Nowhere Else to Go

How the state is using its detention home as a warehouse for mentally ill kids.

A glimpse inside the Juvenile Detention Center. photo: Jimmy Forrest

It’s Monday morning, 8:15 a.m., at the Juvenile Detention Center in the Ala Moana area. Outside the judge’s detention hearing room, the 20 faded maroon plastic chairs are already full, taken by kids brought in the night before and their guardians—fed-up foster parents, tired grandfathers and tearful mothers who don’t always want to bring the kids back home.

In the hearing room, a Family Court judge decides which children get to leave the detention home—DH, as it’s better known—and which have to stay for the two weeks until their trials. Few kids are there for violent crimes, such as murder, rape or robbery. Some are in for things like car theft or drug possession, but most are what the system calls status offenders—kids who’ve run away, cut class or given their parents some other good reason to call the cops on them.

But there’s something wrong with this line of waiting children. Some of them shouldn’t be there at all.

The detention center is basically a kiddie jail, where judges are only supposed to keep kids considered dangerous to the community or flight risks before trial. But mentally ill kids who don’t fit either of these profiles have been locked up at DH—and ended up staying there longer than other jailed juveniles—primarily because there is nowhere else to put them.

The severity of the problem came to light this past May, when Senior Family Court Judge Frances Wong released 22 kids from detention who she says didn’t belong there. Most of them were status offenders who had already stood trial or faced minor charges, like probation violations, which usually aren’t enough to warrant detention. These weren’t violent kids; they weren’t considered dangerous to the community.

What worried Wong the most was that many of them were mentally ill, diagnosed with such emotional and behavioral disorders as depression, attention disorders, bipolar disorder and schizophrenia—kids that DH staff, whose main focus is safety, aren’t trained to help.

“We don’t pretend to be a treatment center; this is a detention home,” she says. “We do not have medical staff here 24/7, much less mental health staff. We’re holding these children, and they’re not being helped by being where they are.”

The detention hall has 40 beds, but judges and staff worry when the population creeps above 30. Kids grow more territorial in crowded spaces, they say, and more likely to take their frustrations out on whatever or whomever happens to be around at the time.

Earlier this year, the DH’s nightly census rose to 50, forcing some kids to sleep on mattresses placed on linoleum floors. Wong, who diligently visits DH every morning before heading to her office, demanded to know why, but no one had a good answer.

“With all the kids who were coming in, I just felt somebody should take an overview right then, because we had too many kids for months in a row,” Wong says. After studying each of the 50 kids’ case files, each at least two inches thick, she found that about half of them didn’t belong in detention.

This is a problem Wong saw coming a long time ago. Up until the early ’90s, there was a specific place for many of the mentally ill kids in the juvenile justice system—the Hawai‘i State Hospital in K-ane‘ohe, which once had a child and adolescent unit. The state shut down the unit soon after the U.S. Justice Department sued the state over conditions at the hospital. The kids were transferred to private programs, including one at Castle Medical Center, which eventually closed as well. The state hasn’t come up with a good replacement, and it’s had more than a decade to do so.

“When we heard [the Hawai‘i State Hospital’s adolescent unit] was going to be closed, we said, ‘Please don’t do that. You’re always going to have children who need to be housed somewhere before whatever the next step is,’” Wong says. “I understand the rationale that some kids were there inappropriately. On the other hand, after that, there was no other safety net. Over the years, we’ve found these kids have ended up at the detention home.”

No one knows how often this happens. Family Court doesn’t track how many mentally ill kids have wound up in detention—or stayed too long there—just because there was no good place to put them. It doesn’t track how many of the kids who come through its courtrooms have mental health problems, either, although it’s estimated nationally that about 75 percent to 80 percent of kids in the juvenile justice system suffer from at least one mental disorder.

The only reason these 22 kids were released in May was because someone took the time to review all of their cases.

