For years, SC has been unlawfully locking up mentally ill youth. Now it wants to stop
For years, South Carolina has failed some of the state’s most seriously mentally ill children by illegally housing them at juvenile detention facilities that aren’t equipped to provide the level of mental health services they desperately need.
The long-standing practice of locking up delinquent kids with severe mental illnesses is expressly prohibited by state law and even denounced by state officials, but persists because South Carolina has since 2015 lacked a mental health facility consistently willing to care for these youth.
Dozens of seriously mentally ill children found guilty of crimes serve out their sentences at the state’s Department of Juvenile Justice each year, at times in isolation, for lack of another option.
“They’re locked up and they’re getting worse,” State Child Advocate Amanda Whittle told state lawmakers last week. “Those kids need serious rehabilitation, they need stability, they need treatment, they need medication management. And when you put kids that need that with kids at DJJ who already are prone to misbehave, it’s a situation.”
To remedy what one state official called the “catastrophic mistake” of closing the lone treatment center that previously provided care to this population, the governor’s office and the heads of South Carolina’s child-serving agencies are proposing to build a new state-run residential treatment facility that would cater to these kids.
“It’s time for the state to step up. That’s the bottom line,” said Brian Symmes, spokesman for Gov. Henry McMaster. “It is time for the state to step up to address the needs of the most vulnerable.”
Children committed to juvenile detention facilities who are diagnosed as seriously mentally ill are supposed to be transferred to the custody of the Department of Mental Health and afforded appropriate psychiatric treatment.
But since 2015, shortly after the agency closed its residential treatment center at Hall Institute on the former Bull Street campus, mental health officials have struggled to place the severely mentally ill subset of justice-involved youth.
As a result, youth diagnosed as seriously mentally ill now make up roughly a quarter of the population at the Department of Juvenile Justice’s Broad River Road complex on any given day, according to agency data.
The department currently has 26 such children it cannot find any facility to take, acting director Eden Hendrick said.
“The only guaranteed bed space these youth ever have is at DJJ,” Hendrick, who was appointed last September after former Director Freddie Pough resigned, testified last week. “That’s why we have kids who have schizophrenia, bipolar, severe personality disorder at DJJ.”
The state’s child-serving agencies have tried to find private residential treatment facilities to meet the needs of this growing group of children, but for a variety of reasons those efforts have failed, officials acknowledge.
While private facilities do occasionally accept such children, some of whom have a history of aggressive or destructive behavior, the vast majority are left to languish in DJJ custody.
The department employs psychologists, social workers and behavioral interventionists to work with youth in its custody, but simply can’t deliver the intensity and specificity of mental health services in the type of stable, therapeutic environment those children need, Hendrick said.
“We are doing the best to meet their needs as we can, but we are a secure residential quasi-not really-correctional facility,” she testified before a Senate panel. “These youth need more than we can give them.”
How SC found itself unable to support juvenile offenders with mental illness
South Carolina’s prohibition on housing seriously mentally ill youth in juvenile justice facilities is relatively recent.
Until the early 1990s, all youth who had been adjudicated delinquent were placed in the custody of what was then called the Department of Youth Services. That practice changed after six youth sued the agency alleging the conditions of confinement were unconstitutional, including that juveniles in need of mental health treatment were not receiving adequate care.
In 1993, the state opened a center staffed by employees from the Departments of Mental Health and Juvenile Justice to provide residential-like psychiatric care to this population.
This facility relocated to the Department of Mental Health’s William S. Hall Psychiatric Institute on Bull Street a few years later and was eventually separated into two programs based on gender.
Around 2010, the number of seriously mentally ill youth being committed to DJJ started to drop significantly, according to Department of Mental Health data.
The declining need for beds at the state-run facility, which corresponded with a spike in new beds at private facilities eager to admit delinquent youth, convinced mental health officials to close the female program, Directions, at the end of that year.
The state mental health commission decided to close the male program, Options, a couple years later due to declining enrollment and an increasing demand for acute hospital services for children, said Mark Binkley, the agency’s director of governmental and legislative affairs.
Options was officially shuttered in September 2015, upon the Hall Institute’s relocation from Bull Street to G. Werber Bryan Psychiatric Hospital in northeast Columbia.
The timing of the closure proved calamitous. It became clear within months the state-run facility likely had been shut down prematurely, although it was too late to reverse course at that point.
The number of justice-involved youth in South Carolina deemed seriously mentally ill exploded in 2015, following a change in diagnostic criteria, ballooning to 118 from a low of 22 the year before, according to Department of Mental Health data.
The 536% one-year increase in seriously mentally ill juveniles coincided with a wave of growing selectivity among private residential treatment facilities. The treatment centers, which once clamored for more state referrals of justice-involved youth, became far less likely to accept them around that time due to a change in state Medicaid policy, Binkley said.
