Wednesday, November 04, 2009

Ramshaw, Tribune tackle TYC mental illness discharges, restraint of disabled kids at school

Yesterday I neglected to offer a bloggerly "Howdy" to our friends over at the just-launched Texas Tribune, but this morning Emily Ramshaw forces the new site onto our radar screen with coverage of TYC's policies regarding mental health discharge, focusing on a recent case in Tyler where a mentally ill youth killed a schoolteacher at John Tyler High School. Reports Ramshaw:

Dozens of juvenile offenders with serious mental illness are released from TYC lock-ups every year because they’re too sick to treat — not because they’re no longer a threat to the community. In the last five years, the agency has discharged hundreds of youth under this mental illness statute.

One was a schizophrenic and psychotic 16-year-old who fatally stabbed a Tyler high school teacher in September, just months after his release from the TYC.

TYC officials say state law requires them to discharge juveniles who are mentally ill or profoundly disabled if they’ve completed their minimum sentence and aren’t benefiting from rehabilitation programs. Of the 206 youth offenders they’ve released under this provision since 2005, 20 percent have been recommitted to either the TYC or an adult lock-up.

Until this spring, a youth discharged for mental illness wasn’t eligible for specialized psychiatric services in the community. Enter Rep. Jim McReynolds, D-Lufkin, who last session shepherded a bill providing reentry services and health care referrals to youths discharged for mental illness. That care is being provided by the Texas Correctional Office of Offenders with Medical or Mental Impairment (TCOOMMI).

Prior to the bill “the treatment youth received out in the community was sporadic,” TYC spokesman Jim Hurley said. Hurley said with the McReynolds bill, the TYC can now refer kids with mental health diagnoses to care providers in their communities.

The legislation fills a gaping hole, but advocates say it isn’t foolproof: It’s tough to force youth and their guardians to participate with treatment plans or fill prescriptions. The mentally disturbed teenager who killed his Tyler teacher was discharged from the TYC after McReynolds’ measure went into effect.

While the Tyler case did occur after McReynolds' bill took effect, IMO that's not an indictment of his approach: It takes time to build up treatment capacity, which isn't necessarily available in every community. And for that matter, a 20% recommitment rate for youth receiving mental health discharges is really quite low compared to TYC's overall recidivism rates, which hover around 50%.

There's a risk the Tyler case will be used as a Willie-Horton-style indictment of Texas' juvenile justice system, when really it's an indictment of the profound lack of community-based mental health treatment and the inadequacy of the justice system to deal with mental illness. That view was expressed in Ramshaw's story by our friend Ana Correa

“For the kids who suffer from severe mental illness, it’s a shame they end up in the TYC to begin with,” said Ana Yanez-Correa, executive director of the Texas Criminal Justice Coalition. “My fear is that [the Tyler case] will be used as an example to not have anyone paroled out, when the truth is we just need better services.”

Relatedly, yesterday Ramshaw offered up an important article on the use of physical restraints on youth with disabilities in public schools. She wrote that in the 2007-'08 school year:

school staff restrained four of every 100 special education students, with some students being restrained dozens of times. More than 40 percent of restrained youth suffered from emotional problems like post-traumatic stress disorder; nearly 20 percent were autistic.

Educators say restraints are sometimes the only way to prevent disasters. They point to the September 2009 case of a 16-year-old Tyler special education student who fatally stabbed his music teacher in a classroom.

But disability rights advocates say the numbers point to a crisis in Texas special education. They say teachers are resorting to physical restraints because they aren’t properly trained to manage their students’ disabilities – posing a threat to vulnerable children and to themselves.

Their concerns were echoed in Washington this spring, where a federal agency exposed thousands of restraints – including several deaths – of special education students in schools nationwide. In many cases, the U.S. Government Accountability Office found restraints were performed on children who weren’t physically aggressive, and by teachers who weren’t trained to use them.

Excellent stuff from Ramshaw and the Tribune. I'm glad to see the new site up and running an wish Evan Smith and everyone involved the best of luck.


davidt5 said...

This is really an indictment of the "coinservative" movement.

