Reacting to an excellent recent
investigative article published in Youth Today, the Fort Worth Star-Telegram has a
story on TYC's recent decision to reduce use of psychotropic drugs among the youth in their care. The story opens:
Anti-psychotic drugs meant to treat mental illness were being used instead as chemical restraints on youths incarcerated in Texas Youth Commission facilities, Commissioner Scott Fisher said.
The medications, which have a sedating effect, are intended to treat schizophrenia and bipolar disorder but were used on youths who did not have those diagnoses.
Fisher, a Bedford pastor, said the commission has worked over the past year to implement a system that focuses on matching drugs to need. Statistics show that since last year the commission has throttled back spending on the drugs.
"I will tell you it wasn't just the reduction in cost that was at issue; it was the inappropriate levels of anti-psychotic medications kids were being subjected to," he said. "And in many cases it was a situation of using a chemical restraint."
Fisher spoke to the Star-Telegram about a recent investigation by Youth Today that uncovered extensive use of anti-psychotics with incarcerated juvenile offenders nationwide. Texas' spending on the drugs was among the highest. Critics say the drugs have replaced leather straps as a way to keep youths under control. Supporters say the drugs reduce aggression and soothe, making youth "more malleable" to treatment, according to Youth Today.
The biggest concern is the off-label use of anti-psychotic drugs on youth who haven't been diagnosed with an illness that corresponds to their recommended use. Just 29% of TYC youth receiving those drugs had diagnoses justifying them, according to Youth Today. Good for Cherie Townsend for beginning to confront this practice before the Youth Today article was published. One hopes the article spurs the Commission to grab this bull by the horns and wrestle it to the ground. The idea of using such drugs as "chemical restraints" is a morally repugnant grotesquery.
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37 comments:
Do you believe everything you read in newspapers? Honestly?
This has more to do with cost cutting than Cheri Townsend doing the right thing - trust me on that one.
9:18, I believe they started cutting back on the meds before they were criticized in the media. I can't read Cherie's mind any more than you can, but I've heard her speak in public about reducing overmedication with no mention of cost. Certainly you've provided nothing (besides cynicism) that indicates she's acting in bad faith. So no, I won't trust you on that one. What evidence do you have that's the case?
The administration of anti-psychotic meds. in any setting, be it corrections or in-patient mental health settings is often used to manage behavior. It is not difficult to attatch a diagnosis to any behavior. Freud said everyone is neurotic and then we all go down from there. Every youth in TYC has their criminal behaviors attatched to a psychiatric diagnosis from DSM. Every one of them has at least an "Adjustment Disorder". My point is that we as a society have given psychologists and psychiatrists the label making machine. It is a short hop from label A to label B. When "dysfunctional" behaviors, such as the kid becoming verbally or physically assaultive occur, they can often get a more serious diagnosis. Yes, there are bona fide diagnosis of episodic psychotic type behaviors as well as more long term chronic psychotic behaviors in many kids. Yes there are bonafide cases of depression that are not transient and require medications, and in those cases a judicious use of anti-depressant and anti-psychotic or other psychotropics may be justified. Unfortunately one problem associated with the prescription process is the lack of an integrated system of triaging kids through a "meaningful" system of risk assessment, integrated treatment planning, documentation, line staff input, parental input, and medical evaluations. Add to that problem the fact that regular physicians who are not trained in Psychiatry can put anyone on these same medications. This is because psychotropic medications have gone from being a specific treatment intervention ordered by a specialist to just another "med" used to treat another part of the body, i.e. the brain as a chemical synaptic switching system that needs "adjustment". Thus it becomes very easy to justify these prescriptions. In some cases, the youths themselves, like some adults, are drug seeking. They are wise enough to say the "magic" words like "suicidal", "depressed", "insomnia", "voices", etc., knowing that this will yield the magic pill of choice "seroquil" from the doctor. Maybe the reduction in the use of these drugs has come about in part because of Advocacy groups, OIO reports, and best practices forces coming together to bring better oversight. Reduced expenditures comes with reduced usage. When you reduce the usage systemically, you have to go back and ask weather or not some new intervention has been introduced to replace these medication, resulting in the symptom reduction. If you identify that intervention, then it appears that you have a better treatment plan. If you can't identify any such intervention, than you were probably using the meds as a chemical restraint first and justifying it as a medical intervention second.
