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Mental-Health Care for Troubled Kids

January 4, 2004

Heather Heilman
Phone: (504) 865-5714

hheilman@tulane.edu

Some kids get in trouble with the law simply by being in the wrong place at the wrong time. Some troubled kids break the law and don't get caught.

healthBut children who end up in the custody of the juvenile justice system are far more likely than their peers to have mental-health issues--whether that be depression, attention deficit/ hyperactivity disorder, post- traumatic stress disorder or psychosis.

Good mental-health evaluation and treatment makes a huge difference in whether or not juvenile offenders are rehabilitated or simply mark time in a correctional center. Yet it's doubtful they'll get the help they need, particularly in Louisiana.

"These kids need mental-health care, and if they get it they're going to be more manageable and have a better chance at success," said Cheryl Wills, assistant professor of psychiatry. She is a board-certified psychiatrist who specializes in forensic child psychiatry.

Forensic psychiatry deals with all the ways mental health and the legal system interact--from setting mental-health policy to providing psychiatric evaluations for civil and criminal courts. It's the perfect field for Wills, who had a hard time choosing between law school and medical school.

During her training, she became particularly interested in the mental health of children in the juvenile justice system. She came to Louisiana in 2001 to run psychiatric services at the juvenile institutions of the Louisiana Department of Corrections. She had experience in helping to reform the mental-health program in New York and Ohio's juvenile justice system and in training clinicians and corrections workers to evaluate and provide mental-health care for kids in corrections systems. In Louisiana, she found a program in disorder.

Kids enter the system through the Louis Jetson Correctional Center for Youth in Baker, La. There they undergo physical and psychological evaluation and are supposed to be sent to an appropriate facility, with less violent and more fragile children going to the Bridge City Correctional Center. But the screening process didn't always work as well as it should.

"I saw 10 and 11 year olds enter the system who were not suited to the system, a lot of them with mental illness," Wills said. "In some cases, their families had previously tried to get help for the child but the resources weren't there."

This is part of a larger, problematic pattern of jails and prisons picking up the fallout of a disintegrating public mental-health system. Unfortunately, the resources to help such kids weren't there in the correctional system, either. There was a shortage of psychiatrists throughout the system and the approach to mental-health services was not based on a medical model. And if the boys were not being well-served, the situation was even worse for the girls.

"There are mental-health issues that are gender-specific," Wills said. "Girls tend to have depression at higher rates than boys. There are different relationship issues and pregnancy issues. Some of them are pregnant while they're in the institution, or they already have kids. You have to be aware that if you restrain girls who've been sexually abused, you could re-traumatize them. There are all kinds of social and developmental issues that are different for girls."

There was a serious problem at the girls' unit at Jetson with girls cutting themselves and engaging in other types of self-injurious behavior. By re-evaluating each girl, providing treatment and being willing to intervene in families, Wills helped put an end to such problems. But changing the whole system proved to be a greater challenge. She found that corrections workers care about the kids and want to help, but they lack funding, training and an effective approach to mental-health care.

"Louisiana does have the potential to improve," she said. "It's highly doable." She came to Tulane last year in order to work with local judges as well as clinicians and others who deal with juvenile offenders. She has been involved with the Teen Court system, a program that aims to keep first-time juvenile offenders out of corrections facilities while helping them get their lives on track.

"Often people are fearful or apprehensive about working with these kids. But when their clinical skills and their comfort level improve, the kids get better evaluations and better treatment, and therefore more of an opportunity to think through their options and make better choices."

Heather Heilman can be reached at hheilman@tulane.edu.

Citation information:

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Tulane University, New Orleans, LA 70118 504-865-5000 website@tulane.edu