Improving Mental Health Care in Teen Justice System
STEVE INSKEEP, host:
This is MORNING EDITION from NPR News. I'm Steve Inskeep.
Every year, more than one and one-half million youngsters enter the juvenile justice system. Experts say a large percentage of these teen-agers are mentally ill, but rarely do they receive mental health treatment. Some juvenile courts have been created across the country with the goal of taking young people with severe mental illnesses out of the mainstream justice system and providing them with effective mental health care. Michelle Trudeau reports.
Judge RAY DAVILLA (Co-founder, Santa Clara Juvenile Health Court): OK, we will start at the top.
MICHELLE TRUDEAU reporting:
On a Tuesday morning at the Santa Clara County Courthouse, a small group gathers in Judge Ray Davilla's chambers.
Judge DAVILLA: You want to go first as usual, Sandhya.
Ms. SANDHYA SHANKAR (Mental Health Clinician): Yeah.
TRUDEAU: Judge Davilla, one of the co-founders of the Santa Clara Juvenile Mental Health Court, is meeting today with his special team. Sitting here in a semicircle around the judge's desk are probation officers, mental health experts and both prosecutors and defense lawyers. It's a highly unusual group of collaborators. Sandhya Shankar, the team's mental health clinician, starts the meeting by discussing the case of a girl named Sonya(ph), who was arrested three years ago for maliciously punching another girl in the face.
Ms. SHANKAR: ...female Hispanic teen-ager who has a long history of bipolar disorder, more depressive symptoms and a lot of violence.
TRUDEAU: Sonya had been in and out of juvenile detention until this team intervened. They recognized she had a severe mental illness, bipolar disorder. They took Sonya out of the juvenile justice system and enrolled her into this unique program. It's for the over 200,000 cases like Sonya's that this mental health court was created, says child psychologist David Arredondo, a co-founder of the program. Arredondo says that at least 60 percent of youngsters in the juvenile justice system have some form of mental illness and about 20 percent have what he calls biologically based disorders of the brain, severe mental illnesses such as bipolar disorder, major depression and schizophrenia.
Dr. DAVID ARREDONDO (Child Psychologist): I've seen children who were delusional. I've seen children that were hallucinating in solitary cells, left there for days because there was no mental health services available for them.
TRUDEAU: Even doctors who do work in juvenile detention don't have the time or the expertise to care for these kids, but this program targets them. To be accepted into the program, a juvenile offender must first be diagnosed with a severe mental illness. Also, the teen can't have committed a violent felony. And he or she must admit to the charges, which will remain on the teen-ager's record. This last policy was adopted to avoid being perceived as an `excuse court.' If these three conditions are met, the teen comes out of juvenile detention and is offered encompassing mental health care, including psychotherapy, medications, alcohol and drug counseling and individualized school programs. Participation in the court's program is voluntarily and the family must agree to it as well.
At the meeting this morning, mental health counselor Shankar reports to the team that Sonya is benefiting from the program.
Ms. SHANKAR: She's doing really well in therapy, doing for the most part well in school and has a lot of friends and has not run away and has not done any of those...
TRUDEAU: The team discusses how Sonya, now living at home, is doing: medically, psychologically, socially, academically. Is she living up to the terms of her probation, wearing her electronic monitoring bracelet, going to therapy, doing community service, getting drug tested, abiding by house curfew and taking her medicines? At this point, Shankar tells the team something new about the 16-year-old.
Ms. SHANKAR: I did see her at school Monday. She's pregnant, so she's off medication. She is rapid cycling in school and she was, like, one minute very happy and really high energy and talking louder and talking non-stop to sobbing and crying.
TRUDEAU: Now pregnant, Sonya's doctor has taken her off the medicines that control her bipolar mood swings. But in spite of this medical complication, Sonya's had no violent episodes and hasn't committed any new offenses, very important measures of success.
Judge DAVILLA: All right, this is number three on this afternoon's calendar in the matter of Sonya O., petition number 2680...
TRUDEAU: Court convenes. Judge Davilla, in his black robes, sits behind a raised bench, the other members of his team seated around the small courtroom. And Sonya, her dark hair pulled back, dressed neatly, her pregnancy not showing, sits very still at a table in front of the judge, next to her mother. As the team each talks about her, she doesn't speak.
Judge DAVILLA: Thank you. The court has read the report. It's an up-and-down report, but we know that that's going to happen, especially since you're not able to take the medications anymore. So we're going to expect a little harder effort on your part to make sure good decisions are made and there's more ups than downs. Comments...
TRUDEAU: For Sonya, this is an important day in court. The judge will decide whether she should be allowed to have her electronic monitoring bracelet removed, a freedom the teen-ager very much wants. Her probation officer and mental health team member Tiffany Newen(ph) weighs in.
Ms. TIFFANY NEWEN (Probation Officer): Considering her overall acceptable behavior in the school and at home, and I just learned from Mom that she's on track to graduate--I'm really glad to hear about that and those are wonderful things that Sonya's been working on, so I would not oppose that.
Judge DAVILLA: All right, I will order that she be taken off the electronic monitoring program today. All right? Keep up the good work.
TRUDEAU: Quietly, Sonya thanks the judge, rises and leaves with her mother and her public defender. They don't want to talk about their case. The next teen-ager's case is called.
Judge DAVILLA: All right, this is number five on this afternoon's calendar in the matter of Timothy...
TRUDEAU: Since the Santa Clara Mental Health Court opened in 2001, over 130 juvenile offenders have been through the program, receiving intensive treatment for their severe mental illnesses. Of these, says Judge Davilla...
Judge DAVILLA: The success rate is very high.
TRUDEAU: Last year, Davilla says, the mental health court reduced its recidivism rate to about 10 percent, significantly lower than the national rate for repeat juvenile offenders. And the Santa Clara Court has been nominated as a model program by the US Justice Department.
Judge DAVILLA: Our kids are out of custody. They're either out without any kind of confinement or they're out on house arrest, but they're home. They're going to their school. They're out, they're functioning. Whereas before the program, odds are those kids would have been at the hall or the ranch.
TRUDEAU: In and out of detention repeatedly. According to Judge Davilla, his mental health court doesn't cost any more than processing kids through the traditional juvenile justice system. No new money was allocated. The judge just redirected existing resources.
Mr. ROBERT SCHWARTZ (Juvenile Law Center): This Santa Clara model seems to be well-designed, cost-effective and targets the right kids.
TRUDEAU: Says Robert Schwartz, director of the Juvenile Law Center in Philadelphia. But getting such a specialty court up and running isn't easy, he adds, and only a handful of mental health courts have emerged around the country. There's a perception, Schwartz says, that opening such a court will require extensive start-up funds that won't be recouped down the line. The Santa Clara Court experience counters this perception, says Schwartz, but, he adds, there's a tougher barrier.
Mr. SCHWARTZ: I think inertia is a very big part of the problem, and many jurisdictions are very, very resistant to assigning new duties to staff and to changing the way they operate. There's a comfort level and the Santa Clara model challenges the comfort level.
TRUDEAU: But it takes strong judicial leadership to create a team of prosecutors, defense lawyers, probation officers and mental health experts, a team that can get these youngsters good mental health care, keep them out of jail and fundamentally change the direction of their lives.
For NPR News, I'm Michelle Trudeau.
INSKEEP: It's MORNING EDITION from NPR News.
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