Part of a trend that has pushed mentally ill children into adjudication rather than medical care, New Orleans lost its last public mental health beds for juveniles in 2009 when Gov. Bobby Jindal closed the New Orleans Adolescent Hospital. The nearest comparable facility is now across Lake Pontchartrain at the Southeast Louisiana Hospital in Mandeville.
“Just before we closed we had five clinics, a crisis service, outreach teams, and we only had about 15 beds, down from 124 in 1991,” said Dr. Martin Drell, the Adolescent Hospital’s clinical director for 19 years. “Bobby Jindal not only closed the hospital, but with it, he closed the outpatient system, which is what people I don’t think realize.”
The hospital’s closure has placed more pressure on local juvenile facilities, said Captain Andre Dominick, director of the St. Bernard Parish juvenile detention center.
So the kids in detention have to stay in detention. Problem is, the detention centers don't have the medical staff, or budget, and there has been a reliance on heavy-duty anti-psychotic drugs to keep the little darlings under control. In a way, it's the by-product of the Ritalin Revolution of parenting.
Both at the local and state level, the patchiness in mental health care means there is a greater likelihood that physicians will rely on medication to simply calm down disruptive juveniles, Harrell said.
“There are some youth who should receive medications who aren’t,” Harrell said. “But there’s also kids who are being medically restrained. Sometimes it’s easier to deal with disruptive kids by drugging them, than doing anything else.”
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In a psychiatric emergency, the response can be ad hoc and sometimes quite primitive. For example the Florida Parishes juvenile detention center still keeps a restraint chair in storage, in case a child becomes suicidal and nothing else can be done immediately. Before the center had the chair, which has not been used in four years according to a center manager, it used to rely on a football helmet to prevent suicidal juveniles from smashing their heads into the floor and walls.
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Prescription drugs administered to juvenile inmates ran the gamut of those available on the market, but with a disproportionate use of so-called second-generation atypical antipsychotics.
These drugs originally developed for bipolar disorder and schizophrenia, are administered four times as often as the conditions actually crop up among incarcerated youth in the facilities studied.
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Seroquel, the brand name for quetiapine, is a second-generation atypical antipsychotic. Other such drugs include Risperdal (risperidone), Abilify (aripiprazole), and Zyprexa (olanzapine), and all are being heavily ordered by youth facilities.
Records show the Swanson Center for Youth, a state facility in Monroe, stocks 400-milligram dosages of Seroquel, a hammer to the head easily four times the standard dosage. And even smaller dosages are often unwarranted. A juvenile at the Youth Studies Center in New Orleans was being given a 100-milligram dose of Seroquel, despite having a simple diagnosis of attention deficit hyperactivity disorder. A spokeswoman for the city pointed out that the drug had been prescribed before the juvenile arrived at the facility.
Atypical antipsychotic drugs limit psychotic episodes among schizophrenics and patients with bipolar disorder by abating the transmission of dopamine from within the brain. But they also block transmission of serotonin, another important brain chemical, and can have a numbing effect.
“I could tell a kid had gotten on these drugs because of the vacant expression,” Faunce said. “They were like little zombies.”