ARREST MY KID.

He Needs Mental Health Care

Last August, Wanda Yanello of Plano, Texas, was terribly worried. Her fifteen-year-old daughter, Heather King, had been diagnosed with bipolar disorder. The illness seemed to be accelerating. Heather was punching holes in the wall and was gone for days on end.

"She was on the street all the time," recalls Yanello. "Say 7 o'clock tonight, she'd go out the door. I can't block the door. And she'd be gone two hours or two days. She's ended up in Texarkana, five hours away. She's ended up in College Station. That's nine hours away."

While on the street, Heather was raped, and her case was reported to the Richardson, Texas, police department. Yanello says her daughter at other times was beaten up, had twice attempted suicide, and was taking drugs.

"Two of the best psychiatrists in Dallas" diagnosed her daughter with bipolar disorder and recommended long-term inpatient care, Yanello says. But Yanello's insurance lapsed, and she couldn't afford the treatment.

So she watched for an opportunity. And she found one when Heather went for a spin in Yanello's car. "She only took it for four miles, thirty-five minutes, but I had her arrested," says Yanello. "Every system along the way has failed my child, and I had high hopes that the juvenile justice system would come through."

Heather King received a referral to a residential treatment program, and her mom picked out the facility. Yanello chose the Campbell Griffin Center, a 120-bed program, six hours away from home, in San Antonio.

Yanello drove Heather to the center herself. It turned out that was a very unusual thing to do. "They said, `What are you doing? No parent brings a child in here. Only police officers bring kids in here. This is a juvenile correctional facility,' "says Yanello.

Yanello claims that Heather did not receive psychiatric care for the first four weeks. After that, the center allegedly refused to treat Heather for bipolar disorder, saying she had attention-deficit-hyperactivity disorder instead. The center did give Heather medication for that, says Yanello.

Officials at the Campbell Griffin Center say they cannot comment on individual patients. Julien Devereux, central division director of Campbell Griffin's parent company, Cornell Company of Houston, also refused to discuss it. "I have no comment on any of that," he says. "I assume that if she has a complaint, she has taken it to the director, and they have dealt with that." He does say, however, that the facility employs two "licensed, competent psychiatrists" for the 106 children at the center, about 70 percent of whom are on psychotropic medications.

According to Yanello, the facility has also given Heather a pen to click whenever she feels manic. "I went to visit her," says Yanello. "She was pacing, clicking a pen. She was like a dog in distemper. It was a mess. To this day, she hasn't been treated for the diseases she went in there with. She's been in since February 20, and nobody will listen to me."

No one will listen to Wanda Yanello because, in having her child arrested, she effectively gave up custody of her daughter to the juvenile justice system. Until Heather is released, Yanello has no say in her treatment. "I've lost all my rights," says Yanello. "I'm not allowed to speak to her doctor."

Yanello fears for her daughter's future. "She is, at this moment, sitting in that place, manic for the last forty-five days, and no one's doing anything," she says. "I just know she's fifteen, and if I don't get help for her now, she's going to end up graduating from this juvenile crap to prison."

As stark as it might seem, Yanello's situation is not unique. Across the country, parents who see no other solution are having their children arrested in the hopes of getting them mental health care that they can't afford or that their insurance companies won't cover.

"It is a national tragedy that American parents feel forced to have their children locked up simply in order to obtain desperately needed mental health services," says Paul Wellstone, the Democratic Senator from Minnesota. "This is a horrendous symptom of the discrimination against mentally ill children rampant in our health care system today."

Just how often parents do this is an open question. Chris Koyanagi, policy director for Bazelon Center for Mental Health Law in Washington, D.C., says it is "quite common." But there are no good numbers "because there is nobody in the bureaucracy asking, `Why did this child come in?' No one says, `Is it the parent seeking services?' There's no way to know other than talking to the families." And many parents who have their children arrested may be too ashamed to admit they have done so.

Chris Siegfried, a Texas-based social worker and mental health consultant, says parents who go this route often have children with extensive mental health needs requiring specialized or longer-term care--the sort that many HMOs don't cover.

"The motive is strictly financial for most parents," says Siegfried. "Parents still want to get their child some help but don't have the money to pay for more extensive help, which is usually residential, or their insurance doesn't cover it." Siegfried says that more parents have their kids arrested for these reasons in states with poorly developed mental health systems. Texas, she says, happens to be one of them.

But entering your child in the juvenile justice system can have unanticipated consequences. "I've heard stories of people saying they've called the police specifically to get their child arrested [to get mental health treatment] and end up seeing guns drawn on them," says Melanie Gantt, director of public policy for the Mental Health Association in Texas.

