Many Youths Reported Held Awaiting Mental Help

The study, presented at a hearing of the Senate Committee on Governmental Affairs, found that children as young as 7 were incarcerated because of a lack of access to mental health care. More than 340 detention centers, two-thirds of those that responded to the survey, said youths with mental disorders were being locked up because there was no place else for them to go while awaiting treatment. Seventy-one centers in 33 states said they were holding mentally ill youngsters with no charges.

The 15,000 youths awaiting mental health services accounted for 8 percent of all the youngsters in the responding detention centers.

Dr. Ken Martinez of the New Mexico Department of Children, Youth and Families said the data showed "the criminalization of mental illness'' as "juvenile detention centers have become de facto psychiatric hospitals for mentally ill youth.''

Mental health advocates, prison officials and juvenile court judges all testified and recommended three types of solutions: more community mental health services, financed in part by Medicaid; more cooperation between police officials and mental health agencies; and more extensive insurance coverage.

The witnesses included experts on psychiatry and juvenile justice. Judge Ernestine S. Gray of New Orleans Juvenile Court testified that 70 percent to 85 percent of the youngsters who appeared before the court had mental health or drug problems.

"All too often,'' Judge Gray said, "children charged with delinquent behavior are identified early on as needing mental health services. But because the services are not available, the children are sent back home until there is another violation. After several brushes with the law, the children are incarcerated, so they might have a chance at getting mental health services.''

Leonard B. Dixon, director of the Wayne County Juvenile Detention Facility in Detroit, said mentally ill children were "more difficult to manage, more explosive and more easily agitated.'' "Most juvenile detention centers,'' Mr. Dixon said, "do not have the luxury of separating youth with mental health problems from the general population.''

Carol Carothers, executive director of the Maine chapter of the National Alliance for the Mentally Ill, told of a 13-year-old who was sent to a detention center even though he was suffering depression and had suicidal thoughts. He was held in isolation for 152 of his first 240 days there, Ms. Carothers said. He was sent to the youth center four more times, becoming more depressed and aggressive, and was punished for misbehavior, worsening the symptoms of his mental illness, she added.

Mr. Dixon, who is also president of the National Juvenile Detention Association, a professional organization, described a 16-year-old who was detained after having been accused of stabbing a classmate in the neck with a pencil. The youth was psychotic and severely depressed and had hallucinations, but was held in a detention center for months before going to a psychiatric hospital for treatment, Mr. Dixon said.

Dr. Steven S. Sharfstein, president-elect of the American Psychiatric Association, said: "We are in a much better position to diagnose and treat mental illness in children than we were just 15 years ago. Many kids who get in trouble should be in treatment. But because of the lack of money and the lack of services, they end up in the criminal justice system.''

In an interview, Dr. Sharfstein, who is president of the Sheppard Pratt Health System in Baltimore, said: "It used to be thought that these were bad kids. But many of them are sick and could benefit from treatment such as medications, psychotherapy or therapeutic education - small classes and individualized attention that focuses on learning disabilities.''

In California, 27 centers reported unnecessary incarcerations of youths awaiting mental health services; 19 reported that some of the children had attempted suicide.

Texas had 17 detention centers with children who could have been released if mental health services were available, according to the survey. New Jersey had 13, Florida and Illinois 7 each and New York 4.