Young Marylanders with serious mental health needs are being “inappropriately” sent to detention centers that struggle to help them, according to the state’s Division of Juvenile Justice.
And it’s possible that these environments, including the Baltimore City Juvenile Justice Center, are making conditions worse for young people, the watchdog said in a recent report.
“The Maryland juvenile justice system cannot become a default part of the state’s mental health system,” the report said. “Maryland state government and its various departments need to address the comprehensive and permanent shortage of the current severe shortage of inpatient mental health services and ensure that comprehensive community mental health services are provided to young people.”
A similar problem is playing out for adult Marylanders. The state has insufficient adult psychiatric hospital beds and a growing number of defendants waiting to be admitted, The Baltimore Sun reported in July. That has resulted in people with serious mental illnesses who are accused of crimes but are not considered well enough to participate in their cases to be held in prisons across the state.
Maryland’s population of incarcerated youth is growing, including in all of the department’s detention facilities. At the state-run Baltimore City Juvenile Justice Center, a city facility for boys, the average daily population in the first quarter of 2024 was 98, compared to 63 in the same period in 2023 and 58 in 2022.
At the same time, there was an increase in the number of assaults and fights among youths in the facility, as well as incidents of smuggling.
The report by the Juvenile Justice Oversight Division, part of the Maryland Attorney General’s Office, did not provide a specific number of young people who would be better served by mental health services than incarceration. It said youth in need of specialized mental health services were being placed, through the court system and the department, in a “secure custodial environment where their conditions often worsen.”
The monitoring unit is tasked with examining the needs of children under the supervision of the youth department and then giving a quarterly report on how young people are treated in institutions. Supervisors have access to the Youth Service’s internal data, carry out unannounced visits and interview youth, staff and managers.
The Ministry of Youth Affairs referred a request for comment to its response in the July report of the Youth Inspectorate. There, the department did not respond directly to the findings of the inspection department, but instead offered a broader update, including on mental health services.
The Department of Juvenile Services said it has access to licensed physicians at each of its residential facilities, but a contracted provider offers services at the detention center such as cognitive behavioral therapy in collaboration with the school, psychiatric and medication management departments.
In the department’s two “holding units” located at the city’s detention center and the Cheltenham Youth Detention Center in Prince George’s County, the department’s doctors have treatment hours similar to what the youth might have access to in a program depending on his or her case. has been adjudicated, the youth system’s validity period once the case is over, the youth department added.
The Juvenile Justice Monitoring Unit praised waiting accommodation units for reducing the “dead time” young people faced in detention while waiting for a place to open. However, it noted that the Cheltenham program may need improvement and suggested that the agency closely monitor contracts for mental health services at its three largest detention centres.
In one case, described in a newly released report on the first quarter of this year, young people were “shuffled” into a series of detention centers between November and May.
During those months, he exhibited “self-harm” and disruptive behavior, such as breaking light fixtures or plastic objects to obtain smaller parts to use in self-harm, or destroying furniture such as telephones, televisions and computers, the report said.
When he broke a unit’s phone and television while in custody at the Baltimore City Juvenile Justice Center, he had to be separated from his peers, who “threatened retaliation.”
The Youth Services mental health contractor did not refer the youth for outside evaluation or treatment, or provide him with effective services, despite his “significant trauma-related needs,” the watchdog said.
He was later sent to Charles H. Hickey Jr. school in Baltimore County, another state-run detention center, where he himself was held in a back room.
He and other “vulnerable” youths often make amends in secure detention facilities, the report said. Decompensation is the medical term for when someone loses normal function or experiences worsening symptoms.
Another young man detained at Hickey was involved in an assault earlier this year, including an attempt to attack a teacher who he said had made inappropriate comments about his late mother. This young person said his medication was not helping him and said he had “deep depression mixed with hyperactivity”.
The attrition of young people in detention is at least in part because correctional staff are ill-suited to treat behavioral and mental health needs, the report says. Staff use verbal commands, restraints, isolation and seclusion with young people to achieve order, the report says, and these practices “are likely to exacerbate young people’s mental health problems.”
“The aim should be to recognize and try to deal with the problem,” the report said.
Melissa Goemann, senior policy advisor at the National Youth Justice Network, an advocacy group, said the environment in a juvenile facility can be a “significant source” of trauma and stress for young people. It separates them from support systems such as family members, who may or may not visit, they are harshly treated and often lack adequate diagnosis or treatment.
“The best way to reduce the number of youth with mental health challenges in the juvenile justice system is to prevent them from entering the front door,” Goemann said.
She recommended building a mobile youth response system separate from law enforcement, increasing the number of mental health services in schools, and creating additional processes for law enforcement to direct youth with mental health challenges to community-based resources.
The report also blamed the lack of accessible mental health facilities in the community or in residential care homes in the country. Without enough of those available, youth with mental health needs “remain trapped within the juvenile justice system” and “are cycled through” facilities, it said.
Joseph Ribsam, director of the Annie E. Casey Foundation’s Child Welfare and Juvenile Justice Policy, said the problem is national: Behavioral health services for children “skip” past outpatient treatment and medication, leaving few options until hospitalization.
The treatments could include wrap-around support, home-based treatment options, peer bonding for children and parents, and mobile response and stabilization, Ribsam said, rather than detention.
“The act of removing a child from their home, from their space, from their community, is actually exacerbating the underlying condition of trauma,” he said. “Even if you’re trying to do the right thing by getting clinical services to deal with other mental health issues, it’s very likely that the teen is so out of control that they can’t accept the treatment they’re offered.” .”
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