First we do away with state supported Mental Health facilities, because they are too expensive.

Then we do away with Community based mental health because it costs tax payers too much.

Then we send all of the mentally ill people who can't handle themselves to prison.

Then som genius discovers that Prison isn't for the mentally ill.

And the circle starts all over again.

We must realize that if we truly want a humane and just society, we must be willing to pay for that humane and just society.

TYC and TDCJ should not be the objects of this new discussion, but the real issue should be, "How can we approach this problem without the recurring cycle of 'coinservativism'?"

Anonymous said...

Like I said before TYC is making them ready for TDCJ.

Anonymous said...

I've had interactions with the community based mental health treatment services in Tyler while trying to get services for a family member. The services provided through Andrews Center are completely inadequate. Like most community based mental health programs in the state of Texas, they just run them through appointment with the psychiatrist which if they are lucky may last as long as 15 minutes and may occur once every three months. They put them on ineffective medications with dangerous side effects while providing little if any other services. The over reliance on medication is a huge problem with mental health treatment in general. Most of that stuff is ineffective. The drug companies do the studies on the medications and throw out the studies with results they don't like and only keep the ones showing the medications to be more effective than they really are. Even then, the studies don't show them to be nearly as effective as many people believe. Often, when something bad happens you hear people, including mental health professionals say "they must have stopped taking their medications". That is often not the case. The truth is often that they have been taking the medication but the medication simply doesn't work. A lot of psychiatrist are simply pushing whatever the drug reps are pushing that month and they don't bother to read the studies or look at any other information.

The lack of knowledge of some mental health professionals regarding the dangerous side effects and lack of effectiveness of these medications as well as the lack of knowledge of other effective treatments is astonishing. For example, ECT is safer than many medications and is much more effective in treating some types of depression. Yet, I have been amazed by the total ignorance of the modern status of this treatment by personnel at both the Andrews Center and Rusk State Hospital. This ignorance rised to the level of incompetence. It is inexcusable for the people in these position to have such a lack of knowledge of effective treatment methods. This is the result of blind reliance on ineffective medications as the primary and, too often, only treatment method.

I could go on and on about this but don't have the time. I'll just say that this isn't the first death that is at least partly the result of an incompetent and ineffective mental health system.

Anonymous said...

To the last anonymous user..Texas is 47th in spending on mental health treatment in the country. So before you blame the local mental health center for all of your problems, you might want to look into who you voted to have control in Washington.

PirateFriedman said...

09:59:00 AM, I can live with a little crime from the mentally ill.

As long as taxes are down and we don't have unemployment like Michigan or California, I'll take it as a reasonable tradeoff.

Anonymous said...

This is the same 'ol liberal BS. Every time someone reoffends, it is the service provider's fault for not doing enough.

We are not trained, we are not providing adequate services, we are not providing enough services, blah, blah, blah...

The kid was incarcerated while at the same time receiving services for his condition. Am I to believe that if he had not been committed to TYC and had been treated in the community, he would not have killed his teacher?

I bet you anything he was receiving services in the community before his referral to the probation department which ultimately got him committed.

He should have never been discharged from TYC!

Anonymous said...

He should have never been sent to TYC! So what your saying is Texas should make mental illness unlawful. Unbelievable. I bet you had a fit when Andrea Yates wasn't sent to prison but rather to a mental health facility when she killed her babies while experiencing a psychotic episode. Let me guess, you wanted the death penalty?

Anonymous said...

Mental illness should not be an excuse to walk about freely when you clearly pose a significant risk to the community!!

You may not agree, but the majority of level headed people would agree.

That kid should have never been discharged from TYC simply because they couldn't 'fix him'. If he could not be rehabilitated, then he should have been transferred to a secure facility that was more equipped to meet his needs!

Anonymous said...

I don't disagree with that.... tell Whitmire and company because the ledge shut down those mental health residential programs for juveniles years ago. State hospitals hold them for 2-4 weeks at best. Are you saying TYC and TDCJ should be the drop off point for these people with these disabilities? If not, there where exactly would you send them genius? Please tell....

Anonymous said...

