Verne Strickland Blogmaster / December 20, 2012
WASHINGTON -- Days before the mass shooting at Sandy Hook
Elementary, a boy in Milwaukee confessed to one his teachers that he had
been troubled by voices and delusions. The voices were insisting that
he do harm, that he shoot people.
He told the teacher that he had access to a gun at home. He said that he was prepared to bring the gun to school.
This is a scenario that unfolds thousands of times every year across
the U.S. It may not involve a school like the high school in Milwaukee
or
an elementary school in Newtown, Conn. But
the catalysts are all hauntingly familiar -- isolation and a troubled teen or young adult in crisis.
Friday's massacre at Sandy Hook Elementary has drawn considerable
attention to gun control, with politicians pondering another assault
weapons ban, a potential curb on high-capacity magazines, and
background checks at gun shows.
On Wednesday, President Barack Obama announced the formation of a task
force to address the gun issue, which he vowed would not be like other
Washington commissions. He said he expects concrete proposals on his
desk in January.
Less attention has been focused on forging a better policy on mental
health care for at-risk kids. Obama devoted a line to the topic while
announcing his gun task force. But mental health legislation may be an
easier fix and an easier sell to Congress.
There are ways of preventing more Sandy Hooks or Auroras. The solutions are out there, and many have long been in practice.
That Milwaukee teacher did not call the police. Nor did the teacher
ignore the boy. The high school knew exactly how to get the teen
immediate help.
School officials dialed Milwaukee's Mobile Urgent Treatment Team, recalled its director, Dr. Chris Morano.
"We knew this was a high risk," Morano explained. His team went to
the school, where they assessed the boy on the spot. With the mother's
help, the team's clinicians surrounded him with services. He was
temporarily hospitalized and began taking medication to help beat back
his inner demons, hush his impulsiveness and stamp out his
turn-on-a-dime aggressiveness. He and his family began developing a
treatment plan with county workers.
The team then assigned him a sort of mental-health bodyguard as
someone he or his mother can call 24 hours a day, Morano said. The boy
would continue getting services for as long as needed.
Morano's team is just one of the entry points into Milwaukee County's social services program, known as
Wraparound Milwaukee.
The program, started in 1995, aims to treat the city's most
vulnerable -- children and adolescents with deep emotional disorders who
have been swept up in foster care or entangled in the juvenile justice
system. For the roughly 550 youth and family members it serves every
year, Wraparound Milwaukee provides coordinated services and therapies
with one catch: Families -- not bureaucrats -- lead the treatment plans.
Bruce Kamradt, Wraparound Milwaukee's director, explained the
philosophy to HuffPost in February. "It's around strengths and needs of
kids," he said. "Better we plan this together. We'll look at family
needs too. If the youth problem is he's in a gang and the mother really
needs to get out of this neighborhood, we may find alternative housing.
If she needs a job, we'll try to find a job for her. We're going to
focus not only on the kid's need but the family's need."
Morano agreed. "Our innovation is that we go to the community, we go
to families," he said. He called parents the "X Factor." "How the parent
or caregiver is handling the stress of the trauma. This, to me, is the
single most important factor in how well a child will adjust in the
aftermath," he explained. "Parents have to handle their own stress and
anxiety, appear as confident and assured as they can. ... This is vital
in helping kids feel good again."
Wraparound Milwaukee also serves an additional 350 kids who are not
attached to the courts, Morano said. The aim is to keep those kids out
of the judicial system. "We recognized that it was vital to provide as
early and as preventative services as possible," Morano said.
Once they get a sense of the family's needs, Wraparound Milwaukee
matches the family with service providers. As Kamradt suggested, the
program prides itself on being flexible and not offering the same old
individual therapies. It all sounds pie-in-the-sky -- empowering
families to stabilize their own children through government agencies and
nonprofits. Despite the odds, the ideas have taken root. State and county data
analyzed by Kamradt's team show that of 411 new youth enrolled from
October 2009 to July 31, 2010, only 11.9 percent committed new offenses.
Its 2011 annual report shows high rates of school attendance, stable families, and satisfaction among families and kids.
The innovations are not under-publicized. Wraparound Milwaukee was the subject of a
PBS documentary. In 2009, the Harvard Kennedy School of Government
gave the program an an innovator award. It's become a national model.
