Treatment or trauma? Children and mental-health arrests

By Tim Louis Macaluso on December 10, 2008
http://rochestercitynewspaper.com/news/articles/2008/12/Treatment-or-trauma-Children-and/

Lynn Marie Webster says that her son seemed to be developing normally until he was almost 3. Then subtle signs began appearing: he started swearing, he was easily distracted, and he all but stopped listening to his parents.

"We were going to our pediatrician constantly because I thought I was doing something wrong," Webster says.

In October 2006, after only two-and-a-half weeks in his Greece kindergarten class, Adam (not his real name), then 5, was suspended from school.

Webster told her son's teachers before the start of the school year that she wanted to be an involved parent and that she expected lots of phone calls and e-mails.

"But I wasn't expecting that call," she says.

Adam, his teacher said,was flipping over desks, throwing books, swearing, and spitting.

The month that Adam was suspendedwas one of the hardest, Webster says, because Adam was having one of his worst episodes, as Webster calls them - kicking, biting, spitting, and even urinating in the middle of the room. She called the Mobile Crisis Team at the University of Rochester Medical Center and they helped calm Adam down. But five minutes after the team left, Webster says, her son became even more violent. Webster called 911 and Adam was arrested under the state's mental hygiene law and he was hospitalized for the first time.

Thousands of adults are arrested every year under the state's mental hygiene law. The law permits police to restrain individuals and take them by ambulance to a hospital for a mental-health evaluation.

But the public might be surprised to learn that children in Rochester - some as young as 4 - are also subject to mental-hygiene arrests. The practice horrifies some teachers, social workers, and mental-health professionals. But to parents like Webster, it is the beginning of getting their children the help that they need.

Under the mental-hygienelaw, police officers with reasonable cause to believe that the people in question may harm themselves or someone else as a result of mental-health problems can be arrested, says Sergeant Daniel Berardini, with the Rochester Police Department. But arrest may be a misleading word, he says, since criminal charges aren't filed.

In the Rochester area, most people are taken to Strong Memorial Hospital, where there is a comprehensive psychiatric emergency care program. The unit at Strong is staffed around the clock with psychiatrists, psychiatric nurses, and social workers. Patients have to be evaluated by a staff psychiatrist within 48 hours of admittance. And patients can be held involuntarily up to 72 hours or longer if specific standards are met.

Mental-hygiene arrests of young people, children, and adolescents are often made in schools, Berardini says, because that's where they spend most of their day. Principals are typically the ones who make the emergency call to police when children's behavior can't be managed in a classroom setting.

But determining exactly how many young people in Rochester are arrested under the mental-hygiene law every year is difficult. The Rochester City School District does not keep records of these types of arrests, says Tom Petronio, a spokesperson for the district. City Schools Superintendent Jean-Claude Brizard and several school board members said that they weren't aware that the arrests are taking place.

But teacher Lori Thomas questioned the practice at a board meeting six months ago - with Brizard present. She wanted to know why children needed to be held down and strapped to a gurney. No one responded to her concerns, Thomas says.

Another reason why tracking down the number of mental-hygiene arrests is difficult is because the call for an arrest can originate from several sources. URMC's records show that more 1,700 children and adolescents were taken to the Strong psychiatric unit in 2007 for evaluation.

Of that number, more than 130 young people came from schools countywide, including students in the city schools.More than 550 came from the Rochester Police Department, which could also include students picked up from the City School District. But the majority of calls - more than 700 - were made by parents and family members.

Obtaining data on the arrests is further complicated by confidentiality constraints. And the stigma associated with mental-health issues has also played a role in keeping the arrests in the closet.

"We forget that mental health is still a taboo subject in this country," says Webster. "The stigma that surrounds these kids is just unimaginable. I can't even tell you how many times people have heard my son swearing and they'll say, ‘Why doesn't she just discipline her child?'"

Even Webster's husband had difficulty understanding his son's problems until he saw Adam's behavior on videotape, says Lynn Marie Webster. Adam was eventually diagnosed as having bipolar disorder, a condition characterized by extreme mood swings. He understands that he has a problem, says Webster, and he often apologizes after he has calmed down. Adam once asked her, she says, if she would trade him for another, presumably better-behaved child.

"That's the reason I'm speaking out, to lesson the stigma," Webster says. "I love him. Our kids are amazing kids when you think about it."