7:51, I agree with you. He completed his time at TYC. Everyone says, he should have been sent somewhere........the question is WHERE???? "Those places" aren't there anymore, thanks to liberals who thought they needed to be closed and were inhumane. He did his crime and did his time. Why shouldn't he be released?
If the family can not pay for private, residental treatment, the state/counties sure don't do it. Just a few days or weeks for stablization. Then he's back on the streets.
People need to realize there's no psychiatric placement for people with these issues.
What should be done about it?
Put them in TYC until they turn 19, then discharge them? Everyone screamed 2 years ago because this was happening at TYC so they wanted kids released, not held for an extended period. Be careful what you ask for, you just might get it!!

Anonymous said...

It may seem that returning to institutionalization would be the thing to do. It's a pointless debate because it isn't going to happen for two reasons. The first is the cost. We would need many, many more facilities in order to lock all of these people up. Of course, are prisons, in many cases are already serving the purpose of locking up the mentally ill. The problem with that is that they are not locked up until they have committed a serious crime. That is the price we are paying for being 47th in mental health spending. The second reason a return to institutionalization isn't going to happen is because the courts aren't going to permit it. You can have the debate about civil rights and idelogical positions (i.e. conservative v. liberal) but its a waste of time. It just isn't going to happen.

What does that leave us with? Since these people are going to be free in our society (at least until they are sent to prison) we either need to be willing to pay for treatment or we are going to pay in other ways. We're already paying in increased costs of incarcerating the mentally ill but we are also paying in situations like this one where the teacher lost his life.

The mental health treatment system is in as much need of reform as the criminal justice system in Texas. The problem is that its more than a problem with the system. Its a problem of relying on ineffective treatment methods. Medication doesn't work for the vast majority of seriously mentally ill people. The studies of many of these medications show that they are only slightly more effective than placebo. Yet, medication is the only treatment many, many patients receive.

Saying that we just need to lock these people up is a waste of time because it isn't going to happen (unless we continue to put them in prison). Arguing over what position is liberal or conservative is also a waste of time. We need to acknowledge there is a problem and be willing to look for solutions.

Those who believe that people who are truly mentally ill (I'm talking about psychotic, not just mildly depressed) that commit crimes only need to be punished demonstrate a complete lack of understanding of mental illness. When a person is delusional, that delusion is real to them. That is their reality at that moment. Lets take a hypothetical situation. Lets say someone gave you a drug that made you hallucinate. You hallucinate that someone has a gun and is about to shoot you so you grab a gun and shoot them. In your mind you are defending yourself. But lets say that person was not really about to shoot you but was actually trying to help you. Should you be locked up for the rest of your life? That is exactly what psychotic people experience. They can do something that in their mind they are absolutely convinced is right at the time. That delusion or hallucination is real to them.

We need to get past this societal need for vengeance and start looking for more rational ways to deal with mental illness. When a person who is psychotic commits a crime based on a delusion or hallucination the issue should be on treatment, not punishment. Yes, we do need to protect society from mentally ill people who are truly dangerous. The question is, how do we do that? As I said before, locking them all up just isn't going to happen. Whether that would be the right thing to do or not, the debate is pointless.

I think a place to start would be to really look at treatments other than medication. Lets start funding more research into other ways to treat mental illness. Lets make ECT, Vagus nerve stimulation, Transcranial magnetic stimulation and other treatments more available. These treatments may cost more initially but will save money in the long run in the reduced need for medication.

Continued in next post.

Anonymous said...

We are going to pay the cost of mental illness one way or another. We are either going to pay to put these people in prison, pay in other ways like the loss of a teacher, or we can get serious about treatment. I don't pretend to have the answer but saying just lock them up or arguing about liberal vs. conservative are both pointless.

Anonymous said...

Amen 8:13.

editor said...

