Gottfried: Wisconsin kids are hurt by state's mental health system

Ernie is a common figure around Eau Claire; tall, disheveled, drooping jaw, blank stare.  He stumbles when he walks.  He talks incoherently except for a constant stream of curses.  He appears threatening when he demands a cigarette or money. 

Tonight, Ernie stumbles into the subway shop on Water Street. The backside of his pants is full, the malodorous smell announcing his presence.  My friends and I watch Ernie as he enters.  One of my friends informs the rest of us that he is going to buy Ernie a sandwich. I try to dissuade my friend, explaining that Ernie survives quite well on his own and knows where the homeless shelter is.  My friend ignores me and orders the meal. The associate behind the counter is slow to fill the order.

I am a residential treatment worker in Eau Claire.  I work with adolescents who, like Ernie, have mental, social and physical disabilities. They have been referred to the facility, for the most part, by the court system.  These individuals may have been diagnosed as pre-schizophrenic, bipolar, oppositional defiant, suffering from post-traumatic stress, or a host of other disorders. They are violent. They reside at the facility I work at, much like their adult counterparts reside at county jails and state prisons. 

Society has yet to find a suitable home for these individuals. Many move from residential treatment, to the street, to prison.  Ernie is not a graduate of the facility I work at, but many like him are walking the streets of Eau Claire and other cities, just waiting for an opportunity to move into jail.

I’ve been at my job for more than seven years. It’s a tough gig. I’ve been pushed, punched, kicked, spat on. I always come to work the next day. I’ve never missed a day of work, never called in sick, never been late for a shift.  I’m proud of that record.  And like many of my colleagues, in spite of the low pay, long hours and dangerous working conditions, I am dedicated to the work we do.

I am not a therapist.  It is my job to engage the residents in activities, to socialize the individuals, to direct them to appropriate ways to control anger — to teach them how to cope with their illnesses. It’s not easy. The residents can become violent at any moment.  Many have been physically, sexually, and verbally abused as children.  Their past becomes a trigger for their present behavior.

Is placement in a residential treatment facility successful?  If community safety is the issue, then the answer is yes. The facility limits the resident’s exposure to the general public.  The resident’s behavior is closely monitored. Residents are less of a risk to themselves, and to others, including parents, peers, and the public. It's a controlled environment, in which medication can be increased, decreased or removed.  Behavior modification practices can be implemented and assessed.

Is the placement in a residential treatment facility beneficial to an adolescent?  We may never know. Teenage angst, raging hormones, interactions between residents and peers and adults all complicates the situation.

Thrown into the mix are health care and legal systems that do not fully support treatment. When the money runs out for their care, residents are pulled from the facility — whether or not it is safe for them to leave.  The immediate fate of the child may be a mental hospital or juvenile detention.  Ultimately that child becomes an adult.  He or she may be placed in a group home — or prison.

Does residential treatment benefit the child?  In many cases, the answer is, “What other choice do we have?”  If the child’s behavior makes it impossible for him or her to be placed in a foster home; if the children cannot be returned to their biological parents; if they have proven to be a danger to others — where else can the child go?

Is residential treatment therapeutic for the child?  No, not when residents are lumped together, sometimes seven or eight to one staff person, in a group setting, without regard to the adolescent’s history of violence.  Group mentality takes over, sometimes with disastrous results. 

We have come a long way in integrating people with disabilities into society.  But individuals with mental health and conduct disorders are an exception.  We need to provide, support, and encourage mental health facilities in our communities.  And we need to provide treatment for these individuals, not just seclusion from the general public.

To make residential treatment systems work, we need to treat the system like a complex of group homes, not a large reformatory.  We are warehousing human beings, not treating them. 

We need to have a maximum ratio of resident to staff of three to one instead of the current ratio of eight to one. Treatment units with large resident-to-staff ratios increase stress and conflicts among residents and between residents and staff.

We also need to attract and employ older and more credentialed adults in these positions. We, and other facilities like us, are chronically short-staffed. 

Warehousing adolescents insulates the general public.  But it’s a short-term fix that serves only one population. Would the investment in more — and more qualified — staff offset costs?  Would it lead to lower adult incarceration rates?  Could these adolescents grow to productive adults, able to cope with the outside world? 

The more individualized care, the better.  The preference among mental health professionals is to assign adolescents to small, specialized treatment foster care homes.  But there is a scarcity of such homes, in large part because of resistance from neighbors.

Making changes now may reap rewards in the future.  But given society’s reluctance to face the problem, investing in the future of these adolescents will never be popular. 

Who benefits from the current treatment system?

No one.

Eli Gottfried lives in Eau Claire.