The National Mental Health Association accords a high priority to the care of all children, especially those with emotional and behavioral problems.
Increasing numbers of children with emotional disorders are entering the juvenile justice system. This growing trend is the result of multiple systemic problems including inadequate local mental health services for children and more punitive state laws about juvenile crime. Because these children are disproportionately poor and children of color, they and their families are in special need of advocacy.
While very little data is presently available about children with emotional disorders in the justice system, it has been estimated that up to 60% of youth who are involved in the system suffer with such disorders. Many children with emotional disorders in the justice system have committed minor, non-violent offenses or status offenses. NMHA believes that these children do not need to be incarcerated. Whenever possible, these children should be diverted away from the juvenile justice system and towards community-based services including treatment as needed. Education, advocacy, and support should also be offered to the families of these children.
Mental health services can both prevent children from committing delinquent offenses and from re-offending. Intensive work with families at the early stages of their child's behavioral problems can strengthen their ability to care for their children at home.
NMHA believes the needs of children and families are best met through a system of collaborative community-based mental health services. These services include prevention, early identification and intervention, assessment, outpatient treatment, home-based services, wrap-around services, family support groups, day treatment, residential treatment, crisis services and inpatient hospitalization. NMHA further believes that these services are most effective when planned and integrated at the local level with other services provided by schools, child welfare agencies, and community organizations.
Because some children with emotional disorders commit serious and violent offenses, it is not always possible to divert them from incarceration. Nevertheless, these children need treatment for their disorders. The juvenile justice system and the mental health system should work together to develop programs and services within juvenile systems for these children. These services should be treatment-oriented, appropriate for the child's age, gender, and culture, individualized, and family-focused.
Placing children with mental and emotional disorders in institutions, especially correctional facilities, poses special risks and obligations. Institutions have the duty to provide adequate medical services, including mental health services, protection from harm, and adequate education. These services are a right of the incarcerated child.
Children with mental and emotional disorders are especially vulnerable to the difficult and sometimes deplorable conditions that prevail in detention centers and youth prisons. Severe overcrowding often contributes to the inadequacy of mental health services and can exacerbate the emotional problems of children.
Adequate delivery of mental health services to children and their families in secure facilities is the responsibility of all professionals at a facility, including psychiatrists, psychologists, social workers, nurses, correctional counselors, correctional officers, and facility administrators. NMHA believes that secure facilities must be sufficiently staffed with mental health professionals, and that such professionals have special obligations to:
NMHA commits itself to protecting the civil rights of children with mental and emotional disorders who are incarcerated in the juvenile justice system. This includes their rights under the US Constitution to adequate medical and mental health care, to protection from harm including staff abuse, and to adequate education and rehabilitative services and treatment. NMHA will work to inform members of law enforcement and correctional groups, judges and attorneys, residential care personnel, mental health professionals and advocates, parents, the community and the media about the rights of incarcerated children with serious mental and emotional disorders.
NMHA also commits itself to identifying and addressing the forces that contribute to the disproportionately high involvement of youth from ethnic and racial minority communities in the juvenile justice system.
When children with mental and emotional disorders must be confined in correctional settings, certain principles should be observed:
All youths should be screened upon admission by trained personnel for mental health and substance abuse problems. When the screening detects possible mental health problems, children should be referred for further evaluation, assessment and treatment by mental health professionals. Children and their families who are already receiving treatment before they enter should be assisted in continuing treatment. All juveniles who are not released within one week should have behavioral, mental health and/or substance abuse evaluations done by qualified mental health staff with expertise in children and adolescents.
Juveniles who suffer from acute mental disorders or who are actively suicidal should be placed in or transferred to an appropriate medical or mental health facility and returned to confinement only with medical clearance. Correctional facilities should have written arrangements with local medical or mental health facilities for providing emergency medical and mental health care.
Mental health services should be available to incarcerated children 24 hours per day, seven days per week. Treatment should be provided in an atmosphere of empathy and respect for the dignity of the child. Different types. of mental health interventions should be available, including the full range of medications. The type of intervention should be tailored to meet the child and family's needs and developmental status, and should be delivered by qualified mental health staff with expertise in children and adolescents. When medications are used, they should be consistent with the treatment plan and well monitored by a qualified mental health professional with expertise in children and adolescents.
Special treatment should be available to children who are sexually abused, who have substance abuse problems, health problems, educational problems, histories of family abuse or violence, and who are sex offenders. Programming in facilities should be appropriate to the child's age, gender and culture. Linguistically and culturally appropriate therapy with the child's family should be encouraged. Under no circumstances should a child be penalized for seeking or receiving mental health treatment.
Facilities should train staff to use behavior management techniques that minimize the use of int ' rusive, restrictive, and punitive control measures. Facilities should have written guidelines for the use of seclusion, room confinement, and restraints. These guidelines should be made clear to children in custody. Distinctions should be made between the use of seclusion and restraints for custodial-administrative purposes and those made for therapeutic purposes. When restraint must be used to prevent injury to self or others, there should be stringent procedural safeguards, limitations on time, periodic reviews and documentation. Generally these techniques should be used only in response to extreme threats to life or safety and after other less restrictive control techniques have been tried and failed.
Under no circumstances, should incarcerated children be the subjects for medical research without proper ethical review and informed consent.
Incarcerated children should have a discharge plan prepared when they enter the correctional facility in order to integrate them back into the family and the community. This plan should be updated in consultation with the child's family or guardian before the child leaves. It should include the continuation of treatment, therapy and services begun in the facility. Confinement facilities should take an active role in promoting continuity of treatment for those released.
Facilities should take extra precautions to assure against suicide by emotionally disturbed children who are confined. Facilities should have a suicide prevention plan that includes appropriate admission screening, staff training and certification, assessment by qualified mental health professionals, adequate monitoring, referral to appropriate mental health providers or facilities, and procedures for notification of the child's parents or guardian. Suicidal youth should never be isolated.
NMHA affirms the specific rights identified below because they have the most potential to be abridged in correctional seftings:
Approved by the NMHA Board of Directors June 6, 1998
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