More than half the teens entering Pennsylvania's maximum security lockups for juveniles have significant mental health problems, and about one in six may be suicidal.
Those are the early findings from a systemwide screening process at state youth camps that began in January.
With data collected on more than 500 adolescents, a disturbing but not unexpected trend has emerged, showing that juvenile offenders are often a complicated package of bad behavior and fragile mental health.
During the first seven months of this year:
22 percent of boys said they sometimes heard voices or saw people who weren't there.
16 percent of boys had thoughts of suicide.
37 percent said they'd had recent bouts of depression;
49 percent reported they used drugs or alcohol.
Responses from girls were even more startling: 32 percent had contemplated suicide and 72 percent said they were depressed.
Lead researcher and assistant professor of psychiatry Elizabeth Cauffman of Western Psychiatric Institute and Clinic cautioned, however, that responses were based on responses from 39 girls, a number too small to have statistical significance.
At the same time, she added, the preliminary figures show they "are finding the same thing everyone everywhere else is finding -- the girls have more problems."
The 13 youth development and forestry camps scattered throughout Pennsylvania hold up to 781 teens for an average stay of about nine months.
The camps represent the last stop for juvenile offenders, a placement ordered by a juvenile court judge after a child has failed to improve in less-restrictive settings such as group homes. Some youths are sentence directly to the camps if their crimes are particularly heinous.
Last year, the Pittsburgh Post-Gazette published a four-part series documenting how seriously mentally ill teens with histories of aggression were being warehoused in detention centers and youth camps.
In the mid-1990s, Pennsylvania, following a path many states were taking, closed the adolescent units in its state hospitals, in part to bring the mentally troubled youth back into the community, where they could live in group homes. But the privately run group homes often reject teens with histories of violence or setting fires or running away.
Especially with girls, that can mean court officials are left with two options -- release them or send them to a maximum security facility.
"The program for girls is so limited," said Cauffman, who previously had studied the California Youth Authority while at Stanford University. "That is a state issue that needs to be addressed."
The lack of options for aggressive, mentally ill teens also puts more pressure on the juvenile justice system, whose first priority has to be the safety and security of its residents and staff, as opposed to mental health treatment.
"We see these kids coming, and we're not quite sure what to do for them," said Jim Johns, who heads the Department of Welfare's Bureau of State, Children and Youth Programs.
Johns has set up a mental health treatment team of supervisor Russell Zemanek and program specialist Tim Davis to oversee staff training and assessments of residents, and to help with crises at individual facilities. Their plan now is to follow up with any teen who indicates mental health concerns which, based on the early findings, could involve about 87 percent of the teen boys and virtually all of incoming girls.
"This is probably the most aggressive plan in the country," Cauffman said.
Crucial to their work is the uniform, systemwide mental health screening of every adolescent entering the system, using the Massachusetts Youth Screening Instrument, or MAYSI. It started in January under the direction of Cauffman, a consulting psychologist who supervises similar survey work for the state's detention centers.
Within two days of admission to one of the camps, each teen is given the 52-question MAYSI to gauge his mental and emotional status. While the responses do not constitute a diagnosis, they can alert staff to a possible problem.
For some conditions, such as psychosis, there's not always an outward indication of what's going on, "Then out of the blue they do something," Cauffman said.
Many facilities, such as the New Castle Youth Development Center, already had multiple psychological assessments in place. But Johns directed all centers to include the MAYSI screen, too, so they could collect and compare information among different facilities.
Johns said it sometimes could be difficult to carry out a mental health plan in a corrections setting.
"Five to seven years ago, there was a real heavy focus in our system on security. At the time, it was necessary," Johns said. "Now we need to move beyond that."
Steve Twedt can be reached at stwedt@post-gazette.com or 412-263-1963.
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