A Safe Place for Troubled Teens

In 2008, Judith Crane made one of the hardest decisions of her life. She called the police on her teenage daughter Cindy. Doing so meant her daughter would soon be headed for juvenile detention for violating probation.

Cindy had flown into a rage and grabbed her mother by the hair. Medical records from various psychiatric hospitalizations and evaluations describe how she has overturned furniture, broken electrical equipment, thrown knives at her sister and threatened to break her neck, and cut her own wrists. Of the many diagnoses assigned to the teenager, two remain: post-traumatic stress disorder from physical violence she and her family suffered at the hands of her late father, and "mood disorder, not otherwise specified."

"It's one of the hardest things for a parent to go through," Judith recalled, her eyes welling with tears at the memory. "That you want them to go somewhere to get help, that you can't help them anymore. And then the guilt comes in massive waves. I thought I was going to die from it. I couldn't stop crying after she left."

Unexpected Help

On any given day in the United States, more than 120,000 minors throng the cells of juvenile detention and other locked facilities. The majority have at least one diagnosable mental-health disorder, according to a 2002 study of the county's juvenile justice system. And the kids are often in custody because desperate parents like Judith had nowhere else to turn. After they get out of "juvi," they are often warehoused in foster care and group homes without ever getting adequate treatment or support. Many drop out of school and end up in the adult criminal justice system. But now there's help from an unexpected source: mental-health court.

In Alameda County and about fourteen other US counties, attorneys have teamed up with judges, social workers, psychologists, psychiatrists, and families to offer treatment and services to minors with psychiatric problems who've broken the law. The idea is to get teenagers like Cindy out of the penal system and help them lead productive lives. Instead of watching kids get thrown out of school for behavior problems, advocates attempt to create environments that would enable them to stay in school. Rather than cycling through group homes, these kids get help so they can live with their families. Instead of simply handing out referrals for psychiatric help, mental-health court makes sure that teens actually attend their appointments. And rather than simply sentencing kids to jail for violating probation, mental-health court tries to address the problems that caused the violation.

Children's unmet mental-health needs too often cause parents to make choices no parent should have to make. A 2003 report by the General Accounting Office noted that during a one-year period parents placed more than 12,700 children in child welfare or juvenile justice systems seeking mental-health services.

Hope for Judith

Judith Crane was seeking help for Cindy when she made the call that sent her to detention. She had no idea how fortuitous that move would prove to be. Among the more than 2,900 children who pass through the doors of the Alameda County Juvenile Hall of Justice detention center annually, Cindy was one of a handful identified to work with the new court.

She became a client of the court in February 2008 at the age of sixteen. Known as the Alameda County Juvenile Collaborative Court, it serves children who have treatable mental-health problems but who are not considered threats to public safety. Children and their guardians must be willing to have the child live at home, and agree to a plan for sorting out their often enormous constellation of problems.

In exchange, a team that includes the court's judge, probation officers, legal aid advocates, law students, the district attorney, and mental-health counselors help the family chart a path to recovery. The goal? For the family to survive together, and the child to remain in school.

Without some kind of intervention, such youth almost inevitably wind up back in court. According to a study from the National Center on Secondary Education and Transition at the University of Minnesota, "The dropout rate for students with emotional/behavioral disabilities is approximately twice that of general education students." And failure to complete school makes it much more likely that these kids will end up in the criminal justice system. Within three to five years of dropping out, "the cumulative arrest rate for youth with serious emotional disturbance was 73 percent," the report said.

"To put them on probation is setting them up for being in the system long-term," said Matthew Golde, the assistant district attorney for Alameda County Juvenile Justice Division, part of the Collaborative Court team

Each family brings its own history to the table. But all arrived at a breaking point. And most of the plans designed to help them have been shaped and reshaped due to an ever-shifting landscape of family problems, a maze of eligibility requirements, and a new and imperfect understanding of how to identify and treat mental-health problems in children and teens.

Take Cindy Crane — whose name, along with that of her mother, has been changed to protect her privacy. When she was doing well, she helped keep classmates out of trouble, acted as a witness when someone was treated unfairly, and tutored other kids in math. She is philosophical about her unmanaged anger, which has led to behavior that's caused police or a probation officer to show up at her house. "I have anger issues," she explained. "But I get angry for legitimate reasons."

A History of Abuse

From the time she was a young girl, Cindy was abused by a violent father who lashed out at her mother and his children. When Cindy was an infant, Judith tried to soothe her so her crying wouldn't anger her sleeping father, who worked the graveyard shift. On a medical record from when she was hospitalized at age thirteen for slitting her wrists, it notes that abuse by her father had led to calls to Child Protective Services, and that as a small child she had "stepped in between her parents to try and protect her mom." Once Judith left the children's father due to domestic abuse, she had to get three different restraining orders against him over a period of nine years for hurting her children.

So the court set up therapy sessions to help the family communicate. In one session, Judith learned that Cindy becomes enraged when she hears the words, "calm down."

"I learned that the hard way in family therapy when she screamed it at me," Judith said. "I warn others, too, that you can say relax, take a deep breath, but never use the words 'calm down.' We've also learned to respect each other more. I don't like her using God's name in vain. She does periodically and she says, 'I'm sorry.' That's just respecting each other more."

Other teenagers get help

On the last day of 2008, juvenile detention at the Alameda County Juvenile Justice Center in San Leandro was more than half full. Some 255 minor teens had been locked up for breaking the law or violating probation. Some were in between placements in group homes. Some were there because their families could no longer handle them. Girls walked in single file down a long hall, their hands clasped together against their backs. Most looked down.

In Unit 6, the mental-health unit, a boy peered out the window of his cell, his hands pressed against the glass. "It's really quiet right now," one staff member observed. "But if one of the kids goes down, twenty go down. It can be a real roller coaster."