While I would agree that using these drugs for this purpose is not a good idea I do not come to that conclusion because it is an off label use. Labeled uses are the minority for all drugs, and in many cases the standard of care does in fact require that medications be prescribed for uses not on the label. Instead, I believe using these particular medications in this manner is a poor idea because I don't see the benefits (though real, to both staff and juvenile) outweighing the substantial risk of serious and life-long side effects that accompany nearly every compound in this class.
Youth being over-drugged for easier control is another example of being "Raped by The State". When you see these youth in a 'cloud', unaware of their presence, one wonders why TYC misused this poilcy for so many years.
I will bet anyone a million dollars that Greg Abbott will rule that how much and what kind of psychotropic drugs is SECRET under Texas law.
It's time to throw Perry and his minions OUT and bring create greater transparency in our government.
Many of these TYC inmates are bouncing off the wall and are volatile with a hair trigger temper. Because of their habits, they are prone to violence if challenged. Still, that is no reason to use chemical restraints. More staff will likely be assaulted if medications are discontinued but staff members knew what they were getting into when they signed up for this job.
No one should pretend to be so shocked. If you are going to define "chemical restraint" to include the off-label use of psychiatric drugs...well, I can tell you that chemical restraints are extensively used by Texas MHMR, many county jails, and many dope-prescribing private physicians in Texas.
Such use should be roundly condemned, but it is silly to act like this usage is mainly a TYC usage of the black arts. They are no worse than any other incompetent prescriber.
Bit off topic but any thoughts on the recent Independent TYC Ombudsman appointee Debbie Unruh from Amarillo?
Do any of those commenting bother to read the article sited?
The article demonstrates that TYC has substantially reduced (more than most other states) the use of antipsychotics, particularly Seroquel. This has been a point of emphasis over the past year with TYC and the UTMB psychiatrists.
And TYC should be applauded for these steps, considering that secure care facilities are more and more being used as de facto mental health centers.
Tom Grisso (expert on juvenile justice) accurately points out that about a quarter of youth in secure care facilities would meet criteria for inpatient psychiatric hospitalization if they weren't in the juvenile justice system.
That TYC has been able to reduce the prescription rates of antipsychotics despite the heavy burden that these mental health kids place on the system is nothing short of extraordinary.
Kudos to TYC.
Twenty five years ago I worked with youth in two residential treatment facilities (ranch setting and "wilderness" setting, not boot camp) and the use of drugs (thorazine, I believe) to drug kids was no longer a practice. There were times when I would have liked to see a kid drugged, because it would have been easier. Fortunately, however, that was not the culture of either place. Trying to prepare youth for functual adulthood life (in an institutuional setting) is tough enough.
I totally agree with Hook Em Horns, and add no state agency can operate as intended with Perry leading state government. (Power corrupts and absolute power corrupts absolutely!)
I wonder how other states are fairing in their treatment of youth.
Don't think it's much different in the detention centers throughout the state. Kids come in taking said drugs and we ust keep getting them refilled. Little or no effort is made to go back and review who and/or why the kid was diagnosed in the first place. That practice needs to change, too.
07:51
You're right about Perry. Did you see Bill White when he spoke at a rally at the University of Texas on October 19?
Kudos to TYC. You must be kidding or high yourself. TYC is a training/refining ground for Texas' worst juveniles.
Hey Gritsforbreakfast, I posted at 9:18 a.m. I have some information. Where do you want it sent? I'll tell you all about it bro. I was there, way up there and I can tell you all kinds of shit. How would you like this shit salade delivered? Chilled or room temp bro? Cheri Townsend is wrong for TYC and Texas, and I'll tell you why this coward needs to go.
