, and I hope there's follow through for this kid and others like him after they get home. A lot of mentally ill kids are warehoused at TYC, like Marquieth, for years because the system has no other options for them.

UPDATE: From the McAllen Monitor, "Hundreds of mentally ill youth prisoners can't see psychiatrist," May 4, and from the Austin Statesman, "Money, location hamper youth lockup medical care," May 5.


Anonymous said...

Yes there are Grits, yes there are.

I shake my head at this every time I see one. It is a crying shame to see that it finally got addressed by being lumped into this current crisis. We've been saying this for at least 20 years now. Some counties don't have the resources to deal with them, and you know, I blame the ledge for ignoring it for as long as they have.


And I swear, I'll personally visit the next judge that gives an 11 year old a 12 year sentence, and I'M SERIOUS NOW, "DEMAND THAT HE NOT RETURN TO HIS HOME THREE YEARS LATER, AND WITH NO, AND I MEAN NO DISCIPLINARY HISTORY IN TYC.

What has gotten in these people?????

Anonymous said...

Okay, I know this case.....
Not the one that I would use as an example to make my point.
TYC has always released kids on MH discharges. The problems with MH discharges is the youth that do have MH issues, but are so aggressive that you don't want them preying on the public, but they don't qualify for hospitalization. These are the ones that go out and kill people they know and ususlly live with. All of the politics is going to prevent a real solution to this problem, but there must be a more in depth discussion with the people that work with these kids to find out what the communities are going to need. The problem is managing their MH issues and ensuring safety of the people around them.

Gritsforbreakfast said...

I'm just curious, since a lot of TYC juvie justice professionals have been commenting here. The source in the second link (based on a Houston Chronicle article) estimated the number of mentally ill kids in TYC at 38-50%.

This brings to mind two questions: a) Do you think that's accurate, and b) Of those, what portion do you think are as dangerous to those around them as our second commenter describes?

Anonymous said...

Those percentages seem more reflective of the kids that have "serious" mental health problems. The last I saw, it was 80% of the population has some sort of mental health problems. Hold the thought until Monday and I'll look this up again.

The second commentor does have a valid point... I would say of that 38-50%, about half pose a serious threat to the community.

But to my original point, if the ledge would fund the communities (counties) to outsource for residential treatment providers, they wouldn't be on the streets, but rather in a facility getting the help they need. However, a big problem is that a lot of these residential treatment centers kick them out! And consequently, the judges then send them to us...

Anonymous said...

I'd say it is accurate but it depends on how you define mentally ill.

Diagnoses can range from serious Mental Illness (Bipolar, Major Depression) to developmental disorders or disorders diagnosed in childhood (lot of AD/HD) to milder mood and adjustment disorders (incarceration can be the cause of an adjustment disorder). Over 50% of students in TYC are diagnosed with Conduct Disorder.

Half the kids sent to TYC have serious enough diagnosis that could benefit from individual treatment besides the correctional therapy (group) that they might not receive help for in local communities. Unfortunately only a small percentage meet criteria for help from services like MHMR who often only have enough funding to treat the most severe disorders.

I'll answer the second question with an analogy. When determining who is a priority for drug treatment you assess the reason for taking the drug. If a person is stealing so he can buy drugs then you clean up the drug problem then it is likely you resolve the need to steal. However, if you clean up a criminal who uses drugs to steal then all you get is a sober/clean criminal who will continue to commit crimes.

Many mentally ill youth commit crimes when they go off their medication or self-medicate through drugs. If you can get them to commit to taking medication then they may stand a good chance of avoiding further incarceration. But there all those who are both mentally ill "and" criminal in their nature, showing little regard for others...and they can be very dangerous.

Gritsforbreakfast said...

Having made the analogy, what percentage of mentally ill kids at TYC do you think are dangerous?

I'm not thinking of conduct disorder, btw, which I've always thought is a pretty bogus diagnosis. (They should replace it with the diagnosis: Crappy Parenting.) I'm talking about serious mental illnesses prioritized by TXMHMR (or whatever it's called now) - basically bipolar, schizophrenia, schoaffective disorders and major depression.

