Mental health court helping kids

While costly now, it might pay off for taxpayers, too,

The 13-year-old St. Bernard boy was always rambunctious, but no more so than other boys. Then, when kids started teasing him last year, he fought back with his fists. The fights prompted school officials to call his home, his mother said. Then came a notice in the mail ordering the boy to appear in juvenile court on a charge of disorderly conduct. But court officials found that the sixth-grader wasn't a bad kid with a bad temper and a long rap sheet. He was mentally ill. And that was the cause of his outbursts and violence.

So, instead of putting him in a jail cell, the new Hamilton County Juvenile Mental Health Court — one of the first in the nation — let him stay home and sent a team of professionals to him and his family to treat his illness. The boy, diagnosed as bipolar, is the first child to complete the requirements of the court, which started in January. Medication has calmed the boy down, and he even finished out the school year, his mother said.

Mental health courts for adults are popping up across the country. Seven counties in Ohio, including Hamilton and Butler, have them. But similar courts in the juvenile system remain rare. Experts say juvenile court might be the first place officials spot a mentally ill child. That's important, they argue, because detecting and treating mental illness early can prevent children from ending up in prison or a mental hospital — saving taxpayers hundreds of thousands of dollars. The juvenile justice system has become a warehouse for mentally ill children, according to the Coalition for Juvenile Justice in Washington, a federally funded group that studies juvenile justice in an attempt to make it better. It has found that between 50 percent and 75 percent of children in juvenile detention nationwide have a diagnosable mental health disorder.

“Children were ending up in the juvenile system because there was nowhere else for them to go,” said Frank Yux, executive director of Court Services for Hamilton County Juvenile Court. “They would be out of control. And with few resources out there, police would encourage parents and schools to press charges.”

Good for kids, public
Mental health courts such as Hamilton County's are one solution, said Nancy Gannon, deputy executive director of the D.C. group. “You bring resources to the court that will really help turn the child around and provide treatment,” Gannon said. “It's good for the young person and good for public safety.”

Hamilton County Juvenile Court Judge Sylvia Hendon said that, in the last decade, she's seen more and more children who are mentally ill. At the same time, treatment programs and hospital care meant to help those kids are dwindling, she said. “Over the years, I have witnessed the mental health needs of our most troubled youth go largely unmet by the state and local mental health providers, and the cost of private mental health treatment beds escalate,” Hendon said.

A judge can't order a child into a private treatment center.
Most juvenile offenders with mental health needs don't qualify for hospitalization, she said — or need to be treated there. “I vowed that if I did nothing else during my tenure as presiding judge of this court, I would do what I could to improve the delivery of mental health care across the board to the children of Hamilton County who came into my jurisdiction,” Hendon said.

In November juvenile court officials and a group of local mental health workers went to Santa Clara, Calif., to study that county's juvenile mental health court. Santa Clara started the first such court in 1999. Local officials were impressed, but they knew Hamilton County didn't have enough money to replicate the court. So they cobbled together pieces of Santa Clara's courts with a home-based treatment program developed in North Carolina — to fashion Hamilton County's juvenile mental health court, Yux said.

Children diagnosed with major depression or post traumatic stress or who are bipolar — a disorder marked by severe mood swings — are eligible to have their criminal cases transferred to juvenile mental health court. Eventually, the court will also help children with more severe disorders, said Jodi Stanton, who coordinates the court. Currently, 11 children are in the court. They range in age from 11 to 17, Stanton said. Last year, 7,809 children were charged with crimes in Hamilton County Juvenile Court. The mental health court is taking on just a few children this year, but Stanton said she expects the court will expand in the coming years.

Court and mental health officials must recommend a child to the court. An important caveat: Parents must be involved and do what experts deem necessary. “For it to be successful, the whole family must be involved,” Stanton said.

The court brings together several services — including probation officers, psychologists and mental health professionals — to help the child.

“This is intensive in-home treatment,” said Amy Anderson, director of child and family services at Summit Behavioral Healthcare. “We go to the family, see what the family need is. “The kid who got in trouble is the reason why we're there, but we work with the whole family.”

Doing so, though, comes with a hefty price tag.
Officials haven't yet calculated the cost for each child. But Yux estimates that during its first year, the cost will be about $650,000 of the court's $36.8 million annual budget. Extra money will come from the Hamilton County Community Mental Health Board, which has pledged $500,000. If it uses all that money to treat the 12 children currently going through the court, the average cost for each child is almost $100,000.

A watchful eye
A second suicide attempt and a bipolar diagnosis by Cincinnati Children's Hospital Medical Center is what landed the St. Bernard boy in the court in February, his mother said. “When we started, it was overwhelming — there were so many people involved,” she said.

A new probation officer was assigned to his juvenile case. Case workers met with the boy at home and at school. So did a therapist.

“It wasn't in an office, so my son was a lot more comfortable,” the mother said. “It made it much easier. Even the doctor (who gave him) medication came here.”

The court's team still meets with the boy and his mother. At first, the boy and his mother went to court once a week. Other team members, though, went to the family's home almost every day. Over the months, as the boy continued to take his medicine and see counselors, his behavior improved, and the visits from court workers lessened.

“The magistrate was very supportive,” the boy's mother said. “She complimented him all the time. With a kid, no matter what age, it makes you feel good.”

Once, the boy's mom said, her son turned to her and said: “Mom, I like these people. They're very supportive, very good — all of them.”

At his last court hearing, two weeks ago, the blue-eyed, blonde-haired boy — who is big for his age — offered a shy smile when Magistrate Tina Ernst told him that he didn't have to come back to court. Still, his conviction for unruliness will stay on his record, and he will remain on probation at least for the next few weeks. The team that treated him, though, won't let him go just yet. They'll continue to check in with his mother until they are confident he can succeed without their involvement.

It's challenging, Ernest said, “but we're seeing our share of success.Success is more difficult to assess when you're talking about a long-term treatment plan” she said. Hendon said she hopes the boy is the first of many successes: “It is a tangible way for our county to say we care enough about these troubled youngsters to change the way we do business and to the community that we truly want to prevent future delinquency, not just punish it.”

Sharon Coolidge
7 July 2004

home / Previous feature