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.
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.
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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