Courtesy of Rush University Medical Center
Dr. Louis J. Kraus
The report from court-appointed expert Dr. Louis J. Kraus on the mental health services provided in Illinois Department of Juvenile Justice facilities details several areas in need of improvement:
Staffing: The report points to the insufficient number of professionals, lack of a child and adolescent psychiatrist, lack of necessary licensing among mental health staff, inadequate salaries, and insufficient number of security staff.
Kraus suggested hiring a full-time child and adolescent psychiatrist at IYC Kewanee, where most youth with serious mental health diagnoses have been traditionally held. He added that the psychology 2 position, which requires a master’s degree, pays about $35,000 per year. “There was not a single psychology 2 professional who I talked to who thought this was a reasonable salary,” he wrote.
Many professionals in IDJJ lack knowledge of the subtleties of mental health issues, Kraus wrote. “My recommendation is to have a comprehensive review of the definition of what a mental health professional is, as defined by the state,” the report states. “The IDJJ should call mental health professionals what they are.”
“There is a need in some cases for higher levels of training and qualifications, having licenses, having a child and adolescent psychiatrist … who can supervise and assist with the tougher cases,” said Adam Schwartz, ACLU lead counsel. “In some cases, there needs to be potentially enhancements in the salaries.”
Mental health screening and assessment: The report says IDJJ does not adequately identify youth with significant needs, allows excessive idle time, provides inadequate psychiatric review, and does not adequately separate youth of different ages.
For example, one youth Kraus interviewed at IYC Harrisburg was “overtly psychotic” and was kept “in his fecal-smelling room about 22 out of 24 hours a day” and yet was classified mental health level 2 out of 4 (with 4 the most severe), was not on psychotropic medication and did not have a clear diagnosis, the report says.
Kraus praised the department for work on screening and assessment tools, noting that it has made use of the MAYSI-2 rating scale and hired Dr. Tom Grisso, the inventor of that scale. “Other assessment tools such as the GAIN and CANS have also been helpful in assessing the youth,” Kraus wrote. “In my opinion, the IDJJ also has done a reasonable job in assessing suicide risk and doing initial screenings in a time efficient way.”
“Having the tools in place is an important and necessary step, but it’s not a sufficient step,” Schwartz said. “What is necessary is the level of staffing to use those tools and properly diagnose and treat these young men and women.”
Solitary confinement: Kraus wrote that IDJJ should end confinement for punitive reasons, particularly the improper use of specialized treatment units up to 22 hours per day. He cites a 1990 United Nations resolution supported by the United States that specifically prohibits solitary confinement of juvenile offenders, with which the American Academy of Child and Adolescent Psychiatry concurs.
If a youth is “out of control with rage and dangerous right now,” a time out works fine, Schwartz says, “capped at an hour, or less if the young person regains their composure.” If a youth is considered a suicide risk solitary “for their own protection might in some narrow cases be appropriate, but after a short time, measured in days,” he said.
Kraus said IDJJ “has done a reasonable job in differentiating solitary confinement from ‘time outs.’” In addition, he wrote “The facilities in IDJJ have done a good job in having youth that are on confinement for more than 24 hours evaluated by a mental health professional. However, the evaluations that I reviewed have been quite cursory.”
Hospitalization: Certain youths need to be removed from IDJJ and cared for in more appropriate settings, Kraus wrote. Among them are youth who are considered suicide risks for more than a short period, Schwartz said. “The longer a person stays in a psychotic state, the higher the likelihood of long term and irreversible cognitive deficits, among other risks and difficulties,” the report states. “Hospitalization can be avoided if appropriate treatment is put into place.”
Psychotropic medication: The report cites inadequate consent for medication, improper use of stimulants for youths with polysubstance use, and insufficient medication monitoring. “Most information given to the psychiatrist in follow up is from the youth,” Kraus wrote. “Occasionally there is an acute acting out behavior that is shared, but other symptomatology, which might be more subtle, clearly is not.”
Discharge issues: Planning can be inadequate, which means youths are sometimes held beyond their release date due to lack of community placements or strictly so they can complete drug treatment, Kraus wrote. “Continued IDJJ confinement, against their will and after they have been rehabilitated, is simply a violation of their human rights,” he wrote. “To force a youth to enter into a substance abuse program that they are opposed to, and force on them additional set time in IDJJ, violates their rights to refuse treatment.”
Other issues: The report cites insufficient training regarding LGBT youth, lack of specialized treatment in special treatment units, lack of outside accreditation for facilities, inadequate mental health training for security staff, failure to obtain hospital records, inadequate family therapy, and inadequate treatment for juvenile sex offenders.
More about Kraus' report, the related lawsuit and the subsequent recommendations is available here.