Townsend: 52% in Texas youth prisons suffer mental health problems

It's been frequently observed that adult jails and prisons are becoming society's de facto inpatient mental health facilities because they incarcerate so many offenders with serious mental illnesses. But if official data are to be believed, that may be even more true in the juvenile system. Reporting on a House Corrections Committee hearing yesterday on juvenile justice, AP says ("Mental health issues common among youth prisoners," Mar. 7) that:

More than half of the people in Texas' youth prisons have a moderate or high need for mental health care, and officials should improve their early intervention efforts to help those young people before they end up behind bars, the head of a new state agency told lawmakers Tuesday.

Cherie Townsend, executive director of the Texas Juvenile Justice Department, said more than 52 percent of teens and other youngsters held at the state's six juvenile detention facilities have been diagnosed with at least moderate mental health problems.

Including those with at least some kind of mental health care needs would make that tally much higher, she said.

"The numbers are increasing, and the percentages are increasing," Townsend told members of the Texas House Corrections Committee, referring to the number of juvenile detainees who have mental health problems and their proportion of the state's total youth population at detention facilities.

Not everybody, though, agreed that Texas youth prisons are morphing into insane asylums. One legislator suggested perhaps overdiagnosis played a role:

Rep. Charles Perry suggested authorities might be classifying too many young people as having mental health problems.

"I'm a little nervous about the discussion," said Perry, a Lubbock Republican, "because I know kids that act out that have no mental health issues, and just act out because they act out."

I don't doubt that mentally ill youth disproportionately end up in youth prisons and it wouldn't surprise me if the ratio is greater than in the adult system. But I also agree with Rep. Perry that youth in the juvenile justice system may be diagnosed with mental illnesses too frequently, and sometimes inappropriately, in hope that their behavior issues can be medicated away - or as so-called "chemical restraint." Hell, it's well known that some schools and psychiatrists promote psychoactive drugs at relatively young ages to counter children's behavioral problems, even for non-delinquents. Foster children are also reportedly overmedicated. So it's unsurprising that youth who've worked their way up to outright criminal behavior have racked up enough diagnoses and prescriptions over the years to appear on paper as though they're suffering from a mental illness. In some cases, that's surely true. But particularly with some common diagnoses, often the child's most fundamental problems stem from other issues like, say,  a crappy home life, absent or ineffective parents, poverty, grief, etc..

Recently Grits mentioned the irony that the Texas Youth Commission had prescribed an off-label antipsychotic medication more than 3,000 times during the same period that the AG was suing the company for marketing the drug for use with juveniles without adequate FDA testing. Given such examples and the ubiquity of overmedicating children, I'm not sure it's appropriate to define the number of mentally ill youth by the number receiving some psychoactive drug. Those medication decisions in some instances may tell us more about our society's desire to fix every problem with a pill than they do about the real mental health needs of the majority of Texas youth prison inmates. (Grits can't back that assertion up with data off the top of my head, but that's my sense.)

That said, I also notice Townsend's 52% number is for youth with "at least moderate mental health problems." By contrast, when similar numbers are calculated in the adult system, they only include diagnoses for the three categories of severe mental illness prioritized by the Department of State Health Services - major depression, schizophrenia, and bipolar disorder. So, though 52% sounds like a much larger number than the 1/4 to 1/3 of offenders with mental illness in the adult system, those aren't apples-to-apples comparisons. Perhaps if you included those with "moderate" mental illness in the adult system, the number would rise above 50% as well. Last week the House Criminal Jurisprudence Committee heard testimony that the adult justice system often ignores treatable mental health problems like anxiety disorders that can have as significant a crime-causing effect as the "big three" diagnoses.

What do you think? Are there disproportionately that many more mentally ill inmates in youth prisons than adult ones? Is the statistic misleading because of over-diagnosis and over-prescription? Or are youth inmates being treated at appropriate levels - dealing with "moderate" instead of only "severe" mental illness - and it's the adult system that's underdiagnosed, because the state doesn't document any but the most extreme mental ailments?

Here's the link if you want to watch the 4+ hour hearing for yourself.