The Rest of the Story

Fifteen thousand children with mental illness are detained every six months, with no treatment.  What country? Cuba? Iraq?

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By Joanne Kenen

WASHINGTON (Reuters) Jul 07 - Thousands of mentally ill American children, some as young as seven, are locked up in juvenile detention centers because there is nowhere else for them to go, a congressional report found on Wednesday.

The report painted a disturbing picture of children with mental illness and/or substance abuse warehoused in jail-like conditions where their mental health often deteriorates.

More than 160 of the 524 centers surveyed reported suicide attempts by youths held unnecessarily.

"The last place some of these kids need to be is in detention," the study quoted a Tennessee juvenile center administrator as saying. "Those with depression are locked up alone to contemplate suicide. I guess you get the picture."

The House-Senate bipartisan report was initiated by Maine Republican Sen. Susan Collins and California Democrat Rep. Henry Waxman. It was the subject of a hearing on Wednesday by the Senate Committee on Government Affairs, which Collins chairs.

Many families struggle to afford mental health care. Health insurers often provide little or no mental health coverage, or pay so little doctors don't want to take part in the health plans. Community clinics are stretched and cannot meet demand.

The study found that 33 states hold youths who have no charges against them of any kind in juvenile detention centers. On any given day, about 2,000 such young people are incarcerated, and over six months, the number is 15,000.

"Too often (children) are simply left to languish in juvenile detention centers which are ill-equipped to meet their needs while they wait for scarce mental health services," Collins added.

Right here is the United States of America, every six months, 1.5x10⁴ children are held in detention centers without treatment.  This is a national disgrace, and it should be an issue in the US November 2004 elections.  So far, only one candidate -- Senator Kerry -- has anything useful to say about the subject. 

But wait, you say!  Didn't President Bush just announce a "sweeping mental health initiative?"  Yes,  but to understand the topic, you need to read a recent article in the British Medical Journal:

Bush plans to screen whole US population for mental illness
BMJ  2004;328:1458 (19 June)

He said the association has called for increased funding for implementation of the overall plan.

But the Texas project, which promotes the use of newer, more expensive antidepressants and antipsychotic drugs, sparked off controversy when Allen Jones, an employee of the Pennsylvania Office of the Inspector General, revealed that key officials with influence over the medication plan in his state received money and perks from drug companies with a stake in the medication algorithm (15 May, p1153). He was sacked this week for speaking to the BMJ and the New York Times. [emphasis mine]

The Texas project started in 1995 as an alliance of individuals from the pharmaceutical industry, the University of Texas, and the mental health and corrections systems of Texas. The project was funded by a Robert Wood Johnson grant—and by several drug companies.

To be fair, it should be pointed out that often the newer drugs are legitimately preferred, because of greater efficacy.  Also, in some cases, they have been shown to be cost-effective. Even though they cost more, they have may have greater efficacy, and other benefits that offset the medication cost: fewer hospitalizations, office visits, and lab tests.  The comment about  is not scientifically valid: Mr. Jones is not qualified to make risk-benefit calculations, and besides, the newer drugs tend to be safer than the older drugs.  Even so, there are at least three problems here.  One, the involvement of the pharmaceutical companies at least creates the appears of impropriety; in some cases, it may have been illegal.  Two, Mr. Jones should not have been taken off the case.  He works in the Office of the Inspector General; it is his job to call attention to problems.  Third, the President's initiative calls for an unnecessary duplication of effort.  We do not need another survey.  We already know there is a problem (see the Surgeon General's report from 1999, for one example).  What we need is more funding for treatment. 

Here is an excerpt from Mr. Allen's whistleblower report, linked above:


It appears that Mr. Bush is following the same model that Dick Cheney used to develop a national energy policy.  He called the most profitable companies in the world, and asked them what the government could do to transform them from being merely rich, to being filthy rich. 

When I get around to it, I will compare and contrast the health care position of the Bush-Cheney campaign with that of the Kerry-Edwards campaign.  Probably I'll get in on line tomorrow, but I can't promise that.