"Many parents are advised that that's the way to go," says Lindy Garnette, a social worker who is director of children's primary care for the National Mental Health Association in Alexandria, Virginia. "But I personally am not familiar with cases where that's been productive. Usually, it's made a very difficult situation much more difficult."

The reason, she says, is that "juvenile justice is responsible for the public safety. That is often in direct conflict with what would be in the best interest of the child for treatment."

First, the child, if convicted, gets a criminal record. And the child will often "get stuck in the system," she says. "Once they get in, they don't have the social skills to play the game to get out of it."

Worst of all, the child may not get the health care that is needed. As Amnesty International reported in 1998, "Many [juvenile justice] facilities have not provided adequate mental health services, and some have responded brutally to the behavioral problems posed by troubled children."

District Court Judge Scott McCown of Austin, Texas, who sits on his county juvenile board, warns that the juvenile system does not have a lot to offer in terms of mental health care. "It's not as if you get Cadillac services when you get into the juvenile justice system," he says. "There is a tremendous shortage of services and a tremendous shortage of quality. You can wind up going this route and not getting much more help than you would if you hadn't gone this route to begin with."

But McCown understands why parents are taking such extreme measures. "To the extent that services are out there, they are standing in line," he says. "There are waiting lists everywhere. One way that you get your kid to the top of the list is you go to a different line. You go to the juvenile line, and you get your kid ahead of everyone else."

In some circles, this seems to be common knowledge.

"There is a general feeling out there that this is a way to get your kid into treatment," says Jenifer Wood, vice president of services and research for the National Mental Health Association. "There are case workers out there saying, `There's nothing I can do unless your child gets arrested.' I hope caseworkers know that this is a horrible and painful thing for families."

But even when social service workers are aware of the dangers, they continue to suggest that parents have their kids arrested. This is because, often, there is nowhere else to go.

Skip Barber, a licensed psychologist and director of the Denver Children's Home, says he has advised parents to have their kids arrested in order to get them mental health care. "I would get a call occasionally from a parent who was desperate," he says, "and I would go through the options."

Because Colorado used to provide mental health care only to those children whose parents gave them up, Barber would tell parents that the juvenile system was "one way to go. It came down to either the state taking custody or the criminal justice system. Both of these have connotations that are not good."

Sometimes calling the police seemed like the best option. "If you had to have something happen fast, the juvenile justice system was quicker," Barber says.

The situation has changed for the better in Colorado. In 1999, the state passed a law providing treatment for kids with mental illness. But Colorado is an exception.

Louisiana is not. "We have nothing for these kids. Nothing. The only facility we have is $250 a day," says Michelle Duncan, an attorney with Mental Health Advocacy Services in the state. "I've had to tell them to plead guilty" specifically so they could get mental health care, she says. "All I do is try to find services for these kids. I've told two judges recently that it's a shame that we have to put them there for them to get help."

It may be hard for many people to fathom why parents would turn their own kids in. But "these are not bad parents," says Ron Honberg, legal director for the National Alliance for the Mentally Ill. "These parents desperately want to get mental health care for their kids. The villains are the uncaring system, or the underfunded system, the insurance companies, the state legislature." There is not, says Honberg, "a real desire on the part of society to meet the needs of these kids."

A July 1999 national survey of parents and other caregivers by the National Alliance for the Mentally Ill backs that up. The survey, entitled, "Families on the Brink: The Impact of Ignoring Children with Serious Mental Illness," found that the unmet needs are great: "49 percent said that their own children have been limited or denied access to service by their managed care plan, to the detriment of their child's health." As a result, "more than one-third of the parents who responded to the survey--36 percent--reported that their children were placed in juvenile justice because needed services were not available."

The U.S. government recognizes that mental health care for children is an urgent problem. A 2001 report from the Surgeon General states, "The nation is facing a public crisis in mental health care for infants, children, and adolescents. Many children have mental health problems that interfere with normal development and functioning. In the United States, one in ten children and adolescents suffer from mental illness severe enough to cause some level of impairment. Yet in any given year, it is estimated that one in five of such children receive specialty mental health services."

Many of those children appear to be funneled into the juvenile justice system. If they had received appropriate treatment early on, they could have been spared this fate.

Joy Ellis's son, Jonathan Wade, is currently in a juvenile facility but will soon be transferred to an adult prison. "He's going to be in prison for a long time. He got a sentence of five to nine years," says Ellis.

The reason? Jonathan assaulted two probation officers.

"I was the first one that ever introduced Jonathan to the court system, unfortunately," says Ellis, of Creedmore, North Carolina. "It was because I had run out of options."

