As politicians get tough on KY juvenile justice, what about kids' mental health?

In 2017, following the death of a 16-year-old girl in isolation, the state of Kentucky paid $130,000 for a team of consultants to tour its juvenile detention centers and recommend ways to make them safer.

The consultants' final report was highly critical of the state Department of Juvenile Justice. It raised concerns still valid six years later, such as dangerously inadequate staffing levels and the practice of confining youths in solitary cells throughout the day.

The consultants also warned that Kentucky failed to provide the behavioral and emotional therapy needed by many youths in juvenile detention centers.

"Staff and administrators at the facilities that we assessed were the first to admit that their facilities did not have access to adequate mental health care," the consultants from the Children's Law and Policy Center in Washington, D.C., wrote in their report.

"DJJ currently does not have any dedicated full-time or part-time mental health staff members on-site at its detention facilities," they wrote. "Access to DJJ's psychiatrist is, at best, only every 30 days, and psychological services were provided by telephone at the facilities we visited."

DJJ holds many youths who have mental illness; who have been traumatized by abuse and neglect and who have witnessed violence; and who, as wards of the state, have spent their childhoods bouncing between foster homes and private social-service agencies.

Failing to treat them not only puts them at risk, the consultants said, it places an "unfair burden" on DJJ staff "who are required to manage the behavior of very troubled youth without guidance and support from professionals."

Much of this warning still rings true true today, according to defense lawyers who spend time in DJJ facilities and internal documents obtained by the Herald-Leader.

In response to riots and assaults in recent months, Gov. Andy Beshear talks a lot about hardening the juvenile detention centers -- building security posts and perimeter fences, assigning Kentucky State Police to escort the youths and equipping staff with tasers and pepper spray. House Republicans have their own get-tough bill.

Not enough is being said about improving the quality of mental health care, said Laura Karem, a public defender whose clients are held in juvenile detention centers.

"I think we could be doing a lot better," Karem told the Herald-Leader recently.

Youths held in custody in Kentucky have attention-deficit/hyperactivity disorder, clinical depression, bipolar and oppositional defiant disorder, post-traumatic stress disorder and autism, among other issues, Karem said. One of her clients in juvenile detention had pica, an eating disorder, she said.

"He would eat your business card if you handed it to him," she said.

These are kids who need intensive therapy and sometimes medication, but there aren't qualified psychiatric professionals on site in the juvenile detention centers, Karem said.

Defense lawyers protest when DJJ transfers youths to a different facility before their mental health needs are assessed or when psychiatric medications are withheld, she said.

In some detention centers, youths periodically go to a common room for remote video sessions with a psychiatrist. But that can be too shallow a standard of care, said Karem, who is the juvenile post disposition branch supervisor at the Kentucky Department of Public Advocacy.

"I mean, we've had kids who are cutters, who cut themselves, and if you're only seeing them on a video screen, you won't necessarily see the scars on their arms, you know?" Karem said.

Some youths who are clinically depressed and suicidal won't admit their feelings on the intake admission form because they know that will land them in an isolation cell with no personal possessions, wearing a flimsy suicide smock, she said.

Once the doors clang shut behind them, no one might ask about their feelings again, she said.

"These are kids who need to have a relationship with a therapeutic adult. They need to develop trust with someone they can get to know. A once-a-week video conference just isn't going to do it," said Sheila Schuster, a longtime Kentucky mental health care advocate.

Detention itself can cause mental issues. Youths hardly ever get to leave their cells at the Adair County DJJ facility, nurse administrator Deborah Curry wrote to medical colleagues in an email last Sept. 29.

"They are confining these kids for basically 23.75 hours of the day," Curry wrote. "I fear of the effects this is going to have on these youth long-term. We thought Covid had a negative effect, I feel this is going to be bigger, especially with those who already have anxiety issues and/or other mental health problems."

'Making it worse'

According to DJJ records obtained by the Herald-Leader:

In December, DJJ staff wrote to a social worker at the Cabinet for Health and Family Services to report upsetting emotional behavior from a boy who was "craving attention" while stuck in his cell for an extended period inside the Adair County DJJ facility.

"They said to entertain himself he was taking his school work and making it into a paper sword and running around his cell and playing king of the mountain on his bed," justice program supervisor Stacey E. Heiser Williams wrote on Dec. 6..

"We all know these are behaviors of a much younger child and that detention is not the best placement for him. I know that we are all in a placement crisis, but I'll be honest, this is one of those cases that breaks my heart to see a child like this in detention," Williams wrote.

The boy could be transferred out of detention to a private agency that treats intellectual and developmental disabilities if only they had vacant bed for him, DJJ staff told the social worker.

In a recently filed whistle-blower lawsuit, two nurses who quit the Adair County DJJ facility said they witnessed the mistreatment of youths in custody. One was a girl -- an abuse victim with mental illness -- whose mental health deteriorated over the summer of 2022 as she was locked alone in a cell for many days, the nurses said.

DJJ medical staff attempted to give the girl medication in her cell, but the girl resisted taking it. She ended up diagnosed as catatonic, naked and covered in her own filth, the nurses said.

Security and medical staff argued over how sympathetically they should treat the girl, who got sicker every day, the nurses said.

At least one security officer publicly mocked the girl's foul smell on social media. Another security officer jammed the girl's hands back through the flap in her metal door when she reached out, begging people for help. He shouted a curse word while ordering other staff to keep the flap shut, according to state investigative reports.

