Friday, February 8, 2008

Courts, School and Mental Health: Getting the silos to work together is a full time job.

One of my colleagues observed the other day that the bulk of mental health treatment in Massachusetts seems to happen in the schools.  He found it interesting that a system designed for teaching found itself dealing with issues like psychiatric diagnosis and how that affected the child's ability to learn.  A similar change has happened in the juvenile courts (or maybe not such a change- didn't Officer Krupke in "West Side Story" have trouble discerning the difference between psychiatric, psychosocial and motivational cause of juvenile delinquency?).  In any event,  I had another opportunity to observe a juvenile court session last week and it felt like a day in the clinic.
We (meaning my advocacy partner Carolyn Pointer of Health Law Advocates and I ) go to the courts to work with Judge Luis Perez in assuring access to mental health services for the youth who seem to have mental health issues driving their legal difficulties.  In the adult literature, it has been clear for a long time that, since the movement for the deinstitutionalization of mentally ill persons in the 1970s, jails have become de facto "places of last resort" for many folks with mental illness.  Turns out that is true for kids in the system as well.  While I sat down in court last week, the first case brought before the judge was a teen who has been treated for ADHD and depression in the past, who violated parole (I forget the original charge) by getting high on marijuana over Christmas, and we doing an intensive treatment program to avoid going back into lock-up.  Criminal activity or attempt at self-medication?  Which lens do you use?  Next came a mother seeking treatment.  Her son, school aged, is under treatment with a psychiatrist prescribing stimulants and counselor working on anger issues.  A school counselor is suggesting a more thorough evaluation, because, despite treatment, he still lies and steals.  His symptoms are attributed to impulsivity, but are we really sure?  She was hoping that the court clinic could help.  Here's a "serious emotional disturbance" waiting for a team (see previous posts) that is more responsive to the mothers wishes, but it the court really the best place to work this out?  The Judge appointed Caroline to be the GAL and find out.  Then there were a series of care and protection orders, flying by so fast I couldn't hear the details.  The last case of the day was a teenager who was running away from home.  The family spoke only Spanish, and , although Judge Perez could have handled it fine on his own, we waited for the court interpreter to try to figure it all out.  I had to leave, so I never did find out if that was mental illness or social chaos.
The line between mental illness, social deprivation, autistic spectrum disorder and juvenile delinquency seems awfully blurred to me when I sit in the courtroom, as does the line between behavior disorder, learning disability and family dysfunction when I sit in an IEP.  It makes me once again realize the wisdom of the approach of the early intervention teams in early childhood:  perhaps we should stop spending time trying to draw lines in the sand between development, mental health and social problems, and start trying to solve them.

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