INTERNATIONAL CHILD AND YOUTH CARE NETWORK
5 MARCH 2002
Too Many Children, and Not Enough Beds
It's hardly ever done, state Superior Court judges testifying in federal court. But there they were several weeks ago, two veterans of the black robe - Cynthia K. Swienton and Michael A. Mack - trying to adjust to the tight confines of the witness box in U.S. District Court.
The sight of prominent state judges testifying in a Hartford federal courtroom was a remarkable twist in an extraordinary trial. Swienton and Mack were subpoenaed to testify about the current crisis in state mental health care for kids and the difficulties they experienced as judges of the juvenile court.
Martha Stone, the renowned civil rights attorney and one of the state's leading advocates for children, wanted a federal court judge to hear about the frustrations judges endure finding appropriate care for troubled children in a juvenile justice system paralyzed by a shortage of mental health services and beds.
The judges offered a rare firsthand look at what they see from the juvenile court bench. The fear and the trauma in the young children's eyes. The way the children cry and pound the walls when they are told time and again that the care and comfort promised them weeks ago is going to have to be delayed.
Sending a child to detention is not an easy decision for any judge to make. Having to keep a potentially suicidal or deeply depressed child locked in a detention cell because there are no available psychiatric services or beds is the hardest of all, the judges said.
These are children who for the most part had no one else in their lives to help them and who rely on the judges to save them. Swienton and Mack said they tried but even their efforts weren't always enough. Their orders to immediately place a child in a psychiatric hospital have gone ignored for weeks, and sometimes months, because of a shortage of beds.
But that may soon change. On Monday, U.S. District Court Judge Robert N. Chatigny ruled that the state was violating the constitutional rights of children in detention by failing to provide them with timely and appropriate mental health care. Chatigny said it was clear to him that children were suffering from a lack of mental health care and that their conditions deteriorate when they are held for long periods of time in detention.
The judge ordered the state Department of Children and Families, which provides juvenile mental health care in Connecticut, and the judicial branch, which runs the detention centers, to immediately begin drafting a plan to correct the problem. Once the plan is drafted, federal court monitors will ensure it is carried out. How the state will pay for the infusion of services and beds necessary to resolve the problem remains a mystery.
But any option, other than detention, would be amenable to the judges. The following is a transcript of part of Swienton's testimony. Riverview Hospital for Children and Youth in Middletown is operated by DCF. Stone, of the Hartford-based Center for Children's Advocacy, questioned the judges.
Q. Judge Swienton, have you sat in juvenile court?
A. Yes, I have...
Q. Sitting as juvenile court judge in Hartford, what were your responsibilities?
A. My responsibilities were to preside over matters in delinquency court and in the child protection court, handling arraignments, trials, judicial pretrials.
Q. Was that your full-time assignment?
A. Yes, it was.
Q. Sitting as juvenile court judge on the criminal cases specifically, did you have children come before you who were incarcerated in the detention center?
A. Yes, I did. ...
Q. What actions did you take in that regard? ...
A. In some instances if the child was exhibiting mental health issues, then I would order that they have a psychological evaluation. I would also order that they have a psychiatric evaluation.
Q. Where were these evaluations to take place?
A. Some of the evaluations were what we termed court based evaluations. Those were evaluations that were done by psychologists and/or psychiatrists that were hired through judicial.
Q. And were there other evaluations that you also ordered in addition to those?
A. Yes. ...Those evaluations were at what we called our 30-day Riverview evaluation. ... The Riverview evaluations were much more intensive than the court based evaluations.
Q. Could you describe some instances where you have ordered Riverview evaluations?
A. If information was given to me regarding the child's mental health issues and they were of such a severe nature, then it was requested that I order a 30-day evaluation. If there was a high psychotic and/or suicidal behaviors being exhibited, where there was information given to me by the probation department that would indicate that the child was suffering from severe mental illness, then Riverview evaluation would be ordered.
Q. Judge Swienton, what difficulties, if any, did you have in getting compliance with these Riverview orders?
A. Well, the difficulties that I encountered on occasion were that the child, even though a Riverview evaluation was ordered, was not immediately sent to Riverview.
Q. How long would the children wait who had received Riverview orders?
A. Well ... As far as I can recall, it was never something that was done immediately, like the next day. It usually took, as far as I can recall, an average, probably between 30 and 60 days.
Q. As a result, the children - what happened to those children? Where did they stay?
A. They stayed in detention.
Q. Did you take any action to try to get compliance with those orders?
A. Yes, I did.
Q. Could you describe for the Court what actions you took?
A. Well, it kind of was a graduated level of what actions I would take. ... So maybe the first couple times I would inquire of the probation officer that was assigned to that child what the holdup was. I would make inquiries to the judicial liaison that was put into place by judicial to act as a liaison between the probation department and the courts and Riverview Hospital. And I would inquire as to where that child was on the waiting list. And on occasion, I took more severe action.
Q. Can you tell us what that more severe action was?
A. I instructed the detention staff on two separate occasions to procure an ambulance and deliver the child to Riverview.
Q. Do you know in those instances how long the child was waiting to get to Riverview?
A. I don't recall.
Q. Was it over 30 days?
A. Yes. ...
Q. Judge Swienton, I believe you were testifying about particular children that you had issued orders to go to Riverview, is that right?
A. That's correct.
Q. And could you further give us some examples of children that you ordered to go to Riverview? And you're allowed to use the initials of the child.
