A New Look at Cure for Troubled Teens : Health: Thousands of frantic parents commit their disturbed youngsters to psychiatric hospitals each year. Many experts question the practice.

Judy Nesmith gripped the wheel while her husband wrestled with their shrieking 14-year-old daughter in the back seat. She accelerated, her eyes riveted to the road and their destination.

“The hospital was a desperate move. The police had just turned her over to us and we had to make a decision,” recalls Wil Nesmith, whose daughter was a repeated runaway. “We’d lost control of our child, and of our lives.”

Tens of thousands of similarly frantic parents commit their troubled teen-agers each year. Some have no choice: Their children are drug-addicted or dangerous. But others, like the Nesmiths, regret being drawn in.

“It feels good at first. Your kid is broken, and so you say, ‘Here, fix my kid,”’ said Wil Nesmith, 47, a financial analyst in Dallas.

The Nesmith’s daughter, Denise, spent 45 days at a private psychiatric facility in Waco, Tex. The stay cost $35,000. Insurance picked up the bill.

The relief, though, was fleeting. Panicked and at wit’s end, the Nesmiths institutionalized their daughter without fully understanding the consequences or alternatives. Their ignorance was far from rare, experts say.

“Hospitals are becoming jails for middle-class kids,” said Ira Schwartz, who directs the University of Michigan’s Center for the Study of Youth Policy.

Schwartz, who has researched the subject extensively, believes more than half of adolescent admissions are for “relatively normal behavior” and that inpatient treatment could be prevented with alternative therapy.

“There’s a lack of credible scientific evidence that hospitalization is any more effective,” Schwartz said. “And the tragedy of it is the damage it does to the kids and their families.”

Generations of adults have battled their offspring over everything from curfew to choice of music, friends or style of dress. But the risks have multiplied and grown direr. AIDS and crack cocaine have brought deadly consequences to what was once worrisome but endurable teen-age rebellion.

And when kids today start to stray, frequently no one is at home to set them straight. Nurturing often is catch as catch can. And old community mainstays, like churches or civic groups, have in many cases taken a back seat to more pressing career goals or financial obligations.

“We used to know how to deal with problems without resorting to something so dramatic as a hospital,” said Dr. Frank Pittman, a family psychiatrist and author of “Turning Points: Treating Families in Transition and Crisis.”

“But today there’s a panic about letting real people lead real, messy lives,” Pittman said from Atlanta. “Psychiatrists are frightened of malpractice. Hospitals discovered marketing and went wild. Anxious parents are being exploited.”

Over the last decade, business has boomed for private psychiatric hospitals, with the number of such facilities more than doubling from 184 in 1980 to 444 in 1988, according to the National Institute of Mental Health.

Mental health professionals have welcomed expanded psychiatric care for a segment of the population long overlooked: seriously disturbed or drug-dependent children under 18. But many worry that the pendulum has now swung too far.

“It’s the proliferation and commercialization of psychiatry,” said Dr. W. Robert Beavers, director of the Southwest Family Institute in Dallas. “We now have something nobody ever heard of 20 years ago--marketing people.”

Beavers, a family psychiatrist for more than three decades, said he has watched with some alarm as the number of children under 18 admitted for inpatient psychiatric treatment increased from about 77,000 in 1970 to about 112,000 in 1986, the last year for which complete statistics were available.

Reported adolescent inpatient discharges at free-standing, private psychiatric hospitals alone were 16,735 in 1980, according to the National Institute of Mental Health.

By 1987, that number had more than doubled to 45,796 and by 1989 it had tripled to 56,945, according to surveys by the National Assn. of Private Psychiatric Hospitals.

However inadvertently, insurance companies contributed to the boom by providing 100% reimbursement for inpatient care, while adolescents treated on an outpatient basis were eligible only for partial benefits.

Charges for juvenile inpatient treatment shot up by 65% between 1986 and 1988 before declining 16% in 1989 as companies adjusted their policies to discourage hospitalization.

Private psychiatric and drug abuse facilities are advertised on television, radio, roadside billboards and in slick, seductive brochures available in high school guidance counselors’ offices.

“He’s secretive. You don’t know him anymore. Get help,” warns one. “Do it for your family,” urges another.

These words fall on receptive ears. Parents are at once overwhelmed and terrified that their children will run away or perhaps slip over the edge into drug addiction, crime or suicide. Given these grim scenarios, a “quick-fix” solution may seem mighty appealing.

“Parents do it because they’re desperate. The world is changing faster than we can catch up and many just don’t know how to cope,” said Lois Power, a volunteer with the Doylestown, Pa.-based parental support group Toughlove.

“The stress gets so great. Things are falling apart and there’s an attractiveness in hospitalization,” said David Wolff, a veteran high school counselor in Prairie Village, Kan. “It seems like a cure-all.”

Unfortunately, that hasn’t proved the case. While teen-agers who pose a threat to themselves or others certainly require inpatient treatment, those with less severe problems often end up embittered by the experience.

Patients are frequently kept under lock and key, their telephone calls and visits restricted. Generally guided by a strict system of reward and punishment, their meals, music and other activities are carefully controlled.

“It wrenches the kid out of the situation that created the problem, but it doesn’t help the kid when he gets home,” said Dr. H. Charles Fishman, executive director of the Institute for the Family in Princeton Junction, N.J.

“Everybody spends all this money, time and energy and the child is returned to the same situation that in many ways created the problem in the first place,” said Fishman, author of “Treating Troubled Adolescents.”

Denise Nesmith’s was such a case. At home, she was hostile toward her brother, verbally abusive and disobedient with her parents. She often skipped school or, when present, fought frequently with her eighth-grade classmates.

She was in trouble. But institutionalization did not improve matters.

“Denise felt very betrayed, very angry. For a long time she wouldn’t even talk to us,” said her mother, 44. “And when she left the hospital she’d learned words and street things she never knew before. Things only got worse.”

Their daughter came home from the hospital more rebellious than ever.

“It was after the hospital that I started doing drugs,” said Denise, now 18. “I was looking for attention, for someone to help me. And I felt like no one was there. I felt like my parents had just tried to get rid of me.”

Ultimately--and successfully--the Nesmiths turned to Toughlove, a national network of support groups that offer consolation as well as coping skills and strategies for parents who feel under siege.

Wil has stopped escaping into his work. Judy has re-examined her sometimes suffocating style of parenting. And Denise, who today works at a day-care center, discovered that she had to respect the rules of the house.

“We all had to learn how to back off and listen to each other,” Judy said. “We had to learn what was important, what wasn’t and where to draw the line,” added her husband.

Where the adolescent poses no threat to himself or others, mental health advocates recommend that parents consider outpatient options, which may incorporate the whole family, as well as friends, teachers or other caretakers.