In a July 10, 2022, email, Curry begged the facility administrator, Tonya Burton, to let the girl at least be taken from her cell to the showers so she could be cleaned.

"This is neglect and abuse on so many levels. I am not going to keep going back and forth as to why she needs a shower," Curry wrote. "She has been secluded for 20-plus days with very little interaction with others. I think we can agree that we would be bonkers if someone did this to us."

The nurse administrator added: "This child is mentally unstable, (and) not only are we not equipped as a department, we are making it worse."

Facilities like the DJJ detention center "are not able to provide the level of mental health care" that the girl needed, a child and adolescent psychiatrist at the University of Kentucky later told state investigators.

An investigator spent four hours trying to get the girl to talk about how she was being treated in detention. The girl, who was 17, would only quietly color with crayons and play with Play-Doh. Finally, the investigator gave up.

On June 30 and July 1, 2021, at the DJJ facility in Warren County, a depressed boy tried to hang himself several times over two days by tying towels and bed sheets around his neck. He attached the other end to a metal shelf in his cell.

When the boy initially told his plans to a staff member, the reply reportedly was, "Oh, well." He even got his linens returned after the suicide attempts. Only after the third hanging attempt did staff call a psychologist and place the youth on suicide watch, which the rules required after the first attempt.

Employees blamed under-staffing at the facility, adding that staff who were on duty did not take the boy's suicide threats seriously.

On April 11, 2021, youths were locked in isolation for more than two weeks following a riot at the Warren County DJJ facility.

That violated the usual 48-hour limit on youth isolation, according to state records. The youths did not leave their cells for meals, classes or recreation. They were not allowed to speak.

One girl reported seeing hallucinations in the darkness, telling investigators, "That room was driving me crazy." One boy ripped up his clothes.

Staff psychologist Kristy Campbell later told investigators she was "concerned for the residents' mental health." Dr. William Heffron, DJJ's chief of mental health services, said nobody at the facility asked for his permission to keep the youths in isolation beyond 48 hours, a practice that he discourages -- when consulted -- for their own health.

'Kids in crisis'

In recent testimony to lawmakers, DJJ Commissioner Vicki Reed said her agency provides mental health care to youths in its custody, including referrals when necessary to its chief psychiatrist or one of its regional psychologists. Counselors in facilities help the kids call home to their families and screen them for suicide risk, Reed said.

Across its 27 detention centers, youth development centers, group homes and day treatment centers, DJJ employs 243 people in "mental health-related positions," with 47 job vacancies, according to the agency. Many of these employees are "social service workers" with a bachelor's degree in social work, psychology or sociology who can start at about $38,000 a year.

The job vacancies create hardships. At the Adair County DJJ facility, for example, superintendent Burton wrote in an Oct. 4 email that she could not let an emotionally distressed, pregnant girl out of her cell because there was no staff available to sit with the girl.

At that time, Burton said, she was serving as superintendent and as her facility's treatment director and counselor as well as doing around-the-clock floor shifts as a youth worker.

"I barely have staffing to do (cell) checks," Burton wrote.

There are legal limits on the counseling that can be provided in a juvenile detention center, Reed said, because youths in detention have not been convicted of a crime and can't speak freely about the actions that got them in trouble.

"We cannot really have that discussion in detention because the kids have attorneys who are going to say, 'Don't talk to anybody.' And if they do, our staff do not have the confidentiality. So somebody could subpoena them and say, 'What did that kid tell you in group (counseling), did he tell you he did this?'" Reed said.

Other types of DJJ facilities that house youths after conviction, such as youth development centers and group homes, can offer better counseling, Reed said. However, she added, a youth can be held in a detention center for weeks, months or even years, depending on the circumstances of his case.

But DJJ once did a better job of offering treatment in detention, signing contracts with regional mental health providers, said children's attorney Rebecca Ballard DiLoreto, who has spent a lot of time in DJJ facilities.

Despite Reed's claims, children's lawyers don't object to their clients getting help in custody, DiLoreto said.

"Most of the children caught up in criminal activity suffer from diagnosable mental health disorders," DiLoreto said. "Lawyers and their teams are constantly seeking ways to get their clients supportive mental health treatment. The lack of such services had a large impact on (violence at detention centers) in Adair, Warren and Campbell counties."

Several lawmakers are pushing this session for guaranteed mental health care for youths in detention. They say an under-staffed DJJ where violence is endemic and kids are locked in cells for meals and classwork almost certainly is failing at treatment, too.

Two House Democrats from Louisville, state Reps. Keturah Herron and Lisa Willner, have a bill to establish a Bill of Rights for Incarcerated Children. Among those are the right to "appropriate medical, mental health and behavioral health care" for youths held in detention.

"Our understanding is that there are no mental health services being provided right now in the detention centers," Willner told reporters at a news conference.

"There is access to bachelor's level 'counselors,'" Willner added, making air quotes with her fingers. "These are not licensed mental health professionals. They are not protected by confidentiality."

The conversation about juvenile justice needs to stop focusing exclusively on adding punitive measures, state Rep. Nima Kulkarni, D-Louisville.

"It's just common sense to me," Kulkarni said after watching Reed testify to a House budget subcommittee.

"These are kids in crisis." she said. "They're there for a reason. Something has gone wrong. What we need to do is provide as much intervention as we can while they're still young so they don't wind up in adult prison."

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