Prior to 2014, the state’s child-serving agencies were required to sign off on any Medicaid-eligible youth admitted to a psychiatric residential treatment facility in the state. The bar for granting admission was pretty high, so private facilities regularly accepted justice-involved youth in order to fill their beds, Binkley said.
After the state Department of Health and Human Services removed state agencies as the gatekeepers of this function in mid-2014, the private treatment centers began to admit Medicaid patients with less severe problems.
“The kids going into (psychiatric residential treatment facilities) suddenly became a lot lower acuity,” Binkley said. “That was a negative particularly that impacted the willingness of (psychiatric residential treatment facilities) to accept kids that were juvenile justice-involved because they had a new market of kids that had lower acuity problems.”
Over time, it’s gotten increasingly difficult to find private facilities in South Carolina that will take severely mentally ill children from the Department of Juvenile Justice, state officials said.
Since 2015, more than 50 such kids each year have remained stuck in detention facilities with nowhere else to go, Department of Juvenile Justice data shows.
Child-serving agencies have tried to incentivize private facilities by offering them better Medicaid reimbursement rates for high needs kids, but it hasn’t been enough to move the needle, officials said.
Even when private treatment facilities do admit justice-involved youth, they’re under no obligation to keep the kids if they become too much to handle, as sometimes occurs.
“As soon as they take the kids, they realize, oh my gosh, this is way more than we want to deal with, I’m gonna kick this kid out and maybe take another kid who’s way less of a hassle for the same amount of money,” Hendrick said. “They’re always going to do that. These are always going to be the last kids. No one wants these kids.”
In the past year or so, child-serving agencies have resorted to seeking out-of-state placements for seriously mentally ill children in state custody whom no in-state residential treatment provider will accept.
The Department of Juvenile Justice currently has three kids placed out of state — two in Tennessee and one in Virginia — and officials said they plan to continue pursuing out-of-state placements absent any in-state options.
“What should be a last resort has become the best possible scenario for these kids,” Symmes, the governor’s spokesman, said.
‘A simple solution’
The governor’s office and the directors of South Carolina’s other child-serving agencies blame the Department of Mental Health for letting the situation get to this point.
They argue the agency has neglected the mental health crisis that’s been unfolding for years inside the state’s juvenile detention facilities and are jointly asking the Department of Mental Health to reopen a psychiatric residential treatment facility for justice-involved youth.
“DMH is just going through the motions while we’re sitting here meeting these kids’ needs,” Hendrick said.
Mental health officials have been aware of these access problems since at least 2016, and started meeting with other child-serving agencies to discuss them that year.
Yet more than five years later, the issue not only persists, but is getting worse, state officials said.
“We’ve got a simple solution to this,” Department of Health and Human Services Director Robbie Kerr said. “Our frustration is why the agency responsible for this isn’t responding to our repeated discussions on it. It’s that simple. They’re charged by state law to do this.”
After the Department of Mental Health failed to ask for money to build a new facility in its 2022 budget request,Hendrick, DJJ’s acting director, took the extraordinary step of asking lawmakers to allocate money to the agency for the project.
“Why wouldn’t DMH be requesting this?” state Sen. Shane Martin, R-Spartanburg, asked Hendrick at a budget hearing last week.
“I’m requesting the money because I want to make sure it happens for these youth,” she responded.
Binkley and DMH Director Kenneth Rogers subsequently affirmed their support for the project and said the agency was open to amending its budget request to include money for it.
Binkley said he actually proposed opening such a facility in 2019, while serving as the agency’s interim director, and has long considered it an important part of the solution, albeit not the only solution, to dealing with this problem.
“We weren’t ignoring the problem,” he said. “We were talking about it, coming up with ideas.”
But between selecting a new state director in 2020, responding to the COVID-19 pandemic and dealing with an exodus of employees, the agency simply got sidetracked, Binkley said.
“It’s not a great explanation,” he conceded. “But that’s my sense of how the state-operated (psychiatric residential treatment facility) kind of got put on hold.”
If lawmakers end up funding the project, Mental Health officials envision housing DJJ’s seriously mentally ill youth at a custom-built 16-to-20-bed facility on DMH-owned land in northeast Columbia.
Design and construction of the facility is expected to take about two years and would cost roughly $20 million, officials said. The Department of Mental Health plans to outsource operations to a private contractor at an estimated cost of $9 to $11 million annually.
State officials prefer an agency-designed build to retrofitting an existing building because of the special needs of the youth who will reside at the facility.
The leaders of South Carolina’s other child-serving agencies said they’re heartened to hear Mental Health wants to pursue the project and plan to partner with the agency to make sure the needs of severely mentally ill youth in state custody are finally met.
“I don’t intend to check that off the box and then move on and say, well I hope that goes well,” said Whittle, the state child advocate and director of the Department of Children’s Advocacy. “I mean we need it built, but then the next responsibility is to make certain that those children are receiving adequate services.”
This story was originally published February 14, 2022 at 5:00 AM.