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Second of four parts
Monday, July 16, 2001
By Steve Twedt, Post-Gazette Staff Writer
Michael Durkin had barely turned 16 when he landed in Shuman Juvenile Detention Center last spring. He was there because of his "failure to adjust" in a local community residential treatment program -- he'd hit and bit two staff members who were trying to break up a fight between Michael and another resident.
Once he was in Shuman, though, Michael seemed to have no way to get out of detention. Because of the assault, treatment program after treatment program turned him down, seven in all.
After a few weeks, Michael's stay at Shuman went sour.
One weekend, Michael got in trouble when other teens heard him direct a flurry of racial epithets at a staff member. After he yelled racial slurs at the other residents, too, both white and black, they beat him up. The nursing staff tended his bruises and black eye, counseled him to watch his language and then sent him to a new unit. Within hours, the script played out again, and Michael was off to the infirmary with a new set of cuts and bruises.
"We told him, 'Michael, you've got to stop saying these things,' " one of the nurses said.
But Michael didn't stop -- or couldn't.
After a transfer to yet another new unit, and a third beating, Michael was back in the infirmary, where the hulking 240-pounder finally broke down in tears.
"I'm not a bad kid," he pleaded to one staff member, "but no one here understands me."
A few days later, the Shuman staff finally understood -- but only by chance. A visiting child psychiatrist, at Shuman to see another youth, recognized Michael in the hallway and sounded the alert.
The psychiatrist said he'd previously diagnosed Michael Durkin with Asperger's syndrome, a condition characterized by highly-developed language ability but woefully inadequate social skills. He was also impulsive, blurting out insults even when it was obvious those words could earn him a fight. His other documented mental diagnoses included obsessive-compulsive disorder, depressive disorder and intermittent explosive disorder.
Michael's experience exposes an inherent flaw in the juvenile justice system, and especially detention centers, where children who have been arrested are sent until they appear in court or are assigned to another program.
Teens arrive at detention centers on short notice, with incomplete medical histories. And even though they get a physical examination that includes a mental health screening, it may be days before the detention staff understands what's really going on with a particular youth.
Even then, the centers aren't really equipped to provide mental health therapy. It's all they can do to keep these children safe until they move on to another place.
"This is detention," said Terri DeFazio, who oversees health services at Shuman. "We try to fit the pieces of the puzzle together and unfortunately, we don't get to see the whole picture."
Putting a boy like Michael Durkin in close quarters with 130 troubled juveniles almost guarantees problems.
Yet it is happening more and more frequently. Youths who can barely maintain their mental balance on the outside are put into detention centers or prisons full of street-wise teens who have a knack for picking on the most vulnerable members of the group. And, once they are there, the mentally troubled teens have difficulty getting out.
New Morgan Academy: Is this private center the answer?
One morning at Shuman: Helping teens who are on the brink
Lack of options keeps mentally disturbed youth locked up
Juvenile justice and mental health: As two worlds collide, teen suffer
Juvenile justice faces growing crisis: What can we do about the girls?
Wrapping troubled teens in a blanket of support
Mental health experts estimate that 40 to 70 percent of incarcerated juveniles nationwide have some diagnosable mental illness, and that up to 10 percent have a serious mental illness, such as bipolar disorder or severe depression. Combined with drug or alcohol abuse, which is often the case, it means these children are on the brink of meltdown.
Yet juvenile justice and mental health professionals say they face a lack of alternatives -- other than juvenile prison -- for helping delinquent teens with mental health problems.
Legal troubles
There's an 18-year-old with schizophrenia currently serving six to nine months at the maximum security New Castle Youth Development Center in Lawrence County. He'll sit, staring at the ceiling for long periods, responding to voices only he hears. His first brush with the law came when police caught him in a stolen car. "He told the officer he was going to pick up the First Lady," said Domenick Lombardo, director of psychological services at New Castle.
Until she was released in February, a teen-ager in Pennsylvania's only maximum security prison for adolescent girls, in Danville, Montour County, spent much of the day at her desk with a blanket over her head. She was convinced germs were falling on her from the ceiling. Her original offense was truancy. She landed in the Danville center after "failing to adjust" in three residential placements, resulting in multiple assault charges against her.
