Melton, Gary B., Lyons, Phillip M. Jr., and Spaulding,
Willis J. No place to go: the civil commitment of minors.
(Children and the law.) Lincoln, Neb. : University of
Nebraska Press, 1998.
In 1977, when I was in college, I discovered that there
was such a thing as a "youth rights movement" and joined
it at once. In those days, the movement was sparse and
scattered, mostly consisting of small, informal, local
groups. The organization I joined, the Three O'Clock
Lobby of Michigan, was much more ambitious than most: it
was a duly incorporated, statewide organization. It was
run by youth; as an adult, I was not permitted to vote or
serve on its governing body. Thanks to the help of some
good people at agencies concerned with youth, the group
obtained some free office space and enough funding for a
toll-free phone number and other basic needs.
I was monumentally ignorant about the issues when I
joined, but I soon found that everyone seemed to be
excited about the prospect of "decriminalizing and
deinstitutionalizing status offenders". I learned that a
"status offense" was an action that was illegal only for
kids, such as truancy, curfew violation, running away, or
"incorrigibility" (which might be defined as intractable
disobedience or misbehavior). I vaguely understood that
there was some new governmental policy which favored "less
restrictive alternatives" for these kids, instead of
continuing to just lock them up. What these alternatives
might be, I didn't know, but it was very important to the
group that they be developed and implemented. It was a
big part of our job to push the state of Michigan in this
direction.
The membership and funding ultimately dried up around 1980
and the group disbanded. It had lasted longer than most.
With a sad sense of futility, I went on with my life
without ever really exploring what became of the movement
toward "less restrictive alternatives".
Twenty years after my first discovery, I rediscovered the
youth rights movement, now national and online. The group
I joined, ASFAR, had essentially no funding, but it was in the
process of incorporating.
Unlike the Three O'Clock Lobby, it welcomed people of all
ages as full members, so I was permitted to run for
office. And now, I am again learning - and relearning -
the issues, by reading books to review for this column.
No Place to Go is a difficult,
disorganized book, wandering erratically from its focus
only to return too suddenly to its topic. It is a hard
book to read and to follow. But for me, it did provide
answers to the questions I had avoided for so long.
In its first few pages, the book clarifies the source of
that "movement" toward getting kids out of jails in the
mid- to late-1970s: the Juvenile Justice and Delinquency
Prevention Act of 1974, which had "explicit goals of
deinstitutionalization and diversion of nonserious
juvenile offenders". According to the authors, the
result, which began occurring almost immediately, was not
DEinstitutionalization, but TRANSinstitutionalization into
mental health facilities. "Many status offenders", the
book reveals, "were relabeled as emotionally disturbed and
placed in mental hospitals". The book goes on to cite
statistics relating the decreases in admissions to
training schools of certain types of youth offenders to
the corresponding increases in their admissions to
residential treatment facilities.
The first chapter also covers the growth of the private
mental health industry in the 1980s. During the Reagan
administration, the Office of Human Development Services
offered grants to health care providers to develop
franchises in child mental health services. While private
residential treatment centers receive the majority of
their funding from government sources, there is little
government regulation or oversight. But when courts
cannot justify sending a child to a juvenile detention
center, they can always accept a doctor's diagnosis of a
mental disorder (there's bound to be a psychiatric label
for any young offender), and if no public facility is
available, a private mental health facility will provide a
place to put them.
The book also discusses the 1979 Supreme Court decision in Parham
v. J. R.,
which denied children the right to a formal hearing prior
to commitment by guardians (and the state may be a
guardian). The view of the court was that guardians and
mental health personnel always act in the child's best
interest, and that since the detention was intended to
help, rather than punish the child, the legal safeguard of
a hearing was unnecessary. It was perhaps this decision
that marked the end of an era of optimism among youth
advocates.
The authors emphasize that the children who are being
committed to these facilities are not mentally ill in the
classical sense of the phrase. They are generally
referred for some kind of misbehavior. They also discuss
the harm that can be done to children by long-term
institutionalization, the "treatment" they receive, and
the living conditions they endure. While the American
Psychiatric Association is criticized for its "deference
to physicians and its underlying faith in institutional
care", the book fails to mention that prior to 1980, the
labels that are now being used to diagnose many of these
children did not exist. In that year, the third edition
of the Diagnostic and Statistical Manual of the
American Psychiatric Association included new
classifications of mental illnesses such as "conduct
disorder" or "oppositional disorder" with descriptions
designed to include the type of young people previously
considered "incorrigible". This may have facilitated,
unintentionally or deliberately, the referral of troubled
kids to the mental health system.
So what happened to less restrictive alternatives? The
book does discuss the few that have been tried and the
even fewer that have been evaluated, such as day treatment
programs and in-home intervention, some of which have
demonstrated superior outcomes at lower costs than
institutionalization. But there has been little
motivation to develop alternatives when beds are available
in the local "treatment" facility.
The authors of No Place to Go were
appointed to a committee to study these issues for the
American Psychological Association; this book was the
result. In an appendix, they include their "Model Act for
the Mental Health Treatment of Minors", which was approved
by the Child, Youth and Family Services Division of the
Association. While this "Model Act" falls short of the
strict criteria for admission and rigid restrictions on
mental health care providers that I would want to see, it
does emphasize the need for due process proceedings prior
to commitment and stresses the involvement of minors in
making decisions about their own treatment, and even
includes some requirements for a child's parents to seek
treament themselves! No Place to Go
has, at least, a note of optimism at the end.