Hosptial for Young Inmates Urged

December 22, 2008

By Molly Hennessy-Fiske  |  L.A. Times  —  

In a move to improve mental healthcare in the troubled juvenile justice system, Los Angeles County probation officials are asking that a 70-bed hospital in Sylmar be built to house and treat the most seriously ill youths in custody.

The facility, which would cost an estimated $5 million to $10 million, would make it possible to transfer incarcerated juveniles now held in 24-hour isolation into a clinical setting, said Probation Chief Robert Taylor. He called it "something that should have been done a long time ago."

Taylorfirst discussed the proposal late last week in separate meetings with the county's chief executive, William T Fujioka; Presiding Juvenile Court Judge Michael Nash; and Department of Mental Health officials.

"I'd be taking the kids I have in juvenile halls now in little rooms and moving them to . . . where they would actually be getting care," Taylorsaid.

But it is not clear where money would come from to build the hospital, which would be located next to Barry J. Nidorf Juvenile Hall. Also uncertain is how soon a detailed proposal could be presented to county supervisors.

Fujioka, who called the talks "extremely preliminary," said his office has not explored funding options for the hospital.

"We merely had a discussion to identify a need. We're not doing this right now," he said. "Given the economy and the state budget problems, we probably won't have the money."

Although Los Angeles County, with about $80 million in reserve, has fared better than other local governments, money is tight. Last week, Fujioka submitted plans to county supervisors to transfer another $141.7 million earmarked for capital projects into the reserve because it is needed to cover anticipated costs of looming state budget cuts.

Taylor, however, said he believed the hospital would save money over time. Moving juveniles from lockdown to a hospital setting would free up probation staff, as well as allow the county to seek Medi-Cal and Medicare reimbursements, which are only permitted if youths are treated in clinical facilities. It takes about 150 staffers each year to provide the 24-hour monitoring at a cost of between $1 million and $2 million.

The care of mentally ill youths who enter the county's 19 juvenile probation camps and three halls has long been at issue.

In 2000, a Los Angeles grand jury found that staff at the county's three juvenile halls frequently overmedicated youths, using up to 16 psychotropic drugs to treat depression, anxiety and mood disorders.

Federal investigators began visiting the halls soon after and last year followed up with an investigation of the county's 19 probation camps. They found suicidal youths in county camps had to wait days to see mental health staff — in one case, 20 days — and sometimes harmed themselves while waiting for help. Youths on psychotropic medications have been pepper-sprayed by probation staff who have not been trained to deal with the mentally ill, investigators found.

Last month, after U.S. Department of Justice investigators threatened to sue the county, probation officials signed an agreement to avoid a lawsuit by, among other things, improving mental health staffing, screening and treatment at the camps. A similar agreement to improve conditions at the halls was signed in 2004.

The number of mentally ill youth in the county's halls and camps has increased in recent years as long-term beds were eliminated at facilities such as Los Angeles Metropolitan Medical Center. More than 15,000 youth were treated last fiscal year by county mental health staff at probation facilities, department spokesman Ken Kondo said.

Between 35% and 40% of the juveniles in county custody at any given time, typically about 3,600, need mental health treatment, Kondo said. Such care ranges from anger management counseling to psychotropic medication. A study last year by the private California Endowment found an even higher need,
with about 60% of probation youth needing substance-abuse or mental health treatment.

Judge Nash, who helped create the county's first juvenile mental health court six years ago to divert mentally ill youth from juvenile halls, said the proposed hospital would improve treatment options.

"The bottom line is there just aren't enough services and if they can provide better services using this facility as a focal point, it sounds good to me," Nash said.

Susan Burrell, a staff attorney with the Youth Law Center in San Francisco, said the proposal was "a creative way to approach the issue" and noted that it would allow the probation department to tap into state and federal funds.

Burrell, whose center has filed lawsuits in the past concerning mental health treatment in juvenile detention facilities, said some other probation systems, such as Alameda County's, have created similar mental health treatment facilities for probation youth.

But she said Los Angeles County would have to guard against the new hospital becoming a dumping ground for mentally ill children. At the same time, she added, "It certainly seems like an important step not to have kids languishing in cells and having untrained staff pepper-spraying them."