Tag Archive for Mental disorder

Mental Health and Substance Abuse Counseling are Woefully Inadequate for Most Youths in Custody


Abused (Photo credit: Andrea Marutti)

The first national survey of kids aged 10-20 in state and local juvenile custody, the Survey of Youth in Residential Placement (SYRP), released in 2010, found that most of them had experienced trauma and suffered from one or more mental health or substance abuse problems, yet a majority of them (particularly those with the severest needs) received no counseling.

The report found that:

Thirty percent of confined young people had experienced sexual, physical, or emotional abuse, 67 percent had seen someone killed or severely injured, and 70 percent reported that something bad or terrible had happened to them. Only 15 percent reported no trauma incidents in their past.

A large share of juveniles in custody reported behaviors that make it difficult to succeed in a conventional classroom, such as having a hard time paying attention in school (45 percent), having a hard time staying organized (40 percent), and being unable to stay in their seat (32 percent). Surprisingly, all three behaviors were reported at a higher rate by girls than by boys.

Anger problems were also rampant, with 68 percent reporting being easily upset, and 61 percent saying they lost their temper easily. Here, too, girls were more likely than boys to report problems.

Signs of more serious mental illness were also widespread. One in six confined youth suffered hallucinations, one fourth had elevated symptoms for depression, and substantial percentages reported: having suicidal thoughts (28 percent), feeling that life was not worth living (25 percent), or wishing they were dead (19 percent). Girls were far more likely than boys to report each of these symptoms. And, alarmingly, 44 percent of confined girls reported that they had attempted suicide, compared with 19 percent of confined boys.

Sixty-eight percent of confined children reported an alcohol or drug problem in the months preceding custody: 49 percent reported drinking many times per week or daily, and 64 percent reported taking drugs this frequently.

Despite these grave and widespread needs, only 53 percent of the 7,073 youngsters sampled in the SYRP report received any mental health counseling in their facilities, and only 51 percent got any substance abuse counseling. Youth with elevated symptoms for depression, anxiety, anger and hallucinations were less likely than kids with fewer symptoms to receive mental health counseling.

Moreover, 38 percent feared being physically abused in their facilities, 35 percent said staff used force against them when it wasn’t necessary, nearly half of them reported that staff in their facilities conducted strip searches, and one-fourth of the youth reported being held in solitary confinement.

A 2010 Justice Policy Institute research review on trauma-informed care for court-involved youth found that:

Confinement has been shown to exacerbate the symptoms of mental disorders, including post-traumatic stress disorder, and the risk of abuse by staff or other youth can be traumatizing.

In particular, characteristics of correctional facilities such as seclusion, staff insensitivity or loss of privacy can exacerbate negative feelings created by previous victimization, especially among PTSD sufferers and girls. Youth in correctional facilities are frequently exposed to verbal and physical aggression, which can intensify fear or traumatic symptoms.

The survey also found that more than one-fourth of confined youth nationwide were held in facilities that did not routinely screen them for suicide risk, and more than half were in places that did not screen or assess all residents for mental health needs. In addition, suicide and mental health assessments were often completed by unqualified staff, and nearly 9 of every 10 confined youth nationwide resided in facilities that relied on unlicensed staff to deliver some or all counseling services.

Several organizations are today striving to rectify these problems.

Related articles

Building Blocks for Youth 

Findings from the First Ever National Survey of Juveniles in Custody 

Traumatic Pasts, Urgent Counseling Needs, Inadequate Services: Findings from the First Ever National Survey of Juveniles in Custody


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Homeless in the New Hampshire Winter

Harrisville, New Hampshire

Harrisville, New Hampshire (Photo credit: Dougtone)

The stereotypical image of a homeless person is usually portrayed in a highly urbanized setting. Just as population is spread across the country, filling both urban and rural niches, so is the chronic problem of homelessness. Small towns and the countryside have more than their fair share of people sleeping rough, and sleeping rough at this time of year can be deadly.

Look at Cheshire County, New Hampshire. Homelessness is a rising problem, fueled by many factors. For one thing, according to Chris Sterndale, executive director of Cross Roads House, the state and local budgets have cut back extensively on mental health funding. The effects can be seen not only in rising homeless numbers but also in a rise in the proportion of them suffering mental illness. Ten years ago the mentally ill comprised one-third of the homeless population, not its one-half.

The biggest factor is hardly surprising – economics. The New Hampshire Union Leader reports:

Overall, though, mental illness is not the driving cause of homelessness; low wages mixed with the lack of affordable housing are the biggest factors.

“In many cases, it’s the working poor. Just because they don’t have a place to sleep this month, it doesn’t mean they are that much different from the other low-income people around us,” Sterndale said. “A lot of these are families that have young kids, and if you can’t earn enough for rent, child care and transportation, something’s gonna give.”

Housing costs in the Seacoast area have only gone up despite the recession, he said. “In a lot of places around the country, rent came down as we went through this first part of the recession, but that didn’t happen here.”

After the Seacoast area, Nashua has the highest rent prices in the state, Brady said, because of its proximity to Massachusetts.

People working in the Bay State who are making higher wages move into Nashua for the lower cost of living compared with that in Massachusetts, pushing the working poor out of housing.

On top of that, northern New Hampshire residents are moving to the area looking for work.

These are not the type of concerns that come immediately to mind when most people think about homelessness, but they are still valid. Every child, every person, left without shelter in the snow is important.

The texture of the problem changes from community to community, although many things remain constant. For instance, rehabilitative approaches are proven effective, and with the rising percentage of mentally ill among New Hampshire’s homeless they make an obvious tactic to embrace. Even so, most of the affected rural areas lack the density of resources larger cities possess.