At the Allentown Secure Treatment Unit in Lehigh County, there's an 18-year-old youth diagnosed as schizophrenic and delusional. His original offense: Trespassing. "In his mind, he didn't feel he was trespassing. But his reality and social skills were totally inadequate to convey that," said Rick Thomas, Allentown director.
Confronted by the landowner, the young man exchanged harsh words with the man, then assaulted him.
Allentown is the state's facility of last resort for adjudicated boys with severe mental or emotional problems. It sits on the grounds of the Allentown State Hospital -- which once had an adolescent unit -- but is starkly separated from the other buildings by its high fence, topped with loops of razor wire. There's no mistake: This is a prison, not a hospital.
That distinction makes an important difference.
Because it is not a hospital, the young man could -- and did -- refuse medications that could have helped him. Under Pennsylvania law, anyone 14 or older can do that unless they are committed to a psychiatric hospital. He didn't take medications for the entire 13 months he was at Allentown. Now he has returned to his central Pennsylvania home, still unmedicated and with a police record.
"At a certain point, maybe two weeks, or two months, or two years, another episode is going to take place," said Thomas. "Our hope is that nobody gets hurt. And we hope they take him to a psychiatric hospital rather than jail."
Limited options
But the treatment options for this young man and others like him are very limited.
The state has closed its adolescent units in state mental hospitals, eliminating dozens of beds that had been available for such youths.
They were replaced by privately-run community mental health programs. But state regulations currently do not allow these programs, known as residential treatment facilities, to lock in their residents.
That makes those facilities reluctant to accept a youth with a history of aggressive behavior, or running away, or setting fires, or sexual offenses. Three of the 10 facilities in the Pittsburgh area won't even consider accepting delinquents because local zoning ordinances forbid it. And because they are usually at or near capacity, they can afford to be choosy.
"If I have a bunch of 15-year-olds who are kind of the same, day in and day out, and here's a kid who comes who has killed his pets, set fires, raped his sister and tried to kill his mother, I think long and hard about taking him," said Lynne Struble, CEO at Southwood Psychiatric Hospital in Upper St. Clair.
That example, by the way, describes an actual recent applicant to Southwood's residential treatment program who was turned down.
"There are certain kids we can't handle," echoed Jim Bendel, interim CEO of Adelphoi Village, based in Connellsville, Fayette County. "We need somebody who can function in a group setting and if there's someone who needs individual attention, he's not going to survive very well."
Glade Run Lutheran Services in Zelienople, despite a good reputation for working with teens who have mental health problems, will not accept those with a primary diagnosis of "conduct disorder," even though it's a recognized psychiatric condition.
"We want to make sure we can keep the kids safe and, if there's any doubt, we would encourage them to look elsewhere," said Kara Rutowski, director of resource development and marketing at Glade Run.
These problems are not unique to this region.
Philadelphia, for example, has had nearly 200 juveniles at one time in facilities in Virginia, Texas, Georgia, Florida, Kansas and Colorado, all because appropriate in-state facilities were not available.
Most residential treatment facilities in Pennsylvania "are regarded as not well-equipped for kids who have severe acting-out problems," said Jim Anderson, executive director of the Juvenile Court Judges Commission in Harrisburg. "I think generally people would say we need a different option."
State reducing role as care provider
But Pennsylvania, like many other states, has been moving away from secure mental health facilities.
On June 30, the state's last juvenile forensic unit -- a licensed psychiatric hospital for juvenile offenders in Bensalem, Bucks County -- closed its doors for good.
"Our plan over the past several years has been to decrease our role as a direct provider of care and increase our role as a purchaser of care," said Charles Curie, deputy secretary in the state Department of Public Welfare's Office of Mental Health and Substance Abuse Services.
The move to private contractors was not a cost-saving measure, Curie said. Rather, it was designed for "all children to have more community-based alternatives and more alternatives that involved their family."
But Curie acknowledged that private providers can and do reject applicants they deem undesirable -- in fact, before Philadelphia County sends youths to out-of-state facilities, its policies require every Pennsylvania residential treatment center to have rejected them first.
This pattern may change, Curie said. The state is looking at allowing its first locked residential treatment facilities, he said, and setting up privately-run specialty programs, say for fire setters or sex offenders, that would be contractually prohibited from refusing teens.
But the discussion and planning for secure, specialty residential centers, already in the works for years, may take several more years to complete.
