For NY youth offenders with mental illnesses, no psychiatrist available to oversee treatment

From The NY Times:

Edwina G. Richardson-Mendelson has been the administrative judge of the New York City Family Courts for nine months, in charge of the judges responsible for the detention of dozens of young people charged with crimes, the vast majority of whom suffer from some form of mental illness.

But it was not until last September that she was informed of what struck her as a startling fact: The State of New York does not have a single full-time staff psychiatrist charged with overseeing the treatment of the 800 or so young people who are detained in state facilities at any given time.

“There wasn’t one human being on-site overseeing all the mental health needs of the population,” Judge Richardson-Mendelson said in an interview. “When we place these children in these facilities, we expect their needs to be met, especially their mental health needs.”

Yet all 17 psychiatrists at the detention facilities in the state’s deeply troubled juvenile justice system work on contract and part time. Weeks often pass between their visits with each troubled youth, and state officials say their turnover rate is very high.

“Those people turn over so quickly that there are often huge chunks of time when there is not even a contracted psychiatrist available to evaluate the youngster or provide needed follow-up services,” said Judge Monica Drinane, the supervising judge in Family Court in the Bronx.

Gladys Carrión, the commissioner of the Office of Children and Family Services, the state agency that administers the juvenile prisons, declined to be interviewed.

Edward Borges, an agency spokesman, said, “The commissioner has said that we need more mental health professionals, that we need psychiatric help, and it’s something that she’s recognized.” Ms. Carrión is in the process of hiring a “chief psychiatrist,” who will work on salary or on contract, Mr. Borges said.

For now, then, the oversight of the mental health treatment of the young people in state facilities falls to several dozen psychologists who visit them for consultations, and staff members at the jails who run group therapy sessions despite often having no qualifications beyond a high school degree.

Aspects of the lack of mental health services throughout New York’s juvenile prison system were described last August in a withering report from the federal Department of Justice that examined conditions at four notorious state juvenile prisons.

The report criticized the state for failing to properly diagnose juveniles’ mental health problems, administering medication inappropriately and making inadequate treatment plans. Young people are frequently assigned several different diagnoses at the same institution, resulting in confused and ineffective treatment.

“One psychiatrist described his role as ‘an outsider’ and expressed frustration because, ‘I have to beg, borrow and steal information,’ ” the report said.

The proposed state budget released by Gov. David A. Paterson in January included an additional $18.2 million to improve services in the juvenile prisons, particularly mental health care. And officials from the Office of Children and Family Services said they had begun more consistent screening of children for mental health issues, reducing the use of physical restraints in the facilities and hiring an additional 37 mental health professionals to work in state-run juvenile residential centers.

But Commissioner Carrión recently told a number of Family Court judges, who decide which children should be sent to prisons, that the conditions at many isolated facilities upstate made it hard to recruit psychiatrists to work there.

Lawyers for the Legal Aid Society said they had many examples of mentally ill children who had been mistreated while in prisons.

One 16-year-old boy received a diagnosis of moderate mental retardation, took powerful psychotropic medication and functioned on a first-grade educational level. Last July he was placed in a state residential facility by a Family Court judge who had ordered that he receive mental health services.

However, he was not placed in a mental health unit until five months later, after being harassed, taunted and restrained at least five times by the prison staff, according to the Legal Aid lawyers.

A 15-year-old girl with attention deficit hyperactivity disorder, conduct disorder and adjustment disorder was sent to a juvenile prison last February. Since then, she has not received proper mental health treatment, and has been restrained by the staff more than 15 times, her lawyers said.

Surveys of youth prisons indicate that about two-thirds of the nation’s juvenile inmates — about 92,800 in 2006 — have at least one mental illness.

“The system just isn’t equipped to deal with children with serious mental health issues,” said Tamara A. Steckler, the lawyer in charge of the Juvenile Rights Practice of Legal Aid. “We need to find another mechanism to treat those children.”

A task force led by Jeremy Travis, the president of the John Jay College of Criminal Justice, recently examined conditions at state juvenile prisons.

“I think it’s clear that for these young people to succeed while they’re in these facilities and for them to succeed when they’re coming home, many of them need extensive mental health services,” Mr. Travis said. “And it’s clear that the current services fall far short of professional standards.”

The problem of ineffective psychiatric care in juvenile prisons stretches back decades. Michael A. Corriero, a recently retired judge who spent 16 years as an acting State Supreme Court justice presiding over Manhattan’s courts that dealt with youth offenders, recalled sentencing a 15-year-old who had sodomized an 11-year-old boy.

He placed the teenager in a juvenile prison, sentenced him to a term of two to six years, and recommended that he receive intensive counseling.

“I said, ‘You’re going to have to get this kid appropriate psychiatric care, and it has to be one-on-one,” Mr. Corriero said. “And the answer was, ‘We don’t have a psychiatrist.’ ”