A Parental Cry for Support

Jesse is only 10 years old but the Santa Paula boy has already been diagnosed with more than one mental illness. His mother Tina said by age 6 he was totally out of control, hitting people frequently, banging his head against the wall and screaming continuously. Now, at an age when other boys are worrying about baseball and Boy Scout badges, he is living with autism and attention deficit hyperactivity disorder.

“He couldn’t function, and I couldn’t get him into a hospital,” Tina said.

Several overwhelming outbursts later, Tina got her son placed at Vista Del Mar Hospital in Ventura, where he stayed a few weeks until he lost control and had to be placed at a hospital at UCLA.

“I just couldn’t deal with my son myself,” Tina said. “I was such a nervous wreck that I had to go on antidepressants myself because this little boy was so difficult.”

Jesse has returned home and is behaving better, but his mother knows she won’t be able to control him if his outbursts become violent again. And if that happens, she may have to put Jesse in a residential treatment center, which won’t be easy. There is only one in the county, and it has a long waiting list.

Jesse and Tina, as well as other children and parents cited, are identified only by their first names to protect their privacy.

While Tina and other parents support the county’s policy of keeping mentally and emotionally troubled youths at home and out of mental hospitals, they contend the county lacks sufficient inpatient facilities with 24-hour supervised care and treatment. Without these support services they fear their children could ultimately land in another sort of institution--Juvenile Hall.

About 1,800 children with emotional, mental and behavioral disorders are being served by Ventura County’s mental-health department. And according to experts, social factors such as divorce, child abuse and neglect are causing that number to rise. Another mitigating factor, said Nancy King, manager of children’s mental health for the county, is earlier detection. King said the county needs to add a mental-health component to medical clinics, hire mental health case managers for youths in the juvenile justice system, and increase staffing at the regional outpatient clinics and at the county’s one residential treatment center.

But others say what is really needed are more inpatient facilities. A 1999 report on juvenile justice issues in Ventura County put near the top of the list a need for more residential-treatment facilities for youths with mental-health diagnoses.

“Sometimes kids need something more intensive--whether it be a locked facility or a mental hospital bed, and we just don’t have that locally,” Chief Deputy Probation Officer Karen Staples said. “We need to go back at looking more seriously at these kinds of things.”

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At least one in five children nationwide suffers from a behavioral, emotional or mental-health problem, according to the Center for Mental Health Services.

Broadly defined, those diagnoses include anxiety-related illnesses such as obsessive-compulsive disorder, major depression, manic-depressive illness, hyperactivity disorder, conduct disorders and schizophrenia. They can be caused by biology, such as a genetic defect, or by environment, such as trauma or neglect, or by a combination of both.

At home or in the classroom, children may obsessively touch others, yell profanities, display a nervous tick or lash out physically. Many disorders are often misdiagnosed or not identified early enough, according to the Center for Mental Health Services, which estimates that two-thirds of children nationwide who need mental-health services do not receive them.

Camarillo State Hospital closed in 1997, leaving no state hospital in the county. In fact, the only state hospital in California that will accept emotionally disturbed youths on a long-term basis is the Metropolitan State Hospital in Norwalk. If children need acute, short-term care, they can go to either Vista Del Mar Hospital in Ventura or Anacapa Hospital in Port Hueneme.

There are 96 beds available in all other placements in Ventura County. But only 26 of those are at a residential treatment center. That center is Casa Pacifica in Camarillo, where therapists, psychologists and counselors are available 24 hours a day. There is, however, a lengthy waiting list.

The other 68 beds are at group homes for children with less serious mental-health problems. Between one-third and one-half of youths whose mental-health problems require placement are sent to facilities outside the county or even out of state.

Casa Pacifica Director Steven Elson said group homes and residential treatment centers are considered Ventura County’s placements of last resort. Consequently, Elson said these facilities have been treated as a dumping ground for youths who can’t make it at home.

“Unfortunately, the group home has been treated like the proverbial red-headed stepchild,” said Barry Boatman, chairman of the Ventura County Group Home Providers Assn.

“But they do serve a purpose and they are necessary,” he said. “The kids coming through the system are more troubled than ever before, so there is going to be a greater need [for out-of-home placements] in Ventura County.”

Plans for Residential Treatment Center

Boatman, who also serves as the director of CARE, or Children’s Alcohol Rehabilitation and Education, is working with two other nonprofit organizations to open a 100-bed residential treatment facility in Rose Valley for emotionally and mentally disturbed children. Although some doubt whether such a facility can be built without county support, Boatman is applying for grants and hopes to open the facility at the end of this year.

Across the state there are plans to provide 400 beds in new community treatment facilities where youths with the most difficult behavior problems could be placed in a locked facility and receive more intensive therapy. About 130 of those beds are expected to be set aside for the “Southern Region,” which includes Ventura County among the region’s 10 counties.

Also, a state bill passed in 1998 called for counties to reexamine the role of group homes. Ventura County is already starting to work with the county’s seven group homes to help them develop the resources and expertise necessary to treat children with severe problems.

Both Crystal, 16, and Melissa, 15, were sexually and physically abused in foster care and now suffer from post-traumatic stress disorder and suicidal ideation. When she was not yet a teenager, Crystal would scratch and bite herself until she bled, abuse her sister and act sexual toward men, even her father.

Her little sister Melissa was diagnosed with bipolar and attention-deficit hyperactivity disorders as a child. By the time she was 7, she was beating up children, stealing, lying and throwing things at teachers.

