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Juvenile lockups ill-equipped to care for young people considering suicide

Sunday, December 09, 2001

By Steve Twedt, Post-Gazette Staff Writer

Ellis Fallen battled psychosis for months before he killed himself at age 15.

It's A Crime

When mentally ill teens commit suicide in jail

Teens in Pennsylvania lockups undergo mental health screen

Treating suicidal teens where they're likely to be


Tabatha Brendle, also 15 when she died, first attempted suicide when she was 5.

David Ryther, 14, tried to end his life at least three times before completing that last desperate act by hanging himself with his bedsheet.

These young deaths are all the more tragic because they occurred in detention or at state-run correctional facilities, where the teens were serving time for such crimes as riding in a stolen car, hitting a group home staff member, or breaking and entering.

As part of its ongoing investigation of mentally ill youths who get trapped in the juvenile justice system, the Post-Gazette reviewed more than 25 teen suicides that have taken place in juvenile lockups around the nation since 1995. The cases are just a fraction of the more than 100 teen suicides that have occurred in custody during that period, according to the work of one national researcher.

Among the tragic findings:

In many cases, records of previous suicide attempts from earlier placements were not forwarded to the facility where teens ultimately killed themselves, so the staff was not alert to the possible threat.

Several teens killed themselves after being confined to their rooms for rules violations -- possibly the worst punishment for a potentially suicidal youth.

Many teens had been in custody for weeks, if not months, before committing suicide, raising questions about how well officials recognize and prevent teen suicides in their facilities. The finding also disputes the traditional notion that the first 72 hours of incarceration is the highest-risk period for suicide.

The lengthy incarcerations these teens experienced before killing themselves underscore the troubling conclusion of a Post-Gazette investigation published in July -- that teens with serious mental and emotional problems are warehoused in detention for months because no community-based program will take them.

The numbers show those delays may put teens' lives at risk.

Many warning signs

Rather than being an unexpected act taken at a desperate moment, juvenile suicides in custody often occur after a series of signs and warnings, including diagnoses of serious mental illness or long histories of suicide attempts.

And they happen in a setting with one mission above all others -- keeping its residents safe and secure.

The series

Link to the introductory series that launched the Pittsburgh Post-Gazette's continuing examination of the fate of mentally ill youngsters caught up in the nation's juvenile justice system.



"Any time you have a suicide in your facility, that's a failure," said Lindsay Hayes, a Massachusetts researcher who has been documenting juvenile suicides that occur in custody for the U.S. Department of Justice's Office of Juvenile Justice and Delinquency Prevention.

"I think everyone would agree that zero tolerance to an issue like this is something we should strive for."

Hayes, project director for the National Center on Institutions and Alternatives, has documented 108 juvenile suicides in custody between 1995 and 1999, and has obtained detailed information on 79 of those deaths. That research will be published next year.

He, too, found many of the teens had been in custody for long periods. Only about 1 in 5 suicides, he said, occurred in the first three days, and some youths had been locked up for more than a year. About half had been confined to their rooms when they decided to end their lives.

"You are dealing with 14- to 15-year-olds who are very impulsive and don't know how to articulate how they feel. So they engage in this behavior as a reaction to their room confinement," Hayes said. He believes the findings may prompt centers to improve monitoring of teens confined to their rooms, or to reconsider "our whole thinking as to whether this is sound practice, to be giving kids time out even for short periods."

To commit suicide in a juvenile facility requires serious effort. Without access to guns or other weapons, teens in custody almost always resort to hanging themselves -- with sheets, with socks, with shoelaces, with curtain cords and, in at least one case, with an elastic waistband torn from underwear.

Peter Chapman, president of the Juvenile Detention Centers Association of Pennsylvania and director of Westmoreland County's detention center, said the suicides around the nation are occurring partly because there is no good place for these youths to go.

When mentally ill teens break the law, he said, often "parents don't want them at home because they're out of control, and the mental health system ... has closed up its state [institution] beds. So, when a police officer shows up, they're calling the probation office and they only have access to shelter and detention."

The 'corrections mindset'

Much of the available public information about juvenile suicides occurring in custody comes from civil lawsuits. Predictably, each suit blames the facility for some form of negligence, such as lax supervision, understaffing or overcrowding.

Looking at the cases together, however, suggests that many juvenile corrections facilities are ill-equipped to deal with severely mentally ill and emotionally disturbed teens. They don't have the money or staff or time to operate like mental health clinics.

Those problems are compounded when staff members look at suicidal teens with suspicion rather than compassion.

When one Ohio teen with a history of running away tried to hang himself, a judge ordered a guard to stay in his hospital room to prevent an escape -- even after the youth was declared brain-dead.

This punishment-vs.-treatment conflict came to the forefront when a Connecticut panel looked into Tabatha Brendle's suicide in 1998.

Before she got into legal trouble, Tabatha had survived multiple sexual assaults, abandonment by her mother, and placement in a series of foster homes and shelters. She was labeled delinquent for running away. She eventually was sent to Connecticut's only correctional facility for juveniles in April 1998. Five months later, she hanged herself, just days after being told she was about to be sent to another program in Pennsylvania.

In those 15 years, the panel said, "Tabatha moved from one end of a continuum where she once had been regarded as a deserving victim to the opposite end where she was viewed as an undeserving delinquent."

Hayes, for one, believes similar tragedies play out more often than people know.

Official denials

Despite Hayes' promise of anonymity for the centers, nearly 30 percent of the juvenile facilities he surveyed would not respond to questions about deaths, and others provided "pretty bizarre" answers, he said. As a result, his expected one-year study has taken more than two years to complete.

In some cases, centers are denying that the suicide occurred, even when Hayes had documentation that it did. In one instance, "a youth lapsed into a coma" following a suicide attempt in lockup and transfer to a hospital, "but didn't die for several weeks. So they said, 'Technically, he didn't die here.' "

The Post-Gazette ran into those roadblocks and others. States such as Colorado have stringent laws prohibiting release of any information on juvenile suicides, for example, even when the death occurs in a corrections facility. Also, the deaths are not reported to any central agency, a fact that Hayes finds "unbelievable."

Those who study mental illness and criminal justice are not surprised that so many suicides occur, though.

"Thirty years ago, a 16-year-old who was disturbed and often in the early stages of schizophrenia or bipolar disorder would have gone into the psychiatric care system, the juvenile ward of a university hospital or the adolescent ward of the state hospital," said Dr. E. Fuller Torrey, whose book "Out of the Shadows" criticized the nationwide trend of closing mental institutions.

"Now," he said, "you can find more mentally ill juveniles in jail than you can in hospitals."

When states like Pennsylvania closed their state hospital adolescent units, "we lost the capacity to provide appropriate treatment, pharmacologically and otherwise, and to hold these kids long enough to be able to turn them around," Torrey said. Unlike mental hospital patients, Pennsylvania teens 14 and older who are in custody can and do refuse to take their medications.

Ultimately, he said, even the best-managed lockup with the best-trained staff cannot replace structured, long-term psychiatric care in a safe setting. The percentage of jailed teens who commit suicide while confined to their rooms is one stark example of that.

Most facilities, hospitals and corrections centers alike, will respond to someone threatening to kill himself with a suicide watch, where the teen is placed under close observation. If the threat is serious enough, a staff member will be assigned to stay with that youth exclusively.

But in the world of corrections, even past suicide attempts are often not enough to keep staff from punishing a misbehaving teen by confining him to his room, which Torrey said amounts to "the complete opposite" of a suicide watch.

In those cases, he said, "they're making their suicide easy for them."

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