After a new report found that more than 90 percent of youth in the county’s juvenile halls had an open mental health case, the Los Angeles County Board of Supervisors pledged to improve mental health care to justice-involved youth in county.
That includes both more services for youth detained in the county’s juvenile detention facilities and more options to divert youth away from incarceration and into less restrictive therapeutic placements in a community-based setting.
“The county’s failure to meet the mental health needs of the youth in our juvenile justice halls and camps was well documented by the U.S. Department of Justice in 2003,” said Supervisor Mark Ridley-Thomas at the board’s meeting on Tuesday. “Yet over 15 years later, the county continues to struggle with this issue, and we have not met our commitments. The failure to adequately address the mental health needs of justice-involved youth has had serious consequences for the county over the years.”
The motion introduced by Supervisors Ridley-Thomas and Janice Hahn calls for the county to come up with a plan to address issues raised by the Department of Mental Health (DMH) in response to a February report from the Office of the Inspector General that found disturbing use of pepper spray and a rise in excessive use-of-force incidents at the county’s juvenile halls.
The board ordered DMH to assess mental health needs in county juvenile justice facilities, opportunities for the county to implement trauma-informed approaches and strategies for reducing the use of force inside those facilities.
According to the April DMH report, more than 90 percent of youth in L.A.’s juvenile halls in 2018 had an open mental health case, an increase of about 25 percent from 2015. About 40 percent of those diagnoses were for disruptive behavior, while another 30 percent were for mood disorders, which includes clinical depression and, in a smaller number of cases, bipolar disorder.
The percentage of incarcerated youth who were prescribed a psychotropic medication jumped from 26 percent in 2018 to 35 percent in early 2019, according to the report.
“Youth who remain detained and housed in probation facilities, particularly juvenile halls, are significantly more likely than youth from a decade ago to suffer from severe mental disorders, particularly trauma-related disorders and symptoms and substance use disorders, and therefore are more likely to receive mental health services,” the report reads.
The DMH report chalked up the higher levels of mental health needs as the result of a few factors, including falling youth crime rates and increased prevalence of diversion opportunities that have caused the number of youth detained in the county’s juvenile justice system to drop five-fold — from a high of about 4,000 15 years ago to about 800 youth held at county juvenile halls and camps today.
Another issue is finding appropriate treatment opportunities in the community, according to Christopher Thompson, medical director of the juvenile justice mental health program at DMH.
“We’ve seen a decrease in residential treatment facility placement options for our juvenile justice youth in the community as places have closed or different facilities have changed their policies about accepting juvenile justice youth,” Thompson said at Tuesday’s meeting.
Cyn Yamashiro, a member of both the county’s Probation Commission and its Probation Reform and Implementation Team, agreed that available in-patient and outpatient services for youth with serious mental health issues has been seriously diminished from where it once was 15 years ago.
But he calls the notion that youth in the system today are much different from their predecessors a generation ago “a misnomer.” The issues remain the same, he said, but the Probation Department has become more interested in learning about the root of behaviors that land youth in the juvenile justice system.
“The kids have been in the system from the very beginning for reasons that are the same as they are now: it’s about poverty, it’s about access to mental health resources and education,” Yamashiro said. “It’s not all of the sudden different now. We’ve just become much more sophisticated at identifying the needs of the kids under the supervision of the Probation Department.”
The DMH report describes the staffing of mental health professionals at juvenile justice facilities as “inadequate,” and that probation staff lack appropriate training to work with a population with such significant experiences of trauma. Shortages of DMH staff are especially acute in the early mornings, evenings and weekends, according to the report.
Outdated facilities and high levels of use of force create an environment that is not conducive to the overall well-being of youth, DMH said, and that environment also frustrates efforts to provide effective services and programming. The report urges the county to pivot away from a correctional model and toward “home-like” residential settings where youth can receive individualized services in a secure environment in locations close to home while staff help them with the transition back home.
“Right now, we do have a dearth of those types of facilities in L.A. County,” said Thompson of DMH. “We’re really going to think hard about how we are able to develop those or have our juvenile justice youth, and the more challenging ones, accepted in the ones that currently exist.”
Specifically, the DMH report cites Missouri, New York City, Virginia and Washington, D.C., as jurisdictions that have implemented successful efforts to provide care for justice-involved youth in a community-based therapeutic setting.
DMH also believes one solution could be greater use of short-term residential treatment programs, a clinically based version of group homes that California’s child welfare system has been implementing for the past two years, though that effort has not always worked according to plan.
If the county is able to develop more options for youth with significant mental health issues, that may help convince judges not to place as many youth in juvenile detention, said L.A. County Probation Chief Terri McDonald.
“There are young people in our care that if there were more placements and more supports in the community, I trust the courts would work with us to do that,” McDonald said.