Sounds like a real winner, huh? A TYC know-all. Probably lives in Austin.
7:56pm sounds like sour grapes, were you sent out for abuse and now you want to be the "Enquirer" and tell all? Go back to your day job and get a life, if you knew anything you would have stepped up when it was taking place rather than talking crap now on a blog.
No one has mentioned the fact that psychotropic medications are taken on a purely voluntary basis at TYC. The students can refuse to take them. What this boils down to is they will start refusing medications to students who are basically asking for them. It's a Catch 22, because many of the students that need them, don't take them, and students who don't need them describe symptoms they know will get them the meds they want.
@ 7:56 - Email what you've got to shenson@austin.rr.com and I'll take a look.
Doping up kids for controllability has a long history at tyc. This isn’t new. Helping a kid get off the dope once in the free world, now that would be something new for tyc. It’s difficult to look at our criminal justice system and think it is something to keep citizens safe, or in the case of tyc, helping troubled youth. One would have to be foolish or simply a liar to think our criminal justice system keeps citizens safe. Looking at our criminal justice system as a job core, or for some, an entrepreneurial opportunity, makes much more since. From that perspective it’s easy to see tyc as an entity to prepare children to go out to the world and make more victims for the criminal justice system. The tyc does a great job at this and they do it on the real cheep.
Sheldon
7:56 has some folks in Austin shaking in their boots. Many have escaped the scandals and forced retirements or firings, but now know their tether lines may be cut by administration. You can see the cowards throughout the building, as they pretend to be so important and 'in-touch' with top bosses. Their hands are about to be forced and many will have to seek shelter in another public agency. Cut this monstors throat and let it bleed out.
There may be a small percentage of kids at TYC that use these drugs, but none of them should not be administered without a diagnosis from a doctor, and to do so otherwise is criminal at best. My son was at TYC, was very well behaved, and I visited every weekend, and got to know a lot of the kids there. None of them should be exposed to these type of drugs without a Dr.'s prescription (a ligit one). If you knew some of the staff (who make minimum wage and have the ability to yield power over anyone they want without fear of retribution), you might want to kick their buts as well!
Gritsforbreakfast-
I have to wait until I hear back from my lawyer in Austin to actually send what I got, but seperate and aside from my issue with this corrupt piece of shit, I'd start asking how they cheated the federal gov. out of Title IV Funds - millions - and how they circumvented Whitmires order that no TYC Central Office employee be raised in their salary. That's not been the case brotha. Field staff got bumped in September. Go look at who elese in CO. A select few. Go look at the payroll. Go look at the payouts for workers compensation and how TYC compares to other state agency's of like kind such as TDCJ and MHMR. Have things gotten better under Cheri Townsend? You tell me. I think not.
Screw Cheri Townsend
And one more: It's an easy one to investigate.
How and why was the Mel Mathews Boy's Ranch was ever considered a High Restriction TYC placement when in fact it never had a fence and it was not secured? You tell me why that program received high restriction TYC contracted dollars. The higher restiction, the more funds they received. Yet this place had as much restriction as a freaking TYC halfway house. How did that happen? It's sure smelling like a kick back.
*Go ask for the books on this one.*
The corruption at TYC will never end. Abolish and fire everyone that works for this rancid agency.
11:23, you said,
"The corruption at TYC will never end."
Making wild accusations is not very convincing. If you have specifics then tell us what they are.
Anoy 10/27/2010 12:45pm
“Making wild accusation is not very convincing. If you have specifics tell us what they are.” This is a great example of simple defecting.
It’s very easy to make negative accusations against tyc. Wild, well that’s an opinion, and a very unintelligent opinion at that. In the 120 year history of the agency, or the 60 year history of tyc, or the 30 year history of the commission there is verifiable story after verifiable story of wide spread abuse. Coupled with each story there are wide spread denials of such allegations. My favorite story is the imps of gatesville receiving an accommodation from a third line assistant governor just before the dam broke with Morales vs turdman. Truly based on factual history anyone who has ever been associated with this wretched agency has been raped by the state. So my question back to you is, are you retarded? And I mean retarded from an engineering perspective and not to offend any special needs people who might be reading this.
