As much as I am joyful about celebrating the Fourth of July holiday, the US day of independence, I am saddened by the fact that thousands of children and youth who have severe behavior problems are locked into 24-hour care facilities.
Now, sure, in accord with penal systems, some of them are in prison-like facilities because they broke the law. The facilities are not swank spas; lots of problems occur in them, as they do in locked psychiatric facilities. And when kids are released, wheather because their doctors say that they have completed therapy or because they’ve served their time, they are going to need some supports.
They and their families are often unable to secure behavioral and mental health services that would permit them to live a much more normal life at home. Why? Well, the services may be too expensive. They may be in too short supply (or not even exist). And, though I hope it’s not the case, there may even be some situations in which someone says these kids and their families don’t deserve services.
Wendy Sawyer (2019) noted that “on any given day, over 48,000 youth in the States are confined in facilities away from home as a result of juvenile justice or criminal justice involvement.” The organization for which she worked, Prison Policy Initiative produced this visual representation of where those nearly 50,000 youths were being held. Because she focused especially on imprisonment, her numbers overlook those housed in psychiatric facilities.
Duaa Eldeib (2020) of ProPublica reported about the issue of children and youth being confined to psychiatric hospitals in Illinois:
Two years ago, officials from the Illinois Department of Children and Family Services vowed to rescue the children they called “stuck kids” — those in state care who had languished in psychiatric hospitals for weeks and sometimes months after doctors had cleared them for release because the agency could not find them proper homes.
But children continue to be held at psychiatric hospitals long after they are ready for discharge, a practice our reporting showed leaves them feeling isolated and alone, falling behind in school and at risk of being sexually and physically abused during prolonged hospitalization.
Hannah Furfaro (2022) of The Seattle Times provided an extensive feature article under the headling, “Institutionalizing her son was the only option, a mother thought. Now she’s fighting to bring him home.” In her story (a fine example of journalism, I’d say), Ms. Furfaro not only introduced the human element (the mother and son in the headline), but also provided results of her research about delays in getting care, how many children and youth are stuck kids, and links to many other stories that she’s covered.
Readers interested in learning more on this topic can consult many different sources.
The US federal government maintains a Web resource about youth at Youth.gov. There are sections about mental health, violence prevention, family engagement, and many other topics. The US Centers for Disease Control and Prevention provides a valuable start page, allowing readers to find more specific content.
Many state government and local areas around the world have mental health services. Because many of them are community-based, they are local and they will know important things about how to secure service in their special area. Funding, for example, often differs from local area to local area. Try searching for services (perhaps with the addition of a name for a specific geographic area such as Virginia, New South Wales, London)
There are examples of superb programs.
Treatment Foster Care Oregon has an excellent record for implementing evidence-based services; the work of these folks is being implemented extensively in the US, Great Britan, and Europe.
Another approach that also has a strong evidence base is Multisystemic Therapy (MST); the goal of MST is to help youths 12 and older who have serious problems (drug use, violence, criminal behavior) to learn how to live successfully in their homes, schools, and communities. There is also a special version for youth 9 and older who have mental health problems. Youth.gov has a Web page documenting the successes of MST.
By adopting and making available models of effective mental health services, we can increase the independence of children and youth and their families. It doesn’t have to happen only on Independence Day, but starting today would be good.
Sources
Eldeib, D. (2020). Hundreds of children are stuck in psychiatric hospitals each year despite the state’s promises to find them homes. ProPublica. 11 September 2020.
Furfaro, H. (2022). Institutionalizing her son was the only option, a mother thought. Now she’s fighting to bring him home. The Seattle Times, 3 July 2022. https://www.seattletimes.com/seattle-news/mental-health/institutionalizing-her-son-was-the-only-option-a-mother-thought-now-shes-fighting-to-bring-him-home/
McCart, M. R., & Sheidow, A. J. (2016). Evidence-based psychosocial treatments for adolescent with disruptive behavior. Journal of Clinical Child & Adolescent Psychology, 45(5). https://doi.org/10.1080/15374416.2016.1146990
Sawyer, W. (2019). Youth confinement: The whole pie 2019. Prison Policity Initiative, 19 December 2019. https://www.prisonpolicy.org/reports/youth2019.html
Thanks to Prof. Lloyd for this thoughtful and informative commentary. The issues deserve serious and sustained attention from institutions and citizens at large. I’d just like to add a philosophical, but I hope not empty, comment. The very concept of special education requires that we build into public policy and general civics a regard for the individual person. This is difficult. People will defend and protect family and clan — that’s built into our biology — but for someone unrelated or unknown the idea of extending care to him/her is a great abstraction. When we do, it’s based on a fragile idea that if I permit your suffering, someone will be free to permit mine — a kind of “we’re all in this together” notion. We do it, but it’s always remarkable when we do, not ordinary. Arrayed against it is the biological imperative that the species, not the individual, must survive and, indeed, the individual can be sacrificed for some “greater good”. There is no “answer” to our dilemma, but the societies we’ve built are ever more insistent that we try. I know this precept from Talmud, but it’s sentiment can be found in all of humanity’s moral systems of thought: “Whoever saves one life saves the world entire.”