Category: Bipolar disorder

A Colorado State of Mind: Youth in Crisis

Colorado Flag

I’ve lived in Colorado for over 18 years now, and while I love the Centennial State for its majestic beauty, abundant sunshine, and plentiful recreational opportunities, my picturesque state falls short when it comes to combating the mental health and substance abuse crisis we are currently facing.

Two years after beginning our fruitless search for mental health treatment for our daughter Mallory, who has bipolar I disorder and a substance abuse addiction, I began attending National Alliance on Mental Illness (NAMI) support groups and classes. After sharing my feelings of hopelessness with the group, the facilitators, who had similar frustrating experiences finding adequate help for their children, acknowledged that Colorado was not the best state in which to raise a child with a mental illness.

According to a 2018 report from Mental Health America (MHA) which ranked all 50 states (plus the District of Columbia) based on the prevalence of mental illness, substance abuse, and access to care, Colorado ranked nearly last at 48th for youth, 40th for adults, and 43rd overall. The Colorado Health Institute also listed Colorado as the state with the 9th highest suicide rate in the nation in 2017.

One Colorado couple who had been battling their insurance company to obtain treatment for their severely depressed son only received approval a month after he took his own life at the age of 14. According to NAMI, suicide is the 3rd leading cause of death in the U.S. among youth ages 10-14 and the 2nd leading cause of death in youth ages 15-24. In Colorado, the statistics are even worse. In a report from the Office of Suicide Prevention, suicide was listed as the number one cause of death among Colorado youth ages 10-24 in 2016. Why must we wait until it’s too late to get help for these kids?

In Mallory’s case, our insurance would not cover residential treatment even though we had a referral from a psychologist. Prior to that, we had sought help from our school district and were told by the director of an alternative school with mental health and substance abuse components that Mallory needed stabilization before she could attend. Despite being told she needed stabilization, we had been turned away from a psychiatric hospital because she hadn’t met their criteria for crisis stabilization. After being taken to another hospital from our home by the police, Mallory had also been discharged less than 24 hours later because she was again not considered an imminent danger to herself or others.

We had heard from several law enforcement officers and Department of Human Services (DHS) workers that if Mallory had criminal charges, more services would be available to us. It seems absurd to me that we have to wait until our kids start committing crimes before someone will help them. Wouldn’t it make more sense to be proactive and intervene before our kids are exposed to the criminal justice system, potentially preventing a lot crime in the process?

MHA stresses the importance of implementing Prevention and Early Intervention (PEI) programs in schools and communities that can assess mental health risk and intervene early. My daughter’s concerning behaviors began at her middle school. She received detentions and suspensions for her behaviors but never met with the school psychologist until her freshman year of high school and only after we had asked repeatedly. By that time, she was already involved in truancy court and diagnosed with bipolar disorder by an outside psychologist we had taken her to for testing.

Mallory’s middle school had only one psychologist for nearly 1,000 kids. Her high school had one psychologist for roughly 2,200 kids. Just as our schools need more school resource officers to protect them from mass shootings, they also need more mental health professionals to prevent them from ever occurring in the first place.

MHA points out that other consequences of failing to intervene early include suicide, incarceration, homelessness, and school drop-out. According to NAMI, 70 percent of the nearly two million youths arrested in the U.S. every year have a mental health condition. If these kids could receive the care they need when they need it, a lot fewer kids would be arrested.

One of Colorado’s biggest shortcomings when it comes to mental health treatment for kids like Mallory who frequently run away and eventually end up incarcerated, is the absence of secure residential treatment facilities. Because there are none, the state places habitual runaways with mental health disorders in “staff secure” (not locked) facilities from which they can easily run. These kids end up on the streets, putting themselves in danger of becoming victims of sex trafficking. According to the National Center for Missing and Exploited Children (NCMEC), one in seven runaways reported in 2017 “were likely victims of child sex trafficking,” and 88 percent of those “were in the care of social services when they went missing.” Too many of us parents have had to place our children’s lives in the hands of our states who have failed them.

