Young Marylanders with serious mental health issues are being “inappropriately” sent to detention facilities that struggle to help them, according to the state's Juvenile Justice Monitoring Unit.
Such environments, including the Baltimore City Juvenile Justice Center, may be making things worse for young people, the monitoring unit said in a recent report.
“Maryland's juvenile justice system cannot become the default component of the state's mental health care system,” the report states. “Maryland's government and its agencies must comprehensively and permanently address the current severe shortage of inpatient psychiatric facilities and ensure the provision of comprehensive community-based mental health services for youth.”
A similar problem exists for adults in Maryland: The state is running out of adult psychiatric beds, leading to a growing number of defendants waiting to be admitted, The Baltimore Sun reported in July. As a result, people with serious mental illnesses accused of crimes but deemed too healthy to commit them are languishing in the state's prisons.
Maryland's prison population is growing, as are all of the state's jails. The state-run Baltimore City Juvenile Justice Center is averaging 98 inmates per day in the first quarter of 2024, up from 63 in the same period in 2023 and 58 in 2022.
At the same time, there was an increase in incidents of assault, fights, and smuggling by young people within the facilities.
The report by the Juvenile Justice Monitoring Unit, part of the Maryland Attorney General's Office, did not provide a specific number of youth who would be better served by mental health resources than in jail. The report said youth who need specialized mental health services are placed through the courts or the Department of Justice in “safe detention center environments where their condition often worsens.”
The Monitoring Unit is responsible for investigating the needs of children under the supervision of the Department of Juvenile Services and reporting quarterly on how young people are being treated in the facility. Monitors have access to the Department of Juvenile Services' internal records, can conduct unannounced visits, and interview young people, staff, and administrators.
The Department of Juvenile Services referred requests for comment to a response in the Juvenile Justice Monitoring Unit's July report, in which the department did not directly respond to the monitoring unit's findings but provided a broader update, including on mental health services.
The Department of Juvenile Services said it has qualified clinicians available at each residential facility, and contracted providers work with schools to provide services such as cognitive behavioral therapy, psychiatric and substance management at detention facilities.
The Department of Juvenile Services added that in two “holding placement units” at the city's jail facility and Cheltenham Youth Detention Center in Prince George's County, the department's clinicians provide treatment time similar to the time youth have available in the program after their cases have been adjudicated — a term that refers to the point in time when a case is concluded in the juvenile system.
The Juvenile Justice Monitoring Unit praised the Detention Holding Unit for reducing the “dead time” young people face in custody while waiting for a place to become available, but it advised that Cheltenham's program may have room for improvement and suggested the department closely monitor the mental health services contracts of its three largest detention centers.
In one case, documented in the recently released report for the first quarter of this year, a young person was “transferred” to a series of detention centres between November and May.
According to the report, over the past few months he had exhibited “self-harming” and destructive behavior, including breaking light fixtures and plastic items to obtain small parts to use in self-harm, and destroying furniture including phones, televisions and computers.
While he was being held at the Baltimore City Juvenile Justice Center, he had to be separated from his classmates, who had “threatened to retaliate” after he damaged phones and televisions in the facility.
The watchdog unit said the Department of Juvenile Services' mental health contractor failed to recommend outside evaluation or treatment and failed to provide effective services to the young man despite his “significant trauma-related needs.”
He was then transported to Baltimore County's Charles H. Hickey Jr. School, another state-run detention center, where he was held alone in a back area of the housing unit.
The report said he and other “vulnerable” youth often decompensate in maximum security facilities — a medical term for the loss of normal function or worsening of symptoms.
A second young man being held at Hickey Prison had a violent incident earlier this year when he tried to assault a teacher who made inappropriate comments about his late mother. The young man said his medication was not working and he was experiencing “bouts of hyperactivity and severe depression”.
The report said that at least some of the reasons young people decompensate in custody is because correctional staff are ill-equipped to treat their behavioral and psychological needs. To gain compliance, staff use verbal commands, restraints, seclusion and isolation — practices that “are likely to exacerbate youths' psychological problems,” the report said.
“The objective should be to recognise and address the problem,” the report said.
Melissa Gorman, senior policy counsel for the National Juvenile Justice Network, an advocacy group, said the environment in juvenile detention centers can be a “significant source” of trauma and stress for young people, who are cut off from their families and other support systems, have uncertain visitation rights, face harsh treatment and often lack access to proper diagnosis and treatment.
“The best way to reduce the number of young people with mental health issues in the juvenile justice system is to prevent them from ever entering the justice system,” Gorman said.
She recommended creating a mobile health response system for youth separate from law enforcement, increasing the number of mental health providers in schools and creating additional processes for law enforcement to direct youth with mental health issues to community-based resources.
The report also decried the lack of community-based or residential mental health facilities available across the state. Without enough facilities, it said, young people in need of mental health care “are trapped in the juvenile justice system” and “are subject to repeated rotations” between facilities.
Joseph Livesam, director of child welfare and juvenile justice policy at the Annie E. Casey Foundation, said the problem is occurring across the country, where children's behavioral health care is “discontinued” after outpatient and medication-based treatment, leaving them with few alternatives before being hospitalized.
Rather than incarceration, treatment could include comprehensive support, in-home treatment resources, peer connections for children and parents, and transportation for response and stabilization, Livesam said.
“The act of removing a child from their home, from their space, from their community is actually exacerbating the underlying trauma,” he said. “Even if you're trying to do the right thing by bringing in clinical services to address other mental health issues, that young person is very likely too disoriented to accept the treatment that's being offered.”