Debra Sims (not her real name) says that her son's behavior began to change when he was about 3-and-a-half. Jake (not his real name) started having severe mood swings and played well with other children only as long as he could dominate them, Sims says. Now a first-grade student in the City School District, Jake has been arrested three times - the most recent was last month.

"They say he was flipping chairs and throwing stuff," Sims says.

Jake will scratch, pinch, punch, and kick others when he is upset, she says. He is also prone to self-inflicted injury, she says, such as biting himself. Sims says that she is anxious because Jake requires so much attention and she has other small children.

"I have to keep my silverware up because I just don't know what he'll do," she says.

When Sims was called to the school last month because Jake was having an outburst, she says that could hear him swearing before she even got to the room. As she tried to help him put his shoes and coat on, he struck her hard across the face.

"I took him home and got him something to eat and he calmed down," Sims says. "I get to the point where I can't handle it."

Sims doesn't have much family support. When she visits a family member's home for dinner, she sometimes has to leave if her son begins misbehaving, she says.

Sims' mother tells her that Jake just needs a good spanking, Sims says.

Parents can usually tell that something is going terribly wrong in their children's lives well before mental-hygiene arrests enter the picture, experts say. "With children, behavior is a communication of unmet needs," says Debbie Bartlett, vice president of the Mental Health Association. "The baby is hungry, so the baby cries. But even as they get older, a lot of our kids don't always have the skills to tell us what they need."

And frequently, parents don't know who to turn to or how to get help for their children. The tantrums and behavior problems seem to take over, causing the children to fall behind in school socially and academically.

It's like watching a slow death, says Melanie Funchess, director of community engagement for the Mental Health Association.

"Each time your child can't do something, the dream you have for them dies a little," she says.

Often the mental-hygiene arrest is the first step in a long process that can help parents and professionals focus on the child. If a clinical diagnosis has been made, says Bartlett, the child is legally entitled to certain state benefits that will help with health-care costs.

"What people need to understand when we talk about mental-health arrests is that we're not talking about a kid with a case of the fidgets," says Dr. Eric Caine, chair of the URMC's psychiatry department. "We're talking about behavior that is frequently out of control and violent. We're trying to prevent what is happening from escalating during adulthood."

But not everyone sees mental-hygiene arrests as a useful tool with small, school-age children.

Mark Primus is an assistant professor with Nazareth College's department of social work. He has worked with the City School District and the Rochester Police Department, and he says that the experiences he had with mental-hygiene arrests left him uncomfortable.

"I believe MHA's are a catch-22," he says. "It's done to protect the child, but it can have the opposite result. Instead of getting the positive reinforcement they need, the child is getting massive amounts of negative reinforcement."

We assume that children come to school ready-made for learning, Primus says, and that's not true.

"These children come to school and they are now in an environment where there is a lot of structure," Primus says. "A lot of students need help learning how to adjust to structure and what they're really saying is, show me how to adjust to sharing or show me how to play - because I really don't know how."

While most school districts have special-education programs for mentally challenged students, there often aren't enough resources, including specially trained teachers and counselors, to work with students who are experiencing mental disorders.

Primus says that it is a little easier to work with older children because they are more verbal and might be able talk about what's upsetting them. But with very young children, it could be anything, he says. It's important not to respond punitively, he says, because these children are unable to control what is happening to them.

"You have to give them space for calming down," he says. "But afterward, you need to be able to talk to them about what you saw them doing. Sometimes you can determine what triggered their response and sometimes you can't."

Mental-hygiene arrests should be the last option, Primus says. And he says that he does think that there is the potential for misuse - pointing out the poverty that plagues the City School District.

"Socioeconomics does play a role because parents may not have been able to teach that piece about sharing or how to play with others," Primus says. "We have to be careful that we are not misreading the situation."

Teacher Lori Thomas says that she decided to speak before the Rochester School Board because she is concerned that the arrests are occurring with greater frequency in the city schools, though she admits that's only a gut feeling.

The arrests could be creating long-lasting emotional scars, she says, and they leave too many children from poor, minority families with diagnostic labels that are limiting.

"We are failing our children," she told board members last June.

But Caine says that there are misunderstandings about the purpose of mental-hygiene arrests and that they shouldn't be viewed as a bad thing. It's a topic that hasn't been talked about, he says, "Which is another way of saying we don't want to hear about it."