A friend and former coworker who once had a family member in DHS custody advised me to get my daughter out of the system as soon as possible. Mallory was 15 at the time. This week we will be celebrating her 19th birthday at a state youth services center in a tiny, locked visitation room with a folding table and four plastic chairs. No cake. No candles. No presents. We’ve never been able to get her out of the system.

In five months, though, Mallory will finally be released from the Division of Youth Services (DYS) after serving the entire two years of a 0-2-year sentence. Four residential treatment facilities and five youth services (detention) centers later, she is in worse shape than the day she was placed in DHS custody. Less than a week after her first DHS placement, she was introduced to a life of homelessness, drug addiction, and victimization – a life she wants to return to when she is released.

Before DHS got involved and before our daughter had a criminal record, we tried for over a year to get help for her. We were denied coverage by our insurance company, and we were repeatedly turned away by hospitals and other treatment providers because she was either “not an imminent danger to herself or others,” or they didn’t know how to help her.

Colorado kids are in crisis, and we need to help them before it’s too late. We need to implement PEI programs in schools and communities to prevent and treat problems in their early stages, we need better insurance coverage for mental health and substance abuse issues, and we need better treatment options that don’t require our kids to have criminal charges or their parents to give up custody of their children. It’s time we protected the beautiful minds of our children who will one day inherit our beautiful state.

The Incarceration of Mental Illness: Mallory’s Story

Incarceration

When my daughter was 14, she confided in me that she was hearing voices. As her mental health began to rapidly deteriorate, I never imagined that getting help for Mallory would be so difficult. There were many barriers to obtaining mental health treatment for my daughter, including the scarcity of effective services, limited insurance coverage, a lack of criminal charges, failing to meet the criteria for being a danger to herself or others, and even Mallory herself. For Mallory and many others struggling with mental illness, these roadblocks to treatment would eventually contribute to her incarceration.

As a proactive parent, it was frustrating for me to watch my daughter’s condition decline in a system that doesn’t begin to offer help until it’s often too late. Even more frustrating was realizing that her situation was only worsened by the services that were eventually offered to us through the Department of Human Services (DHS) and by a broken juvenile justice system that appears to contribute to the epidemic of human trafficking by cycling at-risk youth through ineffective, unsecured residential facilities from which they repeatedly run away. It took three years of runaway reports, sleepless nights, jail visits, court hearings, and unsuccessful DHS placements before my husband and I were finally able to convince a magistrate to put Mallory somewhere safe. Unfortunately, the safest place (at least safer than living on the streets) in the state of Colorado for our mentally ill daughter was the secure facility where she was placed by the Division of Youth Corrections (now called the Division of Youth Services) over a year ago. We had exhausted all other options.

Mallory’s path to incarceration began shortly after she started hearing voices. She had been diagnosed with an unspecified psychotic disorder and was prescribed the antipsychotic drug, Abilify, by a psychiatrist at the Arapahoe Douglas Mental Health Network (now AllHealth Network). While the medication helped quiet the voices somewhat, Mallory’s behavior was out of control. At the beginning of her freshman year of high school, she started defying authority, skipping school, and smoking marijuana. From there, her behaviors escalated to engaging in risky sexual activity, meeting adults she met online, and running away from home. These behaviors, we later learned, were the result of manic episodes.

By the time Mallory was diagnosed with bipolar I disorder with psychotic features and oppositional defiant disorder at the age of 15, she had run away from home twice and was involved in truancy court for excessive school absences. It was clear that a traditional school environment was not working for her. When our school district informed us of an alternative credit retrieval program that had mental health and substance abuse components, we were hopeful that it would be a good fit. Unfortunately, after the intake interview, the director had concerns about Mallory’s psychosis and thought she needed stabilization before she could attend. This was dismaying because she had already been turned away from Highlands Behavioral Health System for inpatient crisis stabilization because she was not considered a danger to herself or others. On another occasion, after being taken from our home to the Parker Adventist Hospital by the police, she was released less than 24 hours later for the same reason.