None of the problems we seek to address is simple. Each one exists in a complex web of community, economic factors, and opportunity. While we seek big picture solutions we also need to keep in mind that each area has slightly different needs, requiring that those approaches be tailored on the local level in order to achieve maximum effect.

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Homelessness, ideals, and profit margins


Homeless (Photo credit: Niklas)

Last month the Department of Housing and Urban Development made an announcement that slipped by mostly unnoticed in the holiday furor. The department reported that the number of homeless people in the U.S. declined slightly in 2012, a drop of 0.4 percent to 633,782. The numbers show a continuous five year trend during which the U.S. has reduced homelessness by 5.7 percent even as the poverty rate grew by 20 percent. It should be noted that this announcement is based on a count on a single night last January.

The editors over at Bloomberg seem confident that they have isolated the cause:

The solution, it seems, lies not in publicly sheltering the homeless for sustained periods but in ensuring that they quickly secure their own places to live.

This approach was first applied to the chronically homeless, who made up 16 percent of all cases in 2012. These individuals almost always have disabilities such as mental or physical health problems or addictions. As a result, they fare poorly in conventional homeless programs, which may require compliance with the rules of an emergency shelter — such as sobriety — before allowing them entrance to a transitional shelter. Further compliance, including treatment for substance abuse, for instance, may be required before they can qualify for permanent housing support.

The alternative strategy places the chronically homeless directly into permanent housing while also connecting them to services to address their other challenges. Most will need this support, at government expense, for life. Yet such comprehensive assistance is probably cheaper than leaving the chronically homeless on the streets, because they often end up in hospitals, detox centers or jails, all on the taxpayer’s dime. Those services cost the public $2,897 per individual per month, according to one study in Los Angeles County, versus $605 for supportive housing.

Once more we see the comparison between short-term expense and long-term savings thrown into sharp relief. There is certainly a lot of public money to be saved in finding more effective ways to combat homelessness, but it also brings up another chronic issue: service providers.

No matter what sort of program gets implemented, it all comes down to how efficiently it is done. Within the for-profit prison system we see justice take a sideline to occupancy quotas and profitability. When talking about homeless issues it is likewise important to remember that many of the service providers seeking public money would be out of business if the homeless problem got solved.

I started thinking about this after an interaction with a homeless blogger named Thomas Armstrong in our Google community about homelessness. Here are the paragraphs that stuck with me:

I am increasingly concerned, and am hearing that others’ concerns are increasing, about a lack of help for mentally ill people in Homeless World Sacramento.

There is a feeling that all the public agencies and nonprofits are shirking responsibility to help those who suffer most and are most in need of help. Instead, the homeless-help industry’s interest is turned near-entirely to getting disability incomes for veterans and chronically homeless persons, which sounds more laudable than it is. The reason vets and the chronically homeless are getting so much attention has everything to do with MONEY — that is so the charities can get buck from these homeless people in exchange for services and so that charities can do their crocodile-tears donations-seeking dance.

The state and county remain in fiscal trouble. It is known that services they provide or fund to help poor or mentally-ill people were among the first to be severely cut or ended in response to the budget crisis beginning three or four years ago. Advocates for the mentally ill and families that include a mentally ill member are not politically powerful.

Many seemingly laudable programs can develop tunnel-vision as they seek funding, becoming out of touch with the reality on the streets. Groups like this can often be identified by their avoidance of discussions about how often the new residents are followed up and/or assisted with in-place operators wanting to see them succeed. That they need homeless people in order to keep their doors open makes their operations deserving of scrutiny.

So, how do we make this arrangement more effective? Long-term solutions are certainly proving to be far more effective at getting people off the streets and into homes, but the human element is of grave concern.

What do you think? Is there a way to deploy funding into effective programs while ensuring that it is employed both strategically and effectively? It is a thorny problem and worthy of discussion, so please share your thoughts.

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It’s More Expensive To Do Nothing About Homelessness in Canada

There is a very interesting study that was recently released in Canada. The findings may provide some insight into the issues of homelessness we face here in the US.

The substantive report (150 pages of it) analyzed the costs of homelessness, including oft-forgotten peripherals like emergency medical expenses and policing. It then compared them to the cost of implementing services and programs designed to combat the problem.

Via The Vancouver Sun:

The estimated annual cost of $55,000 per homeless person takes into consideration the high risk of infectious diseases. The study says some individuals can be slow to accept treatment because they don’t recognize their mental illness, and may circulate through the court system because of a need to get drugs and food.

The study argues that if housing and support were offered to these people, it would cost the system much less – just $37,000 a year.

The report calculated that a capital investment of $784 million is needed to provide adequate housing to the 11,750 homeless people, and a further $148 million per year is required for housing-related support services.

But the study argues that after removing what the province is paying for health care, jail and shelters, and by spreading the capital costs out over several years, taxpayers could ultimately stand to save nearly $33 million annually.

The interesting part is how well these findings complement the research already done on juvenile incarceration and the incarceration of women. In our documentary, It’s More Expensive to Do Nothing, we examined the fiscal and societal gains that can be attained by implementing rehabilitative programs. They are substantive and invite and obvious parallel to the Canadian study’s findings on homelessness.

Another common thread between the two subjects is the recurrence of mental illness and substance abuse as part of the equation. These factors, if not addressed, tend to spiral out of control. Those subject to them can find themselves on a downward path that can be counteracted with the correct therapy and support programs. (On a personal note I know two people who used programs like that to get a grip on things while fighting those battles. They are now well-respected professionals in our community.)

I don’t know of any studies of this nature going on stateside, but it might be worthwhile to encourage it. Our own look at similar fiscal waste, and the human impact it has, was presented in the documentary It’s More Expensive to Do Nothing.

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