ONE OF THE MAIN reasons nonviolent, mentally ill kids wind up at DH is because they’ve run away too many times from other places. There are at least seven different types of residential treatment programs to which the state can send juvenile offenders with mental health problems, depending on how closely they need to be watched and how restrictive an environment they need— therapeutic foster homes with specially trained foster parents, group homes and more intensive, community-based residential programs. The state even sends five mentally ill children to a Mainland treatment center each year.

But unlike the detention center in the Ala Moana neighborhood, none of these facilities is secure. A kid can walk out of any of these programs at any time, and many do. From October to December of last year alone, there were 127 reports of runaways from these treatment programs, many of whom were juvenile offenders, according to the state Department of Health’s Child and Adolescent Mental Health Division.

What often happens is that the detention home becomes the fallback for a system that’s already exhausted all of its options.

“It’s just that we don’t have an appropriate place for them to be—either their home is not appropriate for whatever reasons or the child needs this kind of therapy, and we can’t get him or her in right now,” Wong says. “For many of those kids, it was, ‘Oh, this kid already ran away from home,’ or ‘This kid ran away from placement.’ These are the kinds of kids that we find ourselves facing chronically, and, as a community, we have to figure out a better way to do it.”

ANOTHER REASON adults take too long to find a good place for the kids is because there are so many of them working with each child. There are at least four state agencies that could potentially work with a juvenile offender. In addition to Family Court and the Department of Health, there’s the Department of Human Services’ Child Welfare Services, which is responsible for kids in foster care, and the Department of Education, which has become involved with many more mentally ill children since Felix v. Cayetano—the landmark 1993 case that changed the way public schools handle special-education students.

The sleeping areas of the detention home are empty by day, when kids attend classes elsewhere in the facility. They don’t have many belongings, either—they are only allowed two changes of clothing. photo: Jimmy Forrest

These agencies are supposed to provide mentally ill kids in the justice system with what they call “a systemwide network of care.” Instead, they’ve created a bureaucracy in which children get lost.

“The problem is many of those lines are blurred,” Wong says. “If a kid who comes from a dysfunctional family, where violence has occurred, doesn’t do well in school and is more prone to hang out with a crowd that decides to steal a car, it’s like, well, where do we start? How do we treat them? We get a lot of kids like that.”

Some examples of how complicated the system can get:

As soon as a juvenile is tried, judges want to transfer the child out of DH and into a longer-term residential program immediately, but Department of Health workers can’t work that fast.

“Placement means ‘I need a bed tonight,’” says Christina Donkervoet, administrator of the Department of Health’s Child and Adolescent Mental Health Division. “We don’t do beds ‘tonight.’ From a mental health treatment perspective, we need to focus on what’s clinically necessary for that given child. We do therapeutic placement, and it takes time to decide what’s clinically appropriate for a child.”

Sometimes, it’s judges that slow down the process, Donkervoet says. That happens in cases where a judge orders a child to a particular residential program he feels is best, even if that program already has a waiting list, while others have openings.

One of the more recent kinks in the placement process requires the court to work with a juvenile offender’s school in order to access state mental health services, just one of the changes wrought by the Felix case.

“That seems counterintuitive to us, if every layperson in the courtroom knows this kid needs mental health treatment,” Wong says. “One effect of Felix is that we have this added layer of bureaucracy in getting kids appropriate services.”

HAWAII’S JUVENILE DEtention Center is no place for sick kids. The detention hall sits on two acres surrounded by low-rise apartment buildings on Alder Street—just across South King Street from the old Wisteria restaurant. The state built the facility in 1944, and its 60 years—with little renovation or modernization—shows.

Hairline cracks climb the base of the 15-foot-high concrete wall that surrounds the facility. Chunks of plaster are missing from the faded, sea-green colored walls. Plastic chairs and Formica tables look like decades-old hand-me-downs from local public schools. Everything is cramped—from the two classrooms where DOE teachers give mandatory lessons to the dispensary that can hold little more than the nurse’s desk.

Coed volleyball games on the open-air asphalt courtyard within the facility are the only times boys and girls are allowed in the same part of the facility. At night, kids return to their cells, locked in by staffers and constantly monitored by cameras placed in nearly every room.