I’m guessing your just another cowardly tyc emp on a blog, mindlessly deflecting critique, in a feeble attempt to defend an agency who’s culture of child abuse is bigger than itself and much older than your great grandparents. Saying the corruption will never end is also not accurate. Just because the sun comes up in the east it doesn’t mean it can’t change. Just ask an end times evangelical. However there is a very high probability, I mean at least a 10 9’s chance that the corruption will not cease at tyc. That’s 99.99999999% for the statistically challenged. The probability that it could is only conceivable with the abolition of this agency for state sponsored child abuse. The corruption at tyc will end with the demise of tyc. However that simple thinking applied to closing Gatesville, and the reality was the corruption was simply spread. The good ol boys were replaced by the lower paid team playa’s who brought with them their culture of sexual deviancy, a whole new world of sexual deviancy, the like not seen in tyc past. As example chester bookins.
BTW, like the old timers say about A&M, the same could be said about Gatesville, the place went downhill since they let the chicks in. It just doesn’t seem as well kept today as it was back in the day.
Sheldon tyc#47333 II c/s
What is so sad...Sheldon, they will block it out as though it never happened. Same old TYC...Cover for the abusers and move on; as though all is OK.! Soooooo...sad. State stuck with losers.
I don't care about TYC, but all I know is that Rick Perry sent crazy people to fix the problem. White may be worse, but one can only hope he's better than Perry.
Crazy people to fix it, at least Mr Smith stands up for the field staff. He has brought a lot of great and inspiring practices from his past experiences from other states, which was needed. I for one like the idea of Re-Direct where youth who assault staff or their peers receive no consequence, but are made to learn from their mistakes and become a better person. Just give it time and all of you will reap the rewards.
YES Crazy! Let the darlings assault YOU and receive no consequences, then see if you like it. This is stupid! You are inviting youth to assault others and just treat it with a slap on the hand. No wonder TYC has drifted into the abyss. YOU should be fired along with the idiots that came up with this policy.
Yeh 29; Thats what 'O' stated and look what a disaster he has turned our country into.
"Crazy people to fix it, at least Mr Smith stands up for the field staff. He has brought a lot of great and inspiring practices from his past experiences from other states, which was needed. I for one like the idea of Re-Direct where youth who assault staff or their peers receive no consequence, but are made to learn from their mistakes and become a better person. Just give it time and all of you will reap the rewards"
You have got to be kidding me. The manager named has proven ineffective time and time again in TYC and isn't even a Texas product. He's from Maryland, and if you look at that states history, you'll see all the federal involvement surrounding his ass. But then again, he was a Nedlekoff appointment much like Cheri Townsend was, so what more could you expect. I mean, look at that agency now. What a disaster. Losing 700,000 K on an employee lawsuit? I can assure you, there's more of that coming.....
TYC is a fascinating study as are those that are critical of the agency.
Those that advocate for the abolition of TYC have no answers for where the youth will go when or if the agency is obliterated.
The use of chemical restraints is a maledict form of restraint.
As I understand it however, staff members are only allowed to respond to violent assault by hugging or performing a primary restraint technique on the kids. Staff members are prohibited from defending themselves by TYC policy. The right of self defense is a right that all Texans enjoy, unless you work for TYC.
On the sadder side of things, what tends to occur is that the youths know this and they will tend to assault numerous staff members in rapid succession. These incidents are documented by surveillance video evidence, turned over to law enforcement and then the youth is often either recommitted as a sentenced offender or sent to TDCJ.
With the system we have created after 2007, more youths are being sent to TDCJ for longer sentences.
Good job Texas.
Smith is the glue that this agency needs right now as they continue to push forward. He is like a breath of fresh air that pushes new and informative ideas to the fore front that TYC has never tried before. Look how far this agency has moved forward with his leadership, just give him time.
10:26
I doubt you can support that claim about TDCJ transfers with any data.
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