"With respect to this most recent tragedy, I have to to tell you that
in Milwaukee we've done a tremendous turnaround," Morano said.
It is a turnaround not widely enjoyed elsewhere. Too many
jurisdictions' mental health budgets are consumed by costly hospitals
for the most extreme cases, favoring bed space over prevention programs.
"The problem is that right now kids in particular get very poor
services nationwide," said
Robert Bernstein, president of the
Bazelon Center for Mental Health Law,
an advocacy organization based in Washington.
If you want solid,
flexible services, you can get them only after you've been hospitalized
multiple times, Bernstein added.
Youth Villages, a nonprofit based in Tennessee that works with a number of states, does in-home services for children. Its
stats
show that more than 80 percent of kids remain with their family one
year after completing the program. More than 80 percent of kids report
no arrests. Youth Villages works in 11 states and D.C., yet admissions
in 2010 were barely above 4,000.
"There's good science around what you are supposed to do," said Dr.
Tim Goldsmith, Youth Villages' chief clinical officer. "There's really
no question. People just don't do it. For some it's a lack of knowledge.
For some its a lack of skill. For some, it's a lack of funding. When
you have a young adult in a mental-health system ... it's going to be
the luck of the draw with what you're going to get.
"
Mississippi has wraparound services. But it's nowhere near full
funding and doesn't cover the state equally. "Even with the problems
with the wraparound, the number of families who are getting to
participate in that is very small," explained Joy Hogge, executive
director of Mississippi Families As Allies.
Resources or not, cities and states have found ways to innovate at
one of the most common intersections between a person in crisis and
government.
In the late '80s, the Memphis Police Department decided it needed a
better way to deal with these residents. After one confrontation ended
in a fatal police-involved shooting, the department created the
Crisis Intervention Team model.
Along with training for rank-and-file cops, the department developed
what amounts to a mental-health version of a SWAT team of officers who
go through more intensive trainings.
Memphis residents are no longer afraid to call the police when a
loved one is having problems. In 1988, Crisis Intervention Team officers
fielded 3,000 calls for service. They now receive roughly 12,000 calls
per year. Dozens of police jurisdictions have adopted the program, from
Georgia to Seattle to D.C. "There are a lot of officers who are willing
to get this training," explained Philip Eure, executive director of
D.C.'s Office of Police Complaints. "It's a way of sensitizing people on
the front lines."
When judges in Washington noticed that their courtrooms were seeing
too many mentally-ill residents charged with minor offenses, they
created what's called mental health community court.
One
study
from Georgetown University Law Center and North Carolina State
University noted that five such courts showed reductions in recidivism
at least during a defendant's interaction with the courts. Two courts
showed reductions two years after the defendant left the court system.
The study, which looked at D.C. Superior Court's program, reported that
defendants said they had positive experiences and strongly identified
with the court's goals.
Magistrate Judge Joan Goldfrank presides over the juvenile version of
the court. At least 50 kids have completed the program since the court
began about two years ago. She said it has been a success because it
makes sure kids get promised services and it empowers parents. "I see
kids and parents that can actually have a conversation with each other,"
Goldfrank told HuffPost. "There's a lot of anger for lots of reasons by
many of the kids ... I try to meet the kids where they are."
Eddie Ferrer of
DC Lawyers for Youth
has had two clients in Goldfrank's courtroom, which he called
"fantastic." For one client in particular, he said, the court made a
"world of difference." "One of the main reasons it works is because
there is meaningful services being provided that try to address the core
issue as to why that young person is acting out," he said.
Other juvenile clients aren't so lucky. Ferrer said he has clients
who have been waiting six to nine months and still have not received
quality mental health services.
The need doesn't go away. Back in Milwaukee, Morano said he gets
calls from high schools all day long. Earlier this week, a kid walked
into his office with a care coordinator. He was struggling with violent
hallucinations. "He was so distraught by what he was thinking and
experiencing," Morano said. "He couldn't bring himself to tell me the
details. But he wanted help."
His team, Morano said, also assessed a youth who talked about wanting to replicate Sandy Hook.
"He gestured with his hands about shooting people in class," Morano said.