Before the Juvenile Collaborative Court began in January 2007, probation officer Kevin Day had few options for dealing with mentally ill teens, other than putting them into custody. Now he has other ways to get them help. Unlike regular probation, where kids who break the rules often end up in detention, the collaborative court team examines possible causes for the slipups. A tipping point for bad behavior could be an inappropriate school placement that the court members work on correcting. Or perhaps a change in diagnosis. Or different medication.

One teenage girl was hospitalized in November 2008 for trying to strangle herself. In addition to being suicidal, she had been aggressive and at risk for "going AWOL." But with new medication, her behavior improved enough for her to be transferred to a short-term treatment facility before going home again.

One of the program's biggest challenges is getting past the stigma about taking medication in some communities served by the court.

"I know in the African-American and Latino communities, when you ask about medication people kind of steer away from it or view it in a negative way," said Audrey Banks, the Collaborative Court's case manager. "I know just being an African American myself, and connecting with some of the African-American clients and their parents. They seem to be uniformly negative until we sit down and talk about how the medication can calm this child down, help this child function better in school and in the community, and help this child avoid returning back to jail."

But re-entry can be a challenge. A child who goes from jail to a household ravaged by emotional and economic strife is still a child at grave risk, unless there's some kind of safety net.

Providing a Safety Net

That net is what mental-health court tries to provide. For example, shortly after Cindy Crane was released from juvenile hall, her family was evicted from its ranch-style home after their landlord received a foreclosure notice. From the time Cindy was accepted into the mental-health court through the end of the year, Brian Blalock, an attorney with Bay Area Legal Aid who is the court's civil legal services coordinator, negotiated more time for the eviction and for move-out expenses. He also helped Cindy and her sister secure survivor benefits after their father died. And just after Cindy was released from detention, Blalock helped prevent her from losing a good school placement because of confrontations with her school therapist. "I advised the mom what her rights were as a parent to ask for another therapist," Blalock said.

That teens with mental-health problems have trouble in school is hardly surprising. But if they're not able to finish high school, the prospects for family unity become more tenuous. "One of the first things that happens is families get calls from school saying, 'Please come and pick up your child,'" said Darcy Gruttadaro, the director of the National Child and Adolescent Action Center of the National Alliance for the Mentally Ill. "There's disruption in the work day, and also days where kids with serious mental-health needs don't want to go to school. Ultimately, the needs become so serious they realize they can't focus at work because the child needs them. We hear quite frequently that parents lose their job, divorce, families fall apart."

So keeping kids in school is one of the missions of the Collaborative Court. To help keep Cindy on track, Day, the court's probation officer, required her to call him every other day to tell him if she was having any problems at home or in school. Once, when she was late for school and was demanding her mother drive her there, he made it clear that it was Cindy's responsibility to make it to school on time. And yet he's also driven her around to pick up job applications for part-time work.

A lot of what Day does involves reframing teens' behavior in order to keep pushing for better and better results. "Any time there's a problem, I honestly believe it's opening a door for resolution as long as the behavior isn't overly threatening." He says, for example, that rather than telling a kid they're bad — which is what they hear from many authority figures they encounter — he often says something like, "You've made a mistake, we're moving on. Do you think we can show the judge that I made the right decision by not putting you in custody?"

Hard Work

On the walls opposite the courtroom where Collaborative Court is held, a series of images shows models of good behavior replacing bad: A boy is absorbed in reading a book; a girl wearing a mortarboard grasps her diploma; a boy holding a bullhorn to his mouth tells a crowd, "Men of quality respect women's equality."

For children burdened with the challenge of mental-health problems, the model behavior depicted in these murals is harder to achieve, but it does occur. A teenage girl in Commissioner Paul Seeman's courtroom stood as he announced that her probation was over and she had been dismissed from court. The girl broke down in tears of disbelief as the court's probation officer, public defender, and others clapped in praise.

Later, Commissioner Seeman said the girl had displayed repeated behavior problems at home and in school. For years she had cycled through group-home placements, violating probation over and over by getting into fights with other girls. "We were running out of placements for her," he said. "So the court put together a plan that would allow her to live at home with her mom, where she hadn't lived for several years." The court lined up therapy for her and a special school program, and since then there had been no more problems. "She's done great."

But mental-health court is no magic bullet. Cindy Crane has good days and bad days. During one telephone interview, Judith tearfully said that her daughter had just kicked her. In the background, Cindy yelled, "Why don't you tell her the fucking truth?" Judith and her daughter continue to have heated arguments, often over money. Both have called various agencies to intervene when their clashes seemed to be getting out of hand. Still, the fragile net holding the family together is intact. Mental-health court also helped Cindy's mother acknowledge her own depression, which has made it hard for her to find a new job and — at times — cope with Cindy.

But one year after she began Collaborative Court, Cindy also was dismissed, the equivalent of successfully graduating. She graduated from high school in mid-June and made the honor roll. She talked about getting grants to go to college, having an apartment, and finding a part-time job. Cindy attends church with her mom and helps out at a food pantry. Now, when she gets angry, Cindy says, "I'll either talk to [my boyfriend] about it, yell about it, get out of the house and go for a walk, watch TV, or forget about it. Because I know that I'll be out of the house soon."

For his part, Day hopes the program can be expanded. "The vast majority of my kids don't have criminal personalities," he said. "If we extrapolate, I would say it's safe to say that most kids don't have criminal personalities. If we could identify those kids who might respond to a different way of admonishing their negative behavior, I think we would see a significant decrease in the recidivism rate. It's not to say this approach is a panacea, by any stretch of the imagination. But what it can do is reinforce the idea if we make up our minds, we can identify programs that will better service our kids. And they won't be coming back."