Anon 8:05, he did not "serve his time." When a juvenile is sentenced to TYC, the sentence is indeterminate. TYC, in theory, is based upon rehabilitation, or therapeutic premises, not retribution. In other words, you are given a treatment plan (steps to complete) and once you successfully complete this you go home. Some juveniles take longer than others. If you do not make progress your "treatment" is terminated (you get a psych discharge). This is based upon the notion it is unethical to continue a given therapy if it is not proving successful. Don't get this explanation confused as an endorsement of this policy, I just want the reader to understand that juveniles don't get sentenced the same way that adults do.

Look at for more on this case.

One problem we have is sometimes getting caught up in thinking in absolutes. There is no reason that we can't provide rehabilitation and retribution. There are some options in between the most restrictive environments and the least restrictive environments, but they do cost money. Unfortunately, future risk assessment procedures are not that reliable, so we have a hard time telling where the money should go. In other words, which child are we taxpayers going to provide $5 / day of treatment and which are we going to provide $10 / day? We have assessments for this in community mental health centers that are being used. But, administrators have to decide whether to provide the $10 / day service to less people (thus creating longer waiting lists), or $ 5 / day service to more people. Most community centers decide to widen the net and provide less services to more people. Not sure what the best answer is, but I think it will be a combination of more money and working smarter. Blaming just one entity (whether it's the mh center, or the medication, or the mentally ill person) may make you feel better momentarily, but until we all take responsibility, a change will not happen. Responsibility looks to the future and blame looks to the past. Change is future oriented. - stir crazy

whitsfoe said...

"the question is WHERE????"

Ask John Whitmire. That's where.

It doesn't seem like he cares what happens to these kids, he's just making sure Harris County commitments have a bed - and screw the rest of Texas. As I've said, he wants juvenile offenders closer to home. But what has John Whitmire done in his own district to make it happen? let me help you - 0 - nodda, nothing. John Whitmire is a ZERO when it comes down to children needing reform in Texas.

Anonymous said...

Until the mental health community of Texas is given the proper representation, the problems will continue to exist. The current "band-aid" fix is only costly to the taxpayers and individuals associated with mental illness. With the system Texas has in place, there are no winners.


Anonymous said...

Whitmire is a Texas Hero and he wants TYC truly reformed. He and we are tired of the abuses and mismanagement in TYC. The rape of the state by TYC must stop.

Anonymous said...

The criminal justice system, the mental health system, TYC....can the state of Texas do anything right? Maybe its time to split the state up into 5 separate states as was allowed for when the state was admitted to the union.

Anonymous said...

It just goes to show you the continuum of care for TYC parolees is non-existant. Sunset Commission attempted to consolidate TYC and TJPC to assist in these matters but bleeding heard House Reps McClendon and Turner did everything possible to keep that from happening. When will legislators really investigate and look at what is best for the kids in Texas, not just what is best for their friends. Whitmire and others on Sunset..... do the right thing next session.

Anonymous said...

Seems to me there were plans floating about there from the Northeast region to keep kids from TYC and treat them in the community. Would this kid have been treated or committed???? Who knows now BUT at least there would have been an attempt to treat the kid. Sounds like TYC housed him and then dumped him back into Tyler to re-offend. Looks like the money TJPC put out there for diversionary programs was not enough.

Anonymous said...

Who says TYC did not make an attempt to treat the kid. Am I to believe he would have receivd better treatment outside of TYC? Not necesarily.

The public safety should always be priority over any other objective when dealing with potentially dangerous individuals.

Anonymous said...

Community mental health caseworkers catch a lot of flack from the public in general, but they are often just doing what they are told. Many caseworkers have caseloads of 300-400 clients. TCOOMMI contracts state that caseloads will be unlimited, and contacts are once per month by phone. Is this treatment? I'm thinking this is not adequate. What about the mental health of the mental health professionals? Who can remain mentally well with 300-400 seriously mentally ill clients calling and asking for help and you constantly have to say no, there is no help to be had. I believe we will start seeing the mh professionals cracking under the stress.

Anonymous said...

The problem with the restraints of special education is the inappropriate on clearly unfounded idea of mainstreaming students with severe disabilities like autism. Texas needs to rethink this stuff and spend some money.

Whitsfoe said...

Whoa.... Who is that Editor? Talk about slap-down reasoning? That's what I'm saying! I'll just ride on that! Nice....