How many of THOSE do y'all think are dangers to those around them?

Anonymous said...

Scott are you including sex offenders with mental health disorders when you ask about the danger element? I mean, to me it's dangerous to release a non-treated sex offender with those diagnosis you mentioned... are are you just thinking loss of life here?

Gritsforbreakfast said...

On sex offenders, there's so many different kinds of people on the list now it's hard to generalize, but I'm asking how many pose a danger, i.e., be likely to commit new crimes with victims, so under that definition some sex offenses certainly would be included.

Anonymous said...

Without treatment, I'd say the propensity of re-victimizing would be close to 90-95%. I might even say 98%, assuming these kids are off their medications and not getting any help whatsoever, and have been returned to their environment from which they were sent to us. I bet others will put this number close to 100%, but in my opinion, it's unpredictable at best.

Anonymous said...

Not complete agreement with your assessment as a whole of the conduct disorder and crappy parenting. There are kids with crappy parents who turn out just fine. Depends how nature vs. nurture you are. Me I am about 50/50... attachment at an early age seems to have a lot to do with it

Conduct Disorder really is just a precursor for an Axis II diagnosis of Antisocial Personality Disorder.

Haw many are truly dangerous... I've never really been afraid of Psychotic Behavior as a whole because my experience is that most often they are a greater danger to themselves. Now, I have met a couple truly Sociopathic kids, one or two that I am convinced that would end up on a most wanted list someday in the future...

But overall, I agree with 6:35 p.m. that it is unpredictable at best. There are simply too many variables to really account for. Aftercare and supportive follow-up can have a significant affect. However, most of these kids are returned to the same chaotic environment he/she came out of, greatly diminishing chances of success. I'd really like to see a more gradual release process with more halfway houses...but that can be cost prohibitive

Anonymous said...

It's a complicated problem.

Anonymous said...

I was the one that posted 2nd at 2:56pm.

I know - I should have registered a name.

No doubt this issue is complicated -

If you look at the way TYC prioritizes kids for MH treatment- Then on average 50 kids at any given time in the high restriction system are so mentally ill that they need placement as a priority 1 in a MH hospital type program. TYC calls this the stabilization unit. TYC attempts to stabilize these youth and get them back to a more residential based high restriction program as fast as they can and maintain safety and sound treatment. Most of these kids qualify for MH discharges and most of them are a risk to the community when they are released. All of those youth qualify for services upon release.
Understanding that the MHMR system is broken for this type of youth and if they don't show up for medication they will be discharged from their caseloads. Unfortunately, this is not always their fault if you look at the dysfunctional families they come from in most cases.

Now let’s look at the Priority 2 youth. These youth have a major mental health issue and have a functioning levels that keep them from being able to be placed in a state school. These are the youth you would find in RTC's in the community. As posted previously, these youth have failed these programs because of the criminal pathology they exhibit. They prey on the weaker kids and victims in the community RTC so they will not keep them. Ironically, these are the same kids that when you put them in a state school they are the ones that are preyed on. At any given time there are about 350 of these kids in the high restriction system.

All the rest of the youth with MH issues are usually placed in state schools, they either have lesser diagnosis (ADHD, dysthymia, depression) These youth are usually on medication and functioning in state schools. These are the youth that have MH issue that can be treated in the community on an outpatient basis with MHMR. They too are dangerous at times, but not because of MH issues.

The truth is that the 400 kids in high restriction facilities in TYC are there exactly for the reason talked about before, they cannot be managed at community RTC's and TYC has been able to more successfully deal with them that even state hospitals. This group of youth really need long term services. These are the ones that need secure facilities that are smaller in nature, but that have all the aspects of a high restriction facility. These are the kids that truly need long term help, but that no one wants to deal with. It takes a special person and a lot of money to do it. A large percentage of these 400 kids are dangerous to others and nobody wants to deal with them outside the TYC system.