Aside from one social worker from the state Department of Health’s Child and Adolescent Mental Health Division, there are no mental health experts employed full-time at DH. The only job requirements for staffers who watch these kids around the clock are a high school diploma and “some work experience with children,” says chief court administrator Bill Santos. The women who watch the girls look like lovable aunties; the men who watch the boys look like nightclub bouncers.

The ones who’ve been here long enough will tell you there are more mentally ill kids under their watch today than there were 10 years ago.

“It’s gotten worse, it’s really gotten worse—just the anger, the aggression,” says juvenile detention worker Chuck Rogers.

He points to a glass window, which separates a security room from a community room. It’s just been replaced for the third time in recent memory. The window’s near the communal telephone, making it a common target for kids pissed off by parents who’ve just told them they don’t want them back home. Or maybe they’ve just hung up with their boyfriend or girlfriend, who wants to call it quits because they’ve been apart for too long. One girl recently managed to break a Plexiglass-protected security camera stationed about eight feet above her bed.

Children take their anger out on people, too. Workers are used to breaking up fights; some have taken a few licks of their own.

In recent years, staffers have had to work harder to make sure kids don’t hurt themselves. Staffers have always taken extra precautions, right down to counting every single piece of silverware after each meal. Sometimes it doesn’t help. Girls have been known to use their own fingernails to slice the insides of their arms.

Kids in DH these days are better at finding ways to hurt themselves, making staffers’ jobs tougher and more unpredictable than ever. In June, Family Court enlisted the help of the National Juvenile Detention Association to train workers in suicide prevention and response. Workers have learned techniques to identify troubled kids—they’re not always the ones who yell and pick fights—and how to handle suicide attempts, including the most effective way to free a kid who’s just tried to hang himself.

Most suicide attempters are rushed to The Queen’s Medical Center, where they stay until the “acute crisis has been stabilized,” says Donkervoet.

“But Queen’s only deals with the crisis part of it,” Wong says. “After the child looks like he or she has calmed down, they discharge her and she’s back at DH. And it’s like, Now what do we do? The underlying problem is still there and not by any stretch of the imagination can you tell me that the child is now stabilized.”

Hawai‘i isn’t the only state struggling with mentally ill kids inappropriately placed in juvenile detention centers. A 2004 congressional study found that, over a six-month period, nearly 15,000 kids in juvenile detention centers across the country waited for community mental health services. Two-thirds of the nearly 500 detention centers surveyed acted as way stations for children with nowhere else to go.

The state judiciary doesn’t track the number of mentally ill kids who come through its courtrooms, but “my gut tells me we mirror a lot of those statistics,” Wong says.

In 2005, the state Legislature approved $95 million for the judiciary to build a 70,000-square-foot juvenile detention center in Kapolei and a new Family Court complex. The new center should replace the ramshackle existing Ala Moana facility by 2010, but it will still be a detention facility, not a treatment center for mentally ill kids.

“For some of the kids at DH who were there for not days, but weeks, waiting for placement—you and I as consumers would not stand for that,” Wong says. “We wouldn’t say, ‘Oh yeah, we’re bleeding right now, but we’ll wait to see the doctor in three weeks.’ We’d say, ‘Wait a minute, I’m bleeding right now.’”

There needs to be another secure temporary residence for mentally ill kids who aren’t considered dangerous to the community, until they get longer-term placement, Wong says.

What happens to mentally ill kids who don’t get the treatment they need soon enough? They become mentally ill adults. About 16 percent of inmates in Hawai‘i’s prison system have mental health issues; nationally, one-third of all homeless people are estimated to have mental health issues.

“When kids hit adolescence, they’re still salvageable, if they’re exposed to other alternatives,” says Gerry Wong, a social worker with the Family Court’s Volunteer Guardian Ad Litem program. “But by the time the state goes through its little routine, the kid is 18 years old and ages out of the system. So what good did the state do that kid? No good.”