Gritsforbreakfast said...

Y'all, I just deleted a bunch of personal, off-topic comments, including one that was flat-out libelous, that typified the reasons I eliminated comments for a while on juvie topics earlier this year. If such behavior continues, I'll do so again.

Current and former employees from TYC need to keep their personal squabbles to themselves. It's not all about you. And both to the author and critics of "Raped by the State," all of your off-topic comments were deleted. Just stop, please. Stop.

The Management

Anonymous said...

The entire juvenile justice system needs to work together. Last Leg they did a review but nothing came of it cause the house had marching orders from one of the executive directors. The juvenile probation field is trying with all their might to fix kids and when resources run out the state gets them. TYC then attempts to fix them and when they see they can't they dump back into the community where they reoffend again and it all starts over. Give FRONT END services to these juveniles to attempt to keep them from entering into the system in the first place. Our mental health system in Texas is terrible.

Anonymous said...

I worked for TYC for ten years, and left two years ago when I saw the Agency being taken over by political appointees. Some of the facts in this article are wrong. Two years ago, TYC always referred youth that were discharged for metal health reasons to the local mental health authority in the town the youth was returning to. In fact, often times, the youth was sent to Mental Hospitals and then discharged from the hospitals so immediate follwup care could continue at the youth's local mental health authority. I worked at CRTC and Crockett, and I know for a fact that youth that were discharged were always referred. To me, it sounds like the youth that stabbed the teach in Tyler fell through the cracks. One of the main purposes of the CRTC Stabilization Unit is to ensure that if a youth is discharged for mental health reasons, they have aftercare service. Someone needs to look into this a little closer. While I think McReynold's bill should have helped prevent this incident, controls had long been in place and utilized prior to its passage. This is another situation where the "old TYCers" were doing something right, and the "new TYCers" have apparently screwed it up.

Glad to be Gone

Anonymous said...

This is probably the most important juvie-related issue that nobody ever talks about. So many kids end up in TYC b/c their communities and schools lack appropriate mental health services.

For these kids the path to TYC starts with non-criminal behavior problems in elementary or middle school that starts a record of sanctions. They don't get the proper interventions, meds, etc, then they end up in a system that is not built for them, which worsens their behavior problems.

Releasing such kids back into the community with direction for mental health services is fine, but if the community still doesn't have those services then it may only compound the problem.

Happy to see the Tribune report on this problem.

Bill Bush

Anonymous said...

11/7 7:30 AM... AMEN
In the probation field we see too many kids that get referred to us as a dumping ground because the schools and or parents do not have the resources to treat mental health issues. As a juvenile on probation the department then must expend funds to attempt to treat a kid that should have received services well in advance of whatever delinquent behavior occurred that resulted in their referral to the legal system. Plans were put in play last session by several large counties and small coalitions of counties to take money and place it into front-end services. MORE money needs to be placed on the front end, even prior to a child's delinquent behavior, to prevent referrals to the judicial system.
Many county probation departments are strapped for funds in this economy yet TYC continues to house and NOT treat the juveniles committed to them. If funds were made available to departments to hire Psychologist to treat juveniles referred to the departments then referrals to TYC may be further reduced.

Anonymous said...

The "children's advocates" wanted that kid mainstreamed, despite the recommendations of TYC.

editor said...

Temper yourself Anon 11:09, specific facts are confidential. If you have specific knowledge don't state it here. If you have knowledge from an open meeting, never mind. I know it is difficult to sit back with knowledge that might mitigate one side or another, but it's not worth the integrity of any confidential proceedings. The vengeance for one transgression erodes the whole, in this case, institution of confidentiality.

Anonymous said...

There is nothing confidential about what happened. It has been reported in the minor media, but the mainstream media has not picked it up. The facts are not politically correct. It is much easier to point the finger at TYC, and much more fun!

Anonymous said...

As the article stated, TYC can make a TCCOMI referral, but the family and the community are not forced to accept it. The School District does not have to follow TYC's treatment recommendations. Ultimately, an ARD at the local school level determines the youth's placement within the school system, not TYC.