So, I didn't really answer your question GRITS, but I hope I shed some light on what really goes on.

Anonymous said...

It is nice to see such educated and informed responding to this post, especially after the dirth of responses to the 4/22/07 GFB posting. Youth with serious mental illness and low intellectual functioning are at serious risk for reoffending. Grits, identifying those at risk for violent or sexual reoffending happens to be one of the most difficult questions to answer in the mental health field.

Gritsforbreakfast said...

Thanks for the responses, that helps. Tell me if this is an accurate assessment: About 400 or 8-9% are in TYC because they were too violent or unmanageable in a local mental health facility or the state hospitals, according to 9:03 a.m.. The rest of the mentally ill, then, are just mixed in with the regular population basically because they committed a crime and that's who winds up there? Would that be accurate?

Also, can anybody explain to me what qualifies a youth for a mental health discharge, who evaluates them to decide if they qualify, and what (besides local MH capacity) are some of the issues that go into deciding whether a youth gets one or not?

I'd be surprised if 95% of the up to 50% of TYC youth with serious mental illness, if that's the horrifying correct number, would be dangerous upon release. Even half seems possibly high. My experience is more along the lines of the person who wrote:

"I've never really been afraid of Psychotic Behavior as a whole because my experience is that most often they are a greater danger to themselves. Now, I have met a couple truly Sociopathic kids, one or two that I am convinced that would end up on a most wanted list someday in the future"

That's totally my view of the matter. I'd guess many MH commitments are much more likely to harm themselves than others. The question is, how many are there who are unlikely to harm anyone at all?

Any light y'all can shed on the mental health discharge process would be really appreciated. Thanks!

Anonymous said...

I have had little experience on the discharge of youth for MH reasons and believe it happens rarely. From what experience I have had, the youth has to be shown to be unable to meet/complete the standards for release (phases of resocialization) and having served their minimal length of stay are no longer benefiting from incarceration in TYC. In addition, a the youth's risk/danger to the public would also be evaluated. Generally, this release would be reviewed and approved by central office staff. The las one I recall was actually completed by Corinne Sanders-Alvarez prior to her becoming the head of Rehab.

Someone from Central who might be more intimate with details might be able to clear up any mistakes or assumptions I might have made.

Anonymous said...

The ones who could have answered have been terminated. It's called 1550 I think. It was named after a house bill awhile back. We are going to have to rewrite a new policy, but the 1550 kid has a rule in the policy manual but I can't access it from home.

Anonymous said...

It appears to be GAP 87.89, and I have been able to access it through TYC website. not sure how to hyperlink but here is the web address. The information in the previous post appears to be correct. Approval is done through facilities special services committee (think parole review board grits) and rehab in Austin.

Anonymous said...

Scott - here's the TYC policy on Mental Health discharge

Anyone want to tell me how to get links to work?

Anonymous said...

You can use HTML tags in the comments on this blog. If you know how to add an href tag, you can make a link here. Not as simple as it should be for sure.

The link to the GAP policy being discussed:

Anonymous said...

Sorry it cut off the link that time. Trying again:

Anonymous said... were you able to do that? I thought they had safegurds to prevent anyone accessing GAP on-line without being an employee with access to the "intranet." Limiting access to the policy on-line was meant to safeguard polices from hackers, not to hide. Wow, I just leaned something, but tell me how you did that?

Anonymous said...

I don't know how to make a link to them, but the GAP policies are available online to the public. Anyone can access them through the Internet site, in the About TYC section, under Open Government. It's really helpful to be able to look up a policy from home. The only difference is that the public version does not link to the other internal policy manuals, while the employee version does.

Anonymous said...