The psychologist who diagnosed Mallory had recommended residential treatment, or intense outpatient treatment as an alternate option. Though we had what most people would probably consider a decent health insurance plan, residential care, costing several thousand dollars a month, was not covered by our insurance. Intense outpatient treatment was only partially covered by our insurance, but it was a more affordable option, so we enrolled Mallory in the intense day treatment program at Children’s Hospital Colorado in Aurora. We had heard good things about the program, and again, we were hopeful that she would get the help she needed. She might have, if she hadn’t been kicked out of the program after only a few days for refusing to comply with their dress code. Oppositional defiant disorder (which was one of the reasons Mallory was attending the program in the first place) is characterized by actively defying or refusing requests by authority figures. Though Children’s Hospital Colorado lists, on their website, oppositional defiant disorder as one of the conditions they treat, they did not know how to handle a child who wouldn’t wear appropriate clothing and refused to change into scrubs. Mallory was discharged prematurely. We felt like no one was willing or able to help her.

When Mallory was released from Children’s Hospital, an emergency court hearing was held to decide what to do next. A guardian ad litem (GAL) had been appointed by the presiding magistrate to represent Mallory’s best interests. Because Mallory wouldn’t agree to a home safety plan that day, her GAL recommended that she be removed from our home and placed at The Sanctuary at Shiloh House, a short-term youth shelter in Thornton. This was quite possibly the worst decision anyone has ever made for our child, and it was certainly not in her best interest. Four days after she was placed at The Sanctuary, Mallory walked right out the front door with another girl who introduced her to the streets of Denver. No one at The Sanctuary bothered to follow them. For two weeks, we didn’t know if our daughter was dead or alive. Then the girls were found in Oklahoma with two men who had picked them up in Denver. It was a parent’s worst nightmare. Until our nightmares eventually got worse.

Once a child has been assigned a GAL and a DHS caseworker and is placed into the system, it’s very difficult, if not impossible, to get him or her out. Mallory would spend the next two years alternating between residential treatment facilities (Excelsior Youth Center, Arapahoe House, Southern Peaks) and life on the streets. Each time she ran, she would be on the streets for longer periods of time, and each time she was located by the police, she was in worse shape.

When Mallory was finally incarcerated, at the age of 17, for violating the terms of her probation, she was addicted to crystal meth and heroin and had been living on the streets for months with a 40-year-old homeless, drug-addicted man. Prior to that, we had begged the court, DHS, and Mallory’s GAL to place her in a secure facility to protect her from her homeless, drug addicted lifestyle and from those who preyed upon her. We were told that there were no secure treatment facilities in Colorado. The only secure facilities for girls, her GAL had said, were for violent offenders, and Mallory didn’t have any criminal charges at the time.

Her homeless lifestyle did eventually lead to criminal charges for misdemeanor theft, identity theft, criminal impersonation, and forgery. She had been issued a ticket for shoplifting at a discount store and had shown a fake ID assuming someone else’s identity. Despite our objections, the Arapahoe County District Attorney’s Office offered Mallory a plea deal, and she was given probation for only the misdemeanor theft charge. All other charges were dropped. When Mallory ran for the seventh time, violating the terms of her probation, her team had nothing left to recommend but the Division of Youth Corrections (DYC). Mallory was sentenced to 0-2 years, and DYC placed her in a secure facility due to her run history.

We have slept better at night for the past year at least knowing where Mallory is, but this is only a temporary solution to a permanent problem. In less than a year, Mallory will be back in the community facing the same challenges as an adult. While the mental health and addiction crisis in Colorado is now more severe, there are even fewer mental health and substance abuse services available for youth and adults. Both the Excelsior Youth Center and Arapahoe House (the largest treatment provider in Colorado for youths and adults with substance abuse issues) have closed their doors due to lack of funding.

In a time of frequent mass shootings and drug overdoses, we can’t afford to leave mental illness and addiction untreated. We need additional, affordable, and more effective mental health and substance abuse treatment options for youth and adults in the future, or we will no doubt see more people suffering from mental illness incarcerated for committing crimes we might have been able to prevent had they received proper treatment.