Jonathan Wade was diagnosed with bipolar disorder, attention deficit disorder, and depression. But Ellis couldn't get adequate help for him. She couldn't afford to pay for inpatient treatment--which cost $250 per day--on her nurse's salary. The Granville County mental health office offered counseling on an outpatient basis, but no inpatient care, reported The Charlotte Observer in an investigative series exposing the lack of mental health care in North Carolina. In another article in the same series, the Observer noted, "An estimated 84,000 children [in North Carolina] need mental health services but don't get them because the state can't afford to pay."

Not knowing where to turn, Ellis had Jonathan arrested in June 1998 after a minor altercation. "He didn't really assault me," she says. "He pushed me. And he took my car and left in it." But she pressed charges so Jonathan would get treatment. He was charged with simple assault and unauthorized use of a vehicle.

Unfortunately, the court did not give Jonathan the extensive inpatient treatment he needed. As a result, his condition deteriorated, and he attempted suicide in September of that year.

Things continued to go downhill. When Jonathan took his mom's car again, in June 1999, she turned him in once more, and he was arrested on several probation violations, including failing to keep appointments, curfew violations, positive drug screens, and not doing his community service, according to court testimony from his probation officer, Chris Cagle.

Because Cagle and others explained Jonathan's mental health problems to the judge, Jonathan was court-ordered into twelve months of residential mental health treatment in South Carolina. But the residential facility that the judge recommended, New Hope Treatment Centers, Inc., had chosen "not to pursue Medicaid accreditation in the state of North Carolina," says Jerry L. White, executive vice president and chief clinical officer for the company. This meant that the state funding could not be used for it. So Jonathan was released from state custody in September 1999 with no treatment. He went back home.

Ellis, with the help of the Granville County mental health office, frantically tried to find another placement for her son. But she didn't find one in time. Jonathan went into a manic phase. He was "going up, up, up," says Ellis. "Banging things around the house, very impulsive. I went down to his probation officers. We didn't understand why the probation officers couldn't help us find treatment for Jonathan."

Ellis begged them for help. But she says they pressured her to have him arrested again. "I could not mandate him to take his medicine," Cagle later testified during Jonathan's trial. "I didn't have that authority ... [so I] worked on the violation reports, digging up what nitty gritty I could to use it, if just nothing else, to get him into custody."

Cagle and another probation officer, Earl Hackney, who was armed with a gun, decided to go over to Ellis's house.

"That's when it all broke open," says Ellis. Jonathan started fighting with the officers and was charged with assaulting them. He hit Hackney in the left eye and tried to grab Hackney's gun.

The fact that Ellis had previously had Jonathan arrested became part of the court record. But that record did not say that Ellis did this because she wanted to get care for her son.

"It was used against us," Ellis says. "It didn't help at all, and I only did it because I didn't know what else to do."

Pat Martinez, who lives in Albuquerque, says he could not get adequate mental health services for his son, Jesse, now twenty. Jesse suffers from adult-onset schizophrenia and low intellectual functioning. When Jesse was thirteen, he tried to hang himself. Shortly thereafter, on the advice of a police officer, Martinez had Jesse arrested.

According to Martinez, the officer said: "I understand you're trying to get services for your son. Next time you have a problem, you call us. We have some connections. We'll get him services."

One day, when Martinez was out running errands, Jesse got in a scuffle with his younger brother. The fight, says Martinez, was not serious. Jesse's sister separated them and called the police, which her dad had told her to do if there was any trouble. Jesse ended up in court on several charges, including battery.

Martinez says Nancy Neary, assistant district attorney for the juvenile division of New Mexico, suggested that Jesse should plead guilty. "Nancy Neary told me that unless I plea-bargained to one of the charges, my son wasn't going to get any mental health services. For us to get mental health services, he was being forced to plead guilty to something he hadn't done," he says.

Neary disputes Martinez's statement. "I'm not sure that I ever said such a thing to Mr. Martinez. I never gave him any advice at all," she says. "He was tremendously frustrated because he knew his son was mentally ill and needed treatment. I may have told him that if he were placed on probation, we could have made counseling and treatment a condition of probation."

Neary says that in her line of work, she "regularly" comes across parents who have their children arrested in an effort to obtain mental health care. Parents who do not have private insurance, she says, must go through the state's managed care system. In New Mexico, she says, "there are very few treatment beds for children" with mental health problems. The resulting flow of kids into court, she says, creates a "frustration for everyone in the juvenile justice system."

In the past two years, one-third of the child psychiatrists "have left their New Mexico practices" as the result of the state's managed care policy, reported the Albuquerque Journal on September 5. The exodus left only forty-six, "a number that is half the national average" per capita.

"Parents who deliberately invoke the juvenile justice system in order to try to get mental health treatment for their kids," says Neary, are probably "operating under a misapprehension. Because there isn't much."

Jesse Martinez did not go to jail on this occasion. "The judge found him incompetent to either enter a plea or stand trial," says Neary. However, he was held in the Bernalillo County Juvenile Detention Center for approximately eight months from 1999 to 2000 on a probation violation for taking drugs.

Pat Martinez says that, while in the detention home, Jesse received medicine but did not receive mental health counseling, even though his illness was worsening. "Heck, no," he says. For two months, "they had him in solitary."

"It sucked," says Jesse. "It was just a little, small, tiny room. I stayed in my room for like sixty-two days. They said they had the right to do that, but I don't think they do. They keep me in my room until everyone goes to sleep. Then they let me out to take my shower. When I asked to get a counselor, they wouldn't get a counselor."

April Land, an assistant professor of law at University of New Mexico, says that she was concerned that Jesse was being kept in his room so much. She says she asked the juvenile facility and "was informed, upon complaint, that he was being released one hour a day from confinement."

Other residents were allowed to participate in activities and attend classes. But not Jesse. Land says that Jesse spent so much of his time in lockdown partly because he had trouble following orders. For instance, says Land, Jesse had trouble with commands to line up in odd and even. When he didn't obey, she says, he was punished. Jesse also escaped from his cell on occasion and had fights with the staff.

"I'm not saying he was faultless," says Land. "They didn't have the skill or facilities to address the degree of mental illness combined with the other mental challenges Jesse faces."

Bernalillo County Juvenile Detention Center Director Tom Swisstack says that he cannot discuss Jesse's specific allegations because he was a juvenile while at the facility. But he says that his facility has contracts with psychiatrists, and he denies that extended lockdowns happen there. "All I can tell you is we don't keep kids in their rooms for twenty-three hours a day" for extended periods, he says. "Seventy-two hours is generally it."

On October 3, 2000, Mike Hatch, Minnesota's attorney general, filed a lawsuit against Blue Cross Blue Shield of Minnesota. The suit alleged that the company was "engaging in a `pattern of misconduct' in denying medically necessary health care treatment recommended by physicians for Minnesota children and young adults suffering from mental illness, eating disorders, and chemical dependency." The insurance company, said the attorney general, "routinely attempts to sidestep its coverage obligations by inappropriately shifting the cost of caring for such children to taxpayers and/or families, including instructing parents to have their children suffer `legal consequences' or to make `use of the juvenile justice system.'"

The insurance company was blatant, Hatch tells me. The company would say, "Take him to juvenile court. Have him arrested," says Hatch. Or it would tell parents that their child has "conduct disorder," which, says Hatch, is "a euphemism for saying, `The kid is criminal.'"

One young woman whose family is a plaintiff in the suit was "a chronic runaway" and had been diagnosed with major depression, among other illnesses, according to a filing by the attorney general. A psychologist determined that she was "a threat to her own safety and that she needed in-patient treatment at a residential facility." But the insurance company refused treatment, stating that she "should be treated through the `juvenile justice system,' "says an affidavit from the girl's father. "This was incredibly difficult for us, because the juvenile justice system was exactly what my wife and I were trying to avoid by seeking appropriate mental health treatment."

The girl's therapist wrote a letter to Blue Cross Blue Shield of Minnesota, urging the company to provide her with treatment. "I strongly believe that she will be dead before there will be sufficient criminal charges to warrant treatment through the criminal justice system," says the letter.

Blue Cross Blue Shield of Minnesota allegedly continued to refuse to cover residential treatment. Luckily, the young woman's family inherited $70,000 when her grandfather died. They spent the entire inheritance on her mental health care.

"Over the last six years, 3,000 Minnesota kids who were covered at Blue Cross Blue Shield" had to go either to juvenile justice or into foster care to get treatment, says Hatch. The complaint alleges that Blue Cross Blue Shield of Minnesota has cost the state $14 million.

Blue Cross Blue Shield of Minnesota says that, because of privacy laws, it cannot comment on specific affidavits filed in the case, which is still in .the discovery phase. But Karl Oestreich, corporate spokesperson for the company, says that in instances where a child is diagnosed as mentally ill but is also truant, drinking, or using drugs, it may be appropriate to bring in the juvenile justice system. "There are a lot of parties that need to get involved," he says. "It's not just the health plans." He insists, "We believe we paid for our fair share of treatment."

Wellstone faults insurance companies for scrimping on care. "It is cruel and inhuman that insurance companies choose to cut costs at the expense of children who suffer from this serious, often life-threatening illness," he says. "Children, who should be receiving care through their family's health insurance coverage, are instead locked up in brutal prisons, as the family frantically seeks the care they need."

Anne-Marie Cusac is Managing Editor of The Progressive.