TYC has some data available on their website concerning this issue:

Sorry no hyerlink

I copied this statement from the website:
For youth with mental health problems, 50% of the youth who received specialized treatment had been rearrested or reincarcerated for a felony within 3 years, compared to 63% of youth with mental health problems who did not receive specialized treatment (see Figure 6)

It is also interesting to read the conclusion section of the review of treatment effectiveness which includes the following statement from 2006 (long before all the current theories on "innovative reform (choke)"

Even if TYC identifies interventions or decides to implement elements of the Missouri model that could theoretically have the largest impact on reducing recidivism rates, there are barriers to implementation. Establishing smaller, Missouri-like facilities and a continuum of services in every region would REQUIRE SIGNIFICANT LEGISLATIVE SUPPORT. Public commitment aside, it is difficult to implement programmatic changes with the limited availability of and difficulty in retaining clinical professionals, as well as juvenile correctional staff, in some of the areas where TYC facilities are located. There is also a scarcity of qualified providers for specialized parole or wraparound services in some of the smaller counties to which youth return. These are issues that TYC continues to struggle with in the current environment.


Anonymous said...

sorry that last paragraph is a quote from the TYC reasearch website with some emphasis added

Anonymous said...

anon at 9:08 & 9:09 -

Yes, it takes legislative commitment AND agency vision and integrity. The legislators cannot be the experts on juvenile justice policies. That's not their job. It is TYC's job, and the old administration was too chickenshit to do it. Rather than bury that information in the bottom of their Treatment Effectiveness Survey, why didn't the leaders of TYC trumpet from the rooftops that they knew how to make their system better?

Half of what happened is Missouri was that the Director their juvenile corrections system had charisma, vision, and worked the legislature to get what was best for kids. He got the support of legislators and local politicians, Republicans and Democrats, rural and urban, in favor of what worked best for kids. And they do it at the same price Texans are currently paying for TYC (approx. $160/day/kid).

Maybe if Dwight et al hadn't been so busy covering up the deteriorating conditions and ignoring the complaints from rank and file while working them to death, they could have come up with a plan for a better system -- which might have actually inspired the needed legislative commitment.

Anonymous said...

He/she is absolutly correct. What, the past few LAR's before this one, we asked for very little and then had to give back 10% of our budget. He wasn't a leader.

But I tell you what.... I think we may have been loaned someone who I think we need for the future. This Demitrus Pope is something else. She's getting us going again and she's using the right poeple. In fact, people aren't afraid to come up with innovative ideas with her, and that I embrace. I hope she stays on for awhile.

Anonymous said...

Anon 9:08 and trixie are right on target about the need for legislative support, which can't be emphasized enough. However, I would add that support must be SUSTAINED over a long period of time or all will be for naught.

The history of Texas juvenile corrections is littered with all too brief periods when the legislature became outraged at abuse and eager to fund reforms. But within years, sometimes months, that enthusiasm faded and youth admins and staff were left high and dry... and things quickly reverted back to the way they were before. This happened many times, most spectacularly in the 1910s-20s, 1940s-50s, 1970s-90s, and we're in another such moment now.

Reading the tea leaves in the lege since last Friday, my sense is that the appetite for major reform has already gone. Grits, you follow this more closely than me, what do you think?
Bill Bush, UNLV

Anonymous said...

I realize that there are some problems in TYC, but lets not forget that the media goes crazy with stories like these. I volunteer in a youth facility, while it's not perfect, most of the staff try the best they can. In the case of mental health, alot of these youth get the medical health issues they need taken care of in these facilities, they are given medicine and treatment that their parents might not otherwise seek to obtain either for lack of knowledge or lack of funding. The kids that are in these facilities are coming from dire circumstances, they are not your average middle class kid coming from a picture perfect life. I'm not dismissing the fact that there may be trouble within the system, but you should know all the facts. Someone posted earlier that they would personally visit a judge who gave an 11 or 12 year old a long sentence? What do we think happens to these children who commit murder? Where would this poster like them to be housed, in school with their own children? Don't get me wrong, I love the children in TYC, they are wonderful kids for the most part that have gotten a raw deal in life. But let's not make ALL of TYC out to be the vicious bad guys, some of them truly care and are working for the success of these children.