“It was like having these wild animals in the house,” the children’s adopted mother, Camille, said. “It was like a 24-hour battlefield and trying to maintain any kind of control or balance was impossible. I was a police officer in my own home.”

Finally, Camille gave up, realizing she couldn’t give the girls the help they needed.

Camille said first she tried desperately to place Crystal at Casa Pacifica, but it was full. So she settled for a group home with fewer resources to control disturbed children. There, Camille said, Crystal started using drugs and running away. Eventually, a space opened at Casa Pacifica and Crystal has been there for more than three years.

Need for 24-Hour Treatment Cited

Camille is now awaiting another space for Melissa, now in a group home in Murrieta, more than two hours away.

“It’s amazing what is lacking for these kids who have these serious problems,” Camille said. “Without 24-hour care and counseling and guidance, there is no way to help some who can’t make it at home. They need treatment on a minute-by-minute basis, and parents aren’t trained to deal with these situations.”

Camille is planning to bring Crystal home in September. After intensive therapy and medication, Crystal is less defiant and violent, and more communicative. But without Casa Pacifica’s help, Camille is convinced Crystal never would have been able to live in the community.

What it comes down to is choice, said King, the manager of children’s mental health. She said there needs to be a range of services available. In Ventura County, there are outpatient clinics, on-site mental-health liaisons in schools and a public school and day-treatment center for children with emotional and mental disorders. Mental-health personnel also work with youths in the juvenile justice center and in foster care.

These programs are all part of Ventura County’s “Children’s System of Care” model, created in 1984, which provides integrated services at home and at school. Many believe the model is cost effective and works for most children.

In fact, mental-health costs in Ventura County are among the lowest in the state. Out of 58 counties, Ventura County ranks 52nd in the amount of money spent on inpatient placements, which can cost more than $60,000 annually per child, according to statistics supplied by King.

King said institutionalization, by its very nature, doesn’t teach young people how to survive in the world. Instead, King says, children can learn how to live in the community by having the professional help brought to their doors.

“One of our primary goals is kids being at home, in school and out of trouble,” King said. “Recognizing that there will always be a certain percentage of kids that need to be away from their families for some period of time, our thinking is that we should keep kids in their own homes as often as possible.”

Fearful of Taking Son Out of the House

Cody, 11, has been diagnosed with so many emotional and mental disorders that his mother, Gina, has trouble keeping track: manic depression, obsessive-compulsive disorder, attention-deficit hyperactivity disorder, tactile-defensive disorder, borderline Tourette’s syndrome and borderline autism. His first diagnosis was at age 4.

Somewhere along the way, Gina also lost count of how many medications doctors had prescribed for her son.

Every new diagnosis and every new prescription gave Gina hope. But nearly every day, something would happen. On his worst days, Cody pounced on girls at school, bit the teacher, started fires and chased his mother with a knife. Gina rarely took Cody out of the house because of fear over how he would behave.

Sometimes, Gina said, she locked herself in the bathroom and screamed to release her frustration. Other times she had to get out of the house, so she hired a baby-sitter, who wouldn’t come back.

“I remember thinking I couldn’t go on another day,” Gina said. “But I had to. And then another day and another. I had to keep reminding myself that it wasn’t Cody’s fault. He didn’t ask for this.”

Today, Cody is on effective medication and attending a special school, and Gina said his behaviors are under control. He still has outbursts about once a week, when he yells, runs outside and hits the bushes, but Gina said she is proud of her son and his progress. And she is grateful for the county services Cody receives, though each day is still a struggle.

Despite Ventura County’s focus away from institutionalization, many children are ending up in the juvenile justice system. One-third of inmates in Ventura County Juvenile Hall and all inmates at the Frank A. Colston Youth Center are identified as having serious mental health needs, according to Chris Weidenheimer, division chief for Juvenile Hall.

“There aren’t those places for the kids anymore, so we’re getting a lot more of them,” Weidenheimer said. “Since they don’t have anywhere to go, they go here.”

Weidenheimer said the youths don’t get any ongoing treatment at Juvenile Hall. Rather, they get crisis intervention--only enough help so they don’t hurt themselves or others. And any help they do get is short-term, because the adolescents are forced out of the hall after short periods because of overcrowding.

“We’re not gonna fix them in 60 days,” Weidenheimer said. “Sometimes we’re not going to even break the surface, considering it’s taken 15 years to get to where they [troubled youths] are.”

Colston, however, offers youths various mental-health services, including individual, family and group therapy. Many of the youths are also taking psychotropic medications. But some children need more than the intensive care Colston offers during the two to four months they are there and the subsequent months they are on home supervision, Director Nancy Pierce said. Often, those children come from families where incest, physical abuse and drug dependency are the norm.

A Desire to Get Parents Involved in Treatment

One 14-year-old boy, called an “extreme case” by Pierce, smears his own feces on the wall. She said the boy has a drug-addicted mother, and a brother who may have sexually abused him. Another boy severed an artery by punching his hand through a window in his cell door. And a girl, who is believed to be a victim of incest, cut herself with her wire bra and was placed on suicide watch.

Pierce said it’s crucial to get parents involved in treatment. But she said some parents, even if they participate, are not equipped to care for emotionally and mentally disturbed children.

And some youths are not capable of living in the community. She said a few children are so seriously disturbed that she anticipates they will end up in either adult prisons or mental institutions. These are the children who--whether at home, school or in locked facilities--throw fits, start fires, slash themselves, abuse others and repeatedly run away.

Pierce says there are no easy answers for some mentally disturbed children. But it is the job of the county to do whatever it takes.

“If we can’t help them when they are kids,” she said, “when they are adults what is their future?”