A. All right. When A.R. first came into the court involvement, he was 10 years old. He was exhibiting severe psychiatric problems. And based on the charges that he was in fact facing, it would have indicated that he was suffering from very severe psychotic issues and problems, mainly based on his history of abuse and neglect as a child. And he stayed in the detention facility for some time. He was also a committed child to the Department of Children & Family and on several occasions he was in fact released from the facility and placed in a shelter. However, that did not work out due to his severe psychiatric problems. ... When A.R. finally came back, he did come back into the detention facility, it was reported to me that he was exhibiting behavior in the detention facility that was becoming unmanageable. And as a result it was requested of me that he be sent to Riverview for an evaluation and/or treatment. It wasn't that the detention facility couldn't deal with him or they couldn't manage him. They could not treat his symptoms. They could not treat his diseases.
Q. And what happened in that regard in that particular case?
A. A period of time passed and it became - I become aware that he had not been sent to Riverview. He had not been placed at Riverview. And so in that case, I ordered that he be immediately transported that day.
Q. Do you recall how long he waited?
A. I believe he waited approximately six weeks.
Q. Did you have any other instances where you had to take serious action to effectuate your orders?
A. I think that was probably my most serious action as it relates to a child waiting in detention for a Riverview evaluation.
And when I took that action, it wasn't something that I took lightly. Because by doing that, what I in fact did was bump other children that were awaiting a Riverview evaluation and/or treatment. So on many occasions what I would do was call the judicial liaison and see where that child was on the waiting list. And sometimes you would - I would tend to be a little more direct and forceful saying "Move that child up on the list. This child is in dire need of psychiatric treatment." But what was happening when I did that was I would be bumping another judge's child.
We became possessive with these beds and with these children. You tried to get what you could for your children. It wasn't like you disregarded everyone else. But I knew that if I took that bed, then maybe another judge in Rockville whose child was waiting for a bed that I didn't have any knowledge about, my child might have taken that bed. ...
Q. What harm was there to children as a result of waiting in detention? ... And as a result of seeing these children come back to you week after week, what were your observations about the impact on these children? ...
A. I saw children that would exhibit acting out behavior in the courtroom, crying. On some occasion[s] more wailing, stomping. These were children that had [unusually] severe psychiatric problems.
Q. And were you made aware of what their behaviors were in detention while they were waiting?
Q. And what were those?
A. More severe acting out behaviors. And the public defenders or the children's attorney - most likely it would be public defenders - would indicate to me that the child was decompensating. And what I took that to mean was that there was more acting out behavior and that the child was requiring supervision.
On many occasions, the detention supervisor would come down and tell me that there was a problem and that the close supervision was becoming more and more difficult to manage. Because if they had a 24/7 watch on the child, because of suicidal behaviors for instance, that was one less detention staff that could be involved in watching the greater population. And that child would have to be placed in a room by himself which would normally be used for two children.
Q. And there were children placed on one-to-one suicide watch while they were waiting to go to Riverview?
Q. How did this problem affect your ability to carry out the best interest of the children which you were entrusted to do as a judge? ...
A. It was extremely frustrating and it had a great impact on my ability to carry out my statutory duty to protect the best interests of the child and to make certain that they were receiving appropriate treatment both mental health and psychiatric, and educational and social needs. Whatever they needed, it impacted on my ability.
Q. Judge Swienton, moving away from the Riverview issue, ... What difficulties, if any, did you have in getting residential placements for the children that came before you with mental health problems?
A. The difficulties were that there weren't enough beds. There wasn't enough residential placements for these children. And some of the children that had behaviors that were out of the ordinary, I should say, what we commonly called fire starters - that was one of the problems we had. If we had a fire starter or a sexual predator, there were no residential facilities that would be able to handle their behaviors, so they would wait.
Q. Were there other categories of children for whom there were difficulties?
A. Yes. Low IQ possibly. Some mental health issues. Some out of control behaviors. Oppositional behaviors. So they really, you know, there was a range of behaviors that would require them to be placed in a residential facility as opposed to something else.
Q. Do you have an example of a child that would fall into this category?
A. Yes. W.B. ... came into juvenile court when he was 15 years old. He came in on a disorderly conduct charge. He came in in July of I believe it was 2000. At that time his mother was unable to provide him with the home because she in fact herself was homeless and went from shelter to shelter. W.B. had delinquencies. He also had sexual acting out behavior and he had very low IQ.
When he came to my attention ... I did issue an order of temporary custody (with DCF) because his mother was failing to come to visit. She didn't come to visit him. I in fact felt that he was homeless at that time. ...
He was actually released for a two-week period. But from July until he was finally placed in a residential placement facility, which was January of the following year, he stayed in detention.
Q. On a disorderly conduct charge?
A. On a disorderly conduct charge. ...
Q. ... How prevalent was this problem that you described of children waiting to get into residential placements for mental health treatment?
A. It was very prevalent. ...
Q. Based upon your detention reviews, what observations did you make about the impact that it (the delay) had on these children? ...
A. ... I observed children to be frustrated. They would cry. You know, they look to me as the judge to place orders. If I told them that they were - if I told this child that he was going to be going to a residential placement and then he would come in the next two weeks and the next two weeks and the next two weeks, they would look to me, they would question me. Sometimes they would write me letters and say, you know, when am I going.
For the most part, these children were not children that had involved parents. And so they would come to court with no parent and just their attorney. And they would appear sad. They would look sad. They would be crying.
March 3, 2002 TRANSCRIPT/COLIN POITRAS
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