A handful of residential programs, such as Southwood and a program housed in Monsour Medical Center in Jeannette, Westmoreland County, have licensed psychiatric hospital units on their campuses to handle unexpected crises in their residential treatment units. But that doesn't solve all their problems.
"A child who has made a serious suicide attempt is admitted" to the psychiatric unit. "Then, after 24 hours, you ask them, 'Are you still suicidal?' and the child says no, then the insurance company says, 'Why do you need to keep them in there?' " said Joanne Megon, utilization review nurse at Monsour.
She also thinks there's a bias by insurance companies against accepting teens who come from the juvenile justice system.
"They see the juvenile offender as just that. They don't see juvenile offender behavior as a mental health problem."
Few people, even mental health advocates, argue that mental illness excuses criminal acts. They do believe, though, that not enough is done to redirect the children before their behavior becomes criminal.
As a result, children who once might have spent several weeks in a psychiatric hospital are now spending that time in a juvenile detention facility.
Allentown director Thomas said the youths he sees now are more violent, more seriously ill -- and younger. Typically, the teens filling Allentown's 16 beds are 15 to 18 years old. This past year, they got their first pre-teen, a 12-year-old with clinical depression who had tried to burn down a bank using lighter fluid.
Other state facilities, such as the Youth Development Center at Loysville in Perry County, have recently opened special mental health units. Officials there said they really had no choice-- teens with significant mental problems would not respond to the daily regimentation and discipline the same way other teens did. They were more likely to lash out.
The newest attempt to deal with such troubled juveniles has been launched by Cornell Abraxas, which opened a 214-bed high security academy for mentally disturbed youths east of Harrisburg in October. For about $270 a day, Cornell contracts with individual counties to house adjudicated youths with psychiatric diagnoses.
Looking for an alternative
But New Morgan and the other mental health units at juvenile institutions are only available to teens after they've been in trouble with the law and have failed in many other placements. What teens like Michael Durkin need is help before they land in detention.
Once Michael's psychiatric history became known, a judge allowed him to leave Shuman and stay with his father, Brian, under house arrest.
After the start of this year, Michael moved to the Western Psychiatric Institute and Clinic's KidStep program while attending classes at Pressley Ridge Schools on the North Side during the day. His stay at Western Psych has to be reviewed every 90 days.
It has been a long journey for Michael, who his father describes as a normal, even polite young man "95 percent of the time."
But that other five percent can be a terrifying ride.
Several times over the years, Brian has had to call the police during one of Michael's explosive outbursts. One time, Brian nearly lost part of his ear and suffered serious facial cuts after a dispute with his son about using the family phone.
Yet, when police arrived, "they said they could not take him without criminal charges being filed," he said. "Something's wrong here."
Michael recognizes he should not hit people, "but I do it for different reasons," he tried to explain. "I can't stop and think before I do it."
He added: "I should have never been in Shuman. I'm not a criminal. I have disabilities. Sending me to a prison isn't going to help me because you're putting me in with the criminals. It's just going to make me more like them."
Brian, who has recounted his son's struggles publicly to help other families in similar situations, loves his son and knows Michael is smart and capable -- capable of charming helpfulness and raging anger. While he nurtures the former in his son, he's constantly on guard for signs of the latter.
It's a heavy package of love, fear and worry that he carries, hoping for the best, but unable to block out images of the worst that could happen.
One year ago, Brian Durkin, like the rest of the region, followed the news accounts when South Hills resident Richard Baumhammers went on a rampage, killing five and leaving a sixth person paralyzed. It happened just weeks after Michael's tumultuous stay at Shuman. As the horror of the killings registered and details about the shooter's troubled past surfaced, Brian admitted that a disturbing thought had come to him.
"I can picture myself," he said, "having to deal with what his parents were dealing with that day."
Post-Gazette Staff Writer Steve Twedt can be reached by telephone at (412) 263-1963 or by e-mail at stwedt@post-gazette.com
Michael Durkin and father Brian in a happy moment. Brian says his son is a polite young man 95 percent of the time. The other 5 percent, though, he can be terrifying. (Robin Rombach, Post-Gazette) 
Brian Durkin and his son Michael await a court hearing. Michael, diagnosed with Asperger's Syndrome, was a target during his stay in detention because of his impulsive outbursts. (Robin Rombach, Post-Gazette)