New York State is moving forward with plans to open its first psychiatric residence for kids with mental illness in the juvenile justice system. The planned facility, which will take over the site of a soon-to-close Brooklyn psychiatric hospital, is part of a large-scale reform effort to keep kids close to their homes and in community-like settings. But the state's first job, according to the director of the organization recently chosen to run the facility, is to overhaul the building so it doesn't feel like a prison. The building sits on a campus filling several blocks of Bergen Street in Brownsville. It's a sprawling, two story, L-shaped structure enclosed by a high iron fence with a sliding electric gate overseen by a guard booth. "They're acting like this is either a medium security prison or a target of terrorism," says Michael Pawel, who runs the August Aichhorn Center for Adolescents. "It's the antithesis of a community facility."
The state's Office of Mental Health Services (OMH) expects the new residential treatment facility (RTF) to be up and running by the end of the year, housing city teens who would otherwise be sent upstate to juvenile lockups. Though the residence will house only 24 young people, its opening reflects a critical shift in how the state aims to treat and house children with mental illness who wind up in the juvenile justice system.
Some 50 percent of young people in juvenile correctional facilities have been diagnosed with a mental illness, according to the Office of Children and Family Services (OCFS), which runs the New York State juvenile justice system. Advocates place that percentage even higher. The state has a long history of providing inadequate psychiatric care to these young people. A 2009 Department of Federal Justice investigation of four state juvenile justice facilities found that cases of children with mental illness were mishandled; young people were given powerful psychotropic medications without proper monitoring; and staff at the facilities used excessive force and restraints. Shortly after the investigation, the Department of Justice threatened to take control of four state juvenile facilities unless, among other requirements, children needing more services than the facilities could provide were transferred to more appropriate settings.
But appropriate settings for court-involved youth with mental illness have been hard to find. While some adolescents are sent to residential treatment centers funded through the city's foster care system, they rarely have the level of clinical supervision required for court-involved young people with mental illness.
State-licensed residential treatment facilities, which are funded by OMH, typically have lower staff-to-child ratios and richer clinical services than the residential treatment centers. However, they are also infamously difficult to be admitted to.Only one in New York City accepts children who are violent: Michael Pawel's Aichhorn Center.
It's one of the reasons OMH and OCFS selected Aichhorn over much larger social service agencies to run the new RTF. "This new program will really be able to manage some of the behavioral disruptions that the other RTFs aren't equipped to do," says Susan Thaler, director of children's services at OMH's New York City field office. "There is some expectation that these kids have histories of violence and running away and haven't been able to manage or receive treatment in other kinds of settings."
Thaler says the new program's Brooklyn location will make it easy for teens to visit with their families and will allow for a more natural transition when it's time to return home.
Pawel's plans for the residence, which he presented to OMH this month, are modeled after Aichhorn's adolescent psychiatric facility in Harlem, which currently houses some juvenile offenders. He proposed to break down the tall fence surrounding the building and add an entrance to the street to connect it to the neighborhood. On the inside, he wants to add carpeting and comfortable living room spaces and ditch the locks on the outside of bedrooms as well as the building's electronic "panic system," which staff at the psychiatric hospital now use to alert help with the touch of a button.
The building's living space will be divided into apartment-like units each housing a co-ed group of 8 young people."Having units co-ed is very unique and normalizing and helpful," says Pawel. "People tend to be calmer in co-ed groups."
Each unit will share meals in their own kitchenettes, family-style. And just like at the Harlem residence, mental health services will be folded into most every aspect of the young residents' lives, both while they're living in their units and in school. The site will have the equivalent of one full-time psychiatrist, three unit leaders, and two other therapists.
Pawel believes the program's most important challenge will be getting away from the idea that "might makes right."
"My understanding is that particularly mentally ill youngsters in OCFS facilities are being managed primarily by a lot of physical force," he says. "If you can get a group like this which is a very unhappy, very angry, very violent group and more or less eliminate the incidence of violence while they're being supervised, that's very good and I think that's going to be clear very quickly. And I think we can pull it off."
One internal Aichhorn study compared the outcomes of young people admitted to the organization's Harlem program with other teens who met the same admission criteria but were rejected because beds were not available. Using state court data, the study found that 39 percent of Aichhorn's alumni were subsequently arrested, compared to 60 percent of the group that was not admitted to the program.
Pawel hopes he can produce similar or better results at the new residence. Advocates are optimistic too, but say the new program should be only the beginning. "For far too long, the juvenile justice system has been used to warehouse children with mental illness; an approach that fails both children and the public," Gabrielle Prisco, director of the juvenile justice project at the Correctional Association of New York, said in a written statement. "We hope that this is only one part of a larger transformation from a punitive juvenile justice system to one that meaningfully serves the needs of children, builds upon their strengths, and maintains their connections to their families and communities."
Photo: Sandeep Prasada