Sick Kids

The more services a city has, the fewer sick people are in jail, says Dr. Bill Schnapp, chairman of the Mental Health Needs Council of Houston. "What you've got is a cascading problem and failure of social policy where you've got kids inappropriately or inadequately served. Society is going to pay for these people one way or another," Schnapp says.

The Coalition for Juvenile Justice estimates that 50 to 75 percent of incarcerated kids have a diagnosable mental disorder. Harris County has 4,300 teens on probation but only 16 beds at the psychiatric hospital and about 50 offenders placed in contract services. Dallas County has about 1,900 offenders on probation, but its detention center has only eight psychiatric beds. Two-thirds of the teens arrested committed nonviolent crimes, Reyes says, so theoretically, had these kids received counseling and mental health care, many might not have entered the system.

On February 28, 2001, the House Appropriations Committee adopted the $35 million pilot program Turner authored geared toward improving mental health care for offenders. The plan is to identify kids with mental illness while they're incarcerated and continue care after they leave.

The project is a joint effort of TYC, the Texas Department of Criminal Justice, the Texas Juvenile Probation Commission and local mental health authorities coordinated and funded by the Texas Council on Offenders with Mental Impairments. "The intent is to keep them from progressing in the system," says Dee Kifowit, director of the council. "To keep them from going to prison."

Harris County is getting the lion's share of the funding, receiving $2.5 million. One million is for juvenile programs, the other $1.5 million is for adults. The state's seven largest counties received funding to hire therapists and train four juvenile probation officers to work with 60 mentally ill kids to make sure they see their counselors and take their medication. "There are many that quite honestly deserve the services that we won't ever get to," Bailey says. "But the thought's there." Harris County already has trained two probation officers, but they can't start working because MHMRA hasn't hired the 13 counselors for which it got grant funding. The jobs were posted weeks ago, Schnee says, and the money is in the bank, but qualified candidates haven't surfaced.

Dallas County Metro Care hired therapists before finalizing its proposal and contracts with the coalition. Dallas's first juvenile probation officer trained to work with "special needs" kids began in mid-October, and a second followed two weeks later. "We've started officially without any money," director Griffiths says. "We understand the legislative intent and we are moving forward."

Three years ago the Dallas County Juvenile Probation Center created an eight-bed in-house psychiatric unit with seven Ph.D.'s and six master's-level clinicians doing assessments and outpatient counseling. The department spends about 15 percent of its budget on children with mental illness, Griffiths says. It has contracts with 26 residential treatment centers throughout the state and around the country and 30 contracts with nonresidential treatment programs. Severely psychotic children who are deemed "unmanageable" are sent to the Terrell State Hospital 30 miles east of Dallas, Griffiths says. "Regardless of the charges, if the child needs care, then [the juvenile judges are] going to order them into that facility and hold them in contempt of court if they refuse to admit them," Griffiths says.

It's rare that a Harris County juvenile judge orders an offender into HCPC's acute care unit, Bailey says. A kid who commits a violent crime can't be admitted to the 16-bed subacute psychiatric unit. "If he tricked us or if he got well over there and he wanted to leave, he possibly could because it's not a secure environment," Bailey says. "If they escaped, nobody could feel safe. They stay in detention, they get medicine, they get helmeted, they get constantly watched. We put a big guy in the doorway. They just don't get to have the opportunity to abscond." Two kids escaped from the subacute unit this year. They boosted each other over the wall and went home. They didn't commit any crimes; probation officers found them and took them back to the hospital.

Security measures make it so people who need the most help can't easily get it. A 15-year-old African-American boy was arrested in September. A week later, he sits slumped in a white plastic chair on the fifth floor of the Harris County Juvenile Detention Center, heavily drugged, his empty eyes staring at the white wall. He's schizophrenic, and staffers say he needs more care than he's getting, but because he's charged with murdering his brother, he's deemed too dangerous for the 16-bed unit.

"How are you doing, sir?" asks Diana Quintana, a licensed psychologist who is the department's administrator of mental health services. He looks at her blankly, his eyes half closed. She tells him it's really important to let the doctors know how he's doing on his medication. He doesn't answer.

Three weeks later he stops eating and refuses to take his medicine, and the psychiatric staff say he's steadily deteriorating; a judge orders him into the acute unit at HCPC. "He couldn